From the New England Journal of Medicine: “Shared Decision Making to Improve Care and Reduce Costs”
Making complex medical decisions for which there is more than one course of treatment can be overwhelming and challenging for patients and their families. For many patients, questions about their treatment options can include:
- Is this procedure my only option? What are alternative types of treatment?
- What are the possible outcomes and side effects of each option, including the option of doing nothing?
- What is the estimated cost of the procedure and any related follow-up care or medication?
Shared decision making, a collaborative process between patients and their physicians, uses patient decision aids to help patients answer these important questions, better understand their treatment options, and decide which treatment option best aligns with their preferences and values. Patient decision aids can include fact sheets and questionnaires, interactive online tools, videos, and discussion guides for doctors to use in conversations with patients. The patient can use these aids before an office visit or the provider and patient can use the aids jointly during an appointment.
Although numerous studies show that using patient decision aids can provide a number of benefits—including patients feeling more comfortable with their care decisions, reduced use of invasive treatment options without detracting from health outcomes, and lower costs of care—physicians do not widely use shared decision making for preference-sensitive conditions. Our current payment system does not reimburse physicians for the time they spend with patients or reward them for encouraging patients to opt for the treatment that best aligns with their care goals and values. Additionally, many physicians can’t easily access patient decision aids and haven’t been trained on engaging in shared decision making with patients.
The Affordable Care Act requires the secretary of health and human services to work with organizations to develop standards for patient decision aids and to certify aids that meet these standards. Additionally, the new law allows the Center for Medicare and Medicaid Innovation to test payment models that reimburse Medicare providers for using patient decision aids. Implementation of these provisions, however, has been slow.
We believe it is critical for the secretary to launch pilot programs for shared decision making and work to standardize and certify decision aids. We also propose that Medicare should begin to require the use of decision aids for the 20 most-frequently performed medical procedures, with full reimbursement contingent on documented use of shared decision making. These proposals are further detailed in the paper linked here.
Emily Oshima Lee is a Research Associate and Policy Analyst with the Health Policy team at the Center for American Progress. Ezekiel J. Emanuel is a Senior Fellow at the Center.