How CON status affects total knee replacement volume — 6 things to know

A new study published in the Journal of Arthroplasty examines how certificate-of-need programs affect total knee replacement volume.


Study authors examined data from CON and non-CON states from the 100% Medicare Standard Analytical Files on total knee replacements performed from 2005 to 2014. Key findings in the study include:

1. Certificate-of-need states were associated with lower total knee replacement utilization.

2. Annual total knee replacement procedure volume increase more quickly in states with CON laws — 5.6 percent — compared with non-CON states — 2.3 percent.

3. Total knee replacement, when the data was normalized to the Medicare patient population, increased 2 percent in CON states, compared to a 7.2 percent decrease in states without CON regulations.

4. Reimbursement for Medicare patients was 5 percent to 10 percent lower in states without CON legislation.

5. There were more total knee replacements done in low volume hospitals in non-CON states than in CON states.

6. The data did not suggest CON regulations were associated with better quality of care.

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