How total knee replacement volume is different between CON and non-CON states

A new study published in the Journal of Arthroplasty examines the connection between certificate of need legislation and total knee replacement volume.


Study authors examined Medicare data from 2005 to 2014 across the U.S., examining the differences between CON and non-CON states. The study authors found:

1. CON states had lower per capita TKA utilization, but each year the number of TKAs increased more rapidly in CON states than non-CON states.

2. Over the study period, CON states reported a 5.6 percent increase in TKA volume, compared with 2.3 percent among non-CON states. After data normalization, CON states reported a 2 percent volume increase, compared to a 7.2 percent decrease in non-CON states.

3. In non-CON states, Medicare reimbursement was typically 5 percent to 10 percent lower than CON states throughout the study period.

4. There were more TKAs performed in low-volume hospitals in non-CON states when compared with CON states.

5. A state's CON status was not associated strongly with adverse event rates or outcomes.

"Although our data suggests that these laws are associated with lower per capita utilization of TKA and the use of higher-volume facilities, we were unable to detect any strong evidence that CON regulations have been associated with improved quality of care or have limited growth in the utilization of this procedure over time," concluded the study authors.

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