《医疗需求证明状态对开放式和内窥镜下腕管松解术的利用和报销的影响》

The Impact of Certificate of Need Status on the Utilization and Reimbursement of Open and Endoscopic Carpal Tunnel Release.

机构信息

Stanford University, VOICES Health Policy Research Center, Department of Orthopaedic Surgery, Redwood City, California.

出版信息

J Surg Orthop Adv. 2021 Summer;30(2):90-92.

Abstract

A certificate of need (CON) permits a healthcare organization to build new facilities only if significant medical needs exist. Many states have implemented CON programs to prevent procedure overutilization and price inflation. We hypothesized that there are no differences in reimbursement or utilization for open and endoscopic carpal tunnel release (CTR) when comparing states with and without CON programs. We queried a private-payer database to identify open and endoscopic CTRs performed between 2007 and 2015. In total, 82,689 CTRs were identified: 70,160 open, 12,529 endoscopic. Reimbursement increased for open procedures (compound annual growth rate [CAGR] 1.0% CON, 1.4% non-CON) but only marginally increased or decreased in the endoscopic group (CAGR -0.8% CON, 0.2% non-CON). Utilization increased across all settings, and was highest in the endoscopic CON group (CAGR 17.9%). Least growth was seen in the open non-CON group (CAGR 10.0%). Overall, CON programs may not actually decrease CTR spending or utilization. (Journal of Surgical Orthopaedic Advances 30(2):090-092, 2021).

摘要

需要证书（CON）仅允许医疗保健组织在存在重大医疗需求的情况下新建设施。许多州都实施了 CON 计划，以防止程序过度使用和价格上涨。我们假设在比较有和没有 CON 计划的州时，开放和内窥镜腕管松解术（CTR）的报销和使用没有差异。我们查询了一个私人支付者数据库，以确定在 2007 年至 2015 年期间进行的开放和内窥镜 CTR。总共确定了 82689 例 CTR：70160 例开放，12529 例内窥镜。开放手术的报销增加（复合年增长率 [CAGR] CON1.0%，非 CON1.4%），但内窥镜组仅略有增加或减少（CAGR CON-0.8%，非 CON0.2%）。所有情况下的利用率都有所增加，内窥镜 CON 组最高（CAGR17.9%）。在开放非 CON 组中增长最少（CAGR10.0%）。总体而言，CON 计划实际上可能不会降低 CTR 支出或利用率。（《外科矫形进展杂志》30（2）：090-092，2021）。