93. Certificate-of-Need state laws and elective posterior lumbar fusions: a Medicare trends, costs and outcomes analysis

Abstract

BACKGROUND CONTEXT Certificate-of-Need (CON) state laws have been a major mandate of health policies aimed at forming centralized health planning as a key-core of the US health care system. Though the federal CON mandate was repealed in 1986, several states still continue to use it as a means of limiting health care resource utilization while attempting to provide quality care in high-volume facilities. PURPOSE The current study aimed to utilized a national Medicare claims dataset to assess whether elective posterior lumbar fusions (PLFs) performed in CON vs No CON states had lower utilization rates, lower costs, and better quality of care. STUDY DESIGN/SETTING Retrospective review of administrative claims from the 100% Medicare Standard Analytical Files (SAF100). PATIENT SAMPLE The 2005-2014 100% Medicare Standard Analytical File (SAF100) was queried to identify patients undergoing elective 1-to-3 level PLF. OUTCOME MEASURES Trends in utilization during the study period (2005-2014), average 90-day costs/reimbursements, 90-day complications and 90-day readmissions. METHODS Patients were categorized into ‘CON’ and ‘No CON’ based on existing state laws where they received the procedure. For each group (CON vs No CON), differences in per-capita utilization, 90-day reimbursements and proportion of high-volume facilities (>150 procedures/year) vs low-volume facilities (≤50 procedures/year) have been reported. Multivariate analyses were used analyze 90-day complication/readmission rates between the two groups. RESULTS A total of 188,687 patients underwent an elective 1- to 3-level PLF in a CON state and 167,642 patients received the procedure in a No CON state from 2005 to 2014. The average per capita utilization of PLFs was lower in CON states as compared to No CON states (14.5 vs 15.4 per 10,000 population; p CONCLUSIONS While the presence of CON laws was associated with lower utilization of elective 1-to-3 level PLFs, and a greater presence of high-volume facilities, the mandate's effect on enhancing quality-of-care, by reduction of 90-day readmissions and 90-day complications is minimally significant. Future research, involving other surgical subspecialties, is needed before health policy makers may consider the removal or alteration of these laws. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.