Does Government Regulation Enhance Quality of Cardiovascular Procedures?

Abstract

Cardiovascular specialists encumbered with excessive intrusion into the patient-doctor relationship will likely agree with the conclusion of DiSesa et al1 that the coronary artery bypass grafting (CABG) mortality rate was not different between the 26 states with certificate-of-need (CON) programs and the 24 states without CON regulation. Data from the Society of Thoracic Surgeons’ (STS) National Cardiac Database (NCD) on 595 200 patients undergoing isolated CABG procedures for 4 consecutive years ending in 2003 used the STS NCD risk-stratification algorithm to predict an equivalent occurrence of death after CABG during hospitalization or within 30 days for both the 280 512 patients treated in non-CON states and the 314 710 patients treated CON states (Table 5 in DiSesa et al1). The observed perioperative CABG mortality rate was 2.52% for CON states and 2.62% for states without CON regulations (odds ratio [OR]=0.97, P =0.32). Article p 2122 Text in italics below represents the reflections of a hypothetical potential CABG patient. This artificial dialog was created to help cardiovascular specialists keep the patient at the center of our frame of reference when evaluating any quality-of-patient-care program. Although Dr Jones penned these words, he is not now and hopes never to be a potential CABG patient. From the perspective of an informed patient in need of CABG, my concern is that before operation, patients in both CON and non-CON states were expected to have the same operative risk, and yet an additional 1 out of 1000 patients died in non-CON states compared with CON states. One out of 1000 extra deaths does not seem like much extra risk unless you are the prospective patient. If I lived in Kansas City, Kan, …