Regulation of heart procedures falls short of expectations

Armen Hareyan's picture
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Certificate of Need, a form of state government regulation designed to keep mortality rates and healthcare costs down, appears to do neither with regard to two widespread heart procedures, said a health economics researcher at Baylor College of Medicine and Rice University. The findings are reported in an article appearing in today's online edition of the International Journal of Health Care Finance and Economics.

Lead author Dr. Vivian Ho, associate professor of medicine at Baylor College of Medicine and James A. Baker III Institute Chair in health economics at Rice University, found that Certificate of Need regulations deliver only minor benefit in cases of open heart surgery and no benefit in instances of angioplasty (a less invasive procedure that uses a balloon or stent to open clogged heart arteries). These regulations are designed to prevent hospitals that do not provide care to a prescribed volume of patients from offering heart surgery and similar cardiac procedures.

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"For cardiac (heart) procedures, Certificate of Need doesn't create the kind of savings and reductions in mortality rates that policymakers thought it would achieve," said Ho.

While Certificate of Need regulations do contribute to reductions in average cost per cardiac procedure, they also cause hospitals to perform more cardiac procedures than they would otherwise, raising overall expenditures, said Ho. She hypothesizes that Certificate of Need regulations, which mandate a minimum number of procedures per year (200 for open heart surgeries), may inadvertently compel hospitals to encourage surgery for some patients for whom medication would suffice. The hospitals may perceive they need to perform the extra procedures to meet the regulation's minimum volume quotas.

"I can't directly test for it, but it is my hypothesis that these regulations unintentionally increase the number of procedures performed," said Ho.

Ho's study evaluated cardiac outcomes in 28 states, 18 of which implement Certificate of Need regulations. (Thirty-five states and the District of Columbia fund administer a Certificate of Need program, and 28 explicitly regulate cardiovascular services.)

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