Certificate of need and the quality of cardiac surgery

Historically, states have used Certificate of Need (CON) programs to review proposals for new construction and expanded services in an effort to control costs and to improve the quality of and promote access to health care services. Congressional funding for CON ended in 1987. However, today, 26 states use CON to regulate cardiac surgery. There has been little evidence of the impact of CON on the quality of services. Pennsylvania is in a unique position to study the impact of CON on the quality and outcomes of care because the state terminated CON in 1996 and has publicly reported quality and outcomes data on coronary bypass graft (CABG) surgeries since 1992. Using a statewide inpatient data-reporting system, the volumes and outcomes of CABG surgeries at all Pennsylvania hospitals were examined in the 3 years prior to and the 3 years after the termination of CON. In the 3 years following the elimination of CON, the number of open-heart surgery programs increased 25%, yet there was no significant increase in the number of CABG surgeries performed. Quality, as measured by mortality rate, was not impacted by the real-location of the relatively stable CABG volume in the short term; this may be due, in part, to itinerant surgeons and statewide public performance monitoring. The long-term implications of deregulation are unclear and deserve future study.