Objectives:

Our study aimed to assess whether elective posterior lumbar fusions (PLFs) performed in states with Certificate-of-Need (CON) laws verse states without CON laws had lower utilization rates, lower costs, and better quality of care.

Methods:

The 2005-2014 100% Medicare Standard Analytical File was queried to identify patients undergoing elective 1- to 3-level PLF. Differences in per-capita utilization, 90-day reimbursements and proportion of high-volume between CON and No CON states was reported. Multivariate analyses were used to analyze 90-day complications and readmissions.

Results:

A total of 188,687 patients underwent an elective 1- to 3-level PLF in a CON state and 167,642 patients in a No CON state during 2005-2014. The average per capita utilization of PLFs was lower in CON states as compared to No CON states (14.5 vs. 15.4 per 10,000 population; P<0.001). Average 90-day re-imbursements between CON and No CON states differed by a small amount ($22,115 vs. $21,802). CON states had higher proportion of high-volume facilities (CON vs. No CON - 40.9% vs. 29.9%; P<0.05) and lower proportion of low-volume facilities (CON vs. No CON - 37.2% vs. 45.0%; P<0.05). PLFs performed in CON states had a slightly lower odds of 90-day complications (OR 0.97 [95% CI 0.96-0.99]; P<0.001) and readmissions (OR 0.95 [95% CI 0.93-0.97]; P<0.001).

Conclusions:

The presence of CON laws was associated with lower utilization of elective 1- to 3-level PLFs, and a greater number of high-volume facilities. However, their effect on quality-of-care, via reduction of 90-day readmissions and 90-day complications, is minimally significant.