January 23, 2009

Easing Regulations Has Not Affected Quality Of Cardiac Care

States that dropped regulations overseeing the performance of two common heart procedures showed no increase in death rates, say researchers at Baylor College of Medicine, Rice University and Duke University Medical Center. The findings appear online in the current issue of Health Services Research Journal.

The regulations, known as Certificate of Need (CON), require hospitals to obtain approval from a designated state agency before adding new facilities or offering especially costly services, said Dr. Vivian Ho, associate professor of medicine at BCM and the James A. Baker III Institute Chair in health economics at Rice University.

"Certificate of need was meant to restrict health care costs and ensure high quality care," said Ho, who is also the lead author in the study. "It makes sure that new hospitals and facilities for specialized treatments aren't popping up where they aren't needed and instead are being spread out to areas where more will benefit."

Federal certificate of need regulations for cardiac care expired in 1986, and many states have since discontinued using them. To determine whether health care is affected by a change in regulations, Ho and her colleagues reviewed Medicare inpatient claims between 1989 and 2002 for patients who received coronary artery bypass graft surgery (CABG) and percutaneous coronary interventions (PCI).

"We found no overall increase in mortality rates for bypass or percutaneous procedures after states dropped the regulations," said Ho. "Trends in mortality rates for these procedures were similar across states, whether or not they maintained cardiac certificate of need."  

Ho said the next step will be to look at how hospital costs are affected by changing regulations. Removal of cardiac certificate of need rules was associated with increased entry of new cardiac care facilities, which may have raised the average cost per procedure.

Others who took part in the study include Meei-Hsiang Ku-Goto, James A. Baker III Institute for Public Policy, Rice University, and Dr. James G. Jollis, Division of Cardiovascular Medicine, Duke University Medical Center.

Funding for the study comes from a grant from the National Heart, Lung, and Blood Institute.

The study can be found online at http://www3.interscience.wiley.com/journal/120120473/issue