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Revascularizations Lower in States with Medicare Restrictions

Certificate-of-need regulations do not affect 30-day surgery rates and mortality

TUESDAY, May 9 (HealthDay News) -- A study of more than 1.1 million Medicare beneficiaries with acute myocardial infarction (AMI) shows that those living in states with certificate-of-need regulations have lower rates of coronary revascularization than patients living in other states, according to a report in the May 10 issue of the Journal of the American Medical Association.

Ioana Popescu, M.D., from the University of Iowa Hospitals and Clinics in Iowa City, and colleagues retrospectively examined 1.13 million Medicare beneficiaries with AMI who were age 68 or older and who were admitted to 4,587 U.S. hospitals between 2000 and 2003. The investigators compared rates of intervention and mortality based on state-required certificate-of-need regulations.

Patients in states with these regulations were less likely to be admitted to hospitals with revascularization services (51.5 percent versus 62.8 percent) or to undergo revascularization (26.1 percent versus 31.8 percent) than states without. Fewer patients in states with moderate to highly stringent regulations underwent intervention in the first two days, but the rates were similar at three to 30 days. Mortality was not affected by the regulations.

The study "demonstrates that government-based regionalization is safe for AMI patients in that 30-day mortality is not compromised despite lower revascularization rates," according to an editorial. "The next challenge is to determine how to fine-tune regionalization policies in certificate-of-need and non-certificate-of-need states to create systems that are as effective and efficient as possible."

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