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Heart surgery programs fight for market share

The number of cardiac bypass procedures peaked in 1997 and has been decreasing since.  This study of Medicare claims data analyzed the creation of new cardiac surgery programs in recent years and took a look at whether the new programs improve patient access to care.  The number of cardiac surgery programs increased by about one-third between 1993 and 2004 — most of them opening within 30 miles of an existing program and over half within 10 miles of a competitor.  Not surprisingly, there was a greater increase of new programs in states with no certificate of need.  The authors note that some new cardiac surgery programs — primarily those in rural areas — did, no doubt, improve patient access to care.  Likewise, they mention that some hospitals added open heart surgery capacity in order to be able to do interventional cardiology procedures, which would be beneficial to heart attack patients.  However, they conclude that there is “substantial evidence of duplication of services in highly competitive markets.”

Source: Lucas, F.L., and others.  New cardiac surgery programs established from 1993 to 2004 led to little increased access, substantial duplication of services.  Health Affairs;30(8):1569-1574, Aug. 2011.  Click here: http://content.healthaffairs.org/content/30/8/1569.abstract  Posted by AHA Resource Center, (312) 422-2050, rc@aha.org

Is there a need for Certificate-of-Need?

The answer is an unequivocal MAYBE.

A recent study conducted by the Center for Studying Health System Change (www.hschange.org) for the National Institute for Health Care Reform (www.nihcr.org) provides an excellent summary of the issues and difficulties involved both in administering a state CON program and in shepherding an application through the process.  There are 36 states and the District of Columbia that have CON laws in place; six states – Connecticut, Georgia, Illinois, Michigan, South Carolina, Washington – formed the interview pool from which 42 individuals, representing state agencies, hospitals, physician groups, hospital and medical societies, payers, consultants, attorneys, and policy-makers, were drawn.   

Some of the issues addressed:

  • Variation across states in how the CON process works and what activities are covered
  • Influence (or interference) of politics in the CON process (For example, the Illinois CON authority was temporarily suspended because of conflict of interest issues with several board members.)
  • Lengthiness of a process that may span years and, if contended, has been known to involve the state supreme court and/or state legislature in efforts to overturn unfavorable decisions
  • Impact, if any, of CON on market entry and/or expansion, competition, access, quality, and costs
  • Disparity in decisions that seem to favor not-for-profit hospitals over for-profit hospitals, physician groups, ambulatory care providers, etc. 

Despite the somewhat rough and rocky CON landscape, many respondents still feel there is a viable role for CON if the following can be achieved:

  • Renew the focus of CON on its original mission of state health planning
  • Establish a rigorous process for establishing, assessing, and enforcing CON standards
  • Ensure adequate funding and staffing for the state agencies responsible for administering the CON program

Source: Yee, Tracy, and others.  Health care certificate-of-need laws: policy or politics?  Research Brief.  (4)1-9, May 2011.  http://www.nihcr.org/CON_Laws.html

Additional resources:

American Health Planning Association.  National Directory: State Certificate of Need Programs, Health Planning Agencies.  2010 edition.  Published annually.  www.ahpanet.org

Cimasi, Robert J.  The U.S. Healthcare Certificate of Need Sourcebook.  Washington, DC: Beard Books, 2005.  www.beardbooks.com