Certificate of need and the cost of competition in home healthcare markets.

We used 2010-16 Medicare Cost Reports for 10,737 freestanding home health agencies (HHAs) to examine the impact of home health (HH) and nursing home (NH) certificate-of-need (CON) laws on HHA caseload, total and per-patient variable costs. After adjusting for other HHA characteristics, total costs were higher in states with only HH CON laws ($2,975,698), only NH CON laws ($1,768,097), and both types of laws ($3,511,277), compared with no CON laws ($1,538,536). Higher costs were driven by caseloads, as CON reduced per-patient costs. Additional research is needed to distinguish whether this is due to skimping on quality vs. economies of scale.

Wide Variation in the Diffusion of a New Technology: Practice-Based Trends in Intensity-Modulated Radiation Therapy (IMRT) Use in the State of Michigan, With Implications for IMRT Use Nationally.

PURPOSE: To characterize the adoption and variation of intensity-modulated radiation therapy (IMRT) use in the state of Michigan. METHODS: As a certificate-of-need state, Michigan requires every radiation oncology facility to report the number of external-beam and IMRT treatments delivered annually. We examined the percentage of treatments delivered using IMRT across centers from 2005 to 2012. We constructed a repeated-measures longitudinal linear regression model to evaluate bivariable and multiple variable associations with IMRT use. RESULTS: The median proportion of treatments delivered with IMRT rose from 16% in 2005 to 42% in 2012. All treatment centers in the state of Michigan possessed the capacity to deliver IMRT as of 2009. The fraction of treatments delivered with IMRT varied between 23% and 96% (standard deviation, 19%) in the lowest- and highest-use centers in 2012. Higher IMRT use was significantly associated with freestanding facilities and year of treatment, with a trend toward higher IMRT use in academic centers and low-volume facilities. CONCLUSION: IMRT use grew significantly across the state of Michigan over time, with four-fold variability among centers, which was related to facility characteristics. These data provide no indication of an ideal or appropriate level of IMRT use. Rather, the wide variation in IMRT use among centers indicates a lack of consensus regarding the situations in which IMRT provides significant clinical benefit. This supports further research and interventions to ensure that patients receive appropriate care, regardless of where they are treated.

Providers issue brief: certificate of need: year end report-2002.

At one time, every state was required by the federal government to have a certificate of need (CON) program. The process was intended to keep down costs associated with the construction of new health facilities in the state, and prevent over development. When the federal requirement was lifted, however, a number of states did away with their programs. Some later restored them in some form, and many have kept their programs alive for years, requiring a governmental seal of approval for building new facilities such as hospitals and long-term care facilities or for acquiring major medical equipment.

New wine in old bottles: certificate of need enters the 1990s.

Although state certificate-of-need (CON) programs have been the subject of intense criticism over the past decade, recent evidence suggests that CON programs may be more effective than commonly believed. While many state programs have yielded disappointing results, the CON process can also be used to achieve other important policy objectives, such as increasing access to care for the uninsured and increasing lay participation in health policy planning. In sum, rather than fading away after the termination of federal support for health planning in 1986, state CON programs are poised to assume new roles during the 1990s.

The major ambulatory surgical center and how it is developed.

Of the more than 20 million surgical operations performed each year in this country, 40 to 50 per cent can be done without hospitalizing the patient, and more and more of these out-of-hospital operations are being done on patients requiring general anesthesia or a period of postoperative observation. This article reviews the advantages and disadvantages of major ambulatory surgery in general, as well as those of the different types of ambulatory surgical units. The steps in the development of a unit, including the various committees involved in its development and operation, are outlined.