Healthcare News & Insights

Shared decision making: Improves care while lowering costs

A recent report in the New England Journal of Medicine, touts that shared decision making provides numerous benefits for patients, clinicians and the healthcare system, including increased patient knowledge, less anxiety over the care process, improved health outcomes, reductions in unwarranted variation in care and costs, and greater alignment of care with patients’ values.

Even the Affordable Care Act (ACA) thinks so. It has a provision in it that encourages greater use of shared decision making in health care.

Reason: Patients and their families often get confused and overwhelmed when making complex medical decisions where there is more than one treatment option. They have questions such as:

  • Are there other procedures?
  • Are there alternative treatments?
  • What are the outcomes of the procedure/treatment?
  • Are there side effects?
  • What are the costs involved?
  • What type of follow up care or medication is involved.

Shared decision making, a collaborative process between patients and their physicians,  can clear up those questions and better align patients’ preferences and values.

Decision aids

One key to shared decision making is using patient decision aids, which can be written materials, such as fact sheets and questionnaires, videos and interactive electronic presentations designed to inform patients and their families about care options, outcomes, benefits, side effects, the healthcare team’s skills and costs.

Despite a number of studies that show using patient decision aids can offer benefits such as patients feeling more comfortable with their decisions, reduced use of invasive treatment options without detracting from health outcomes and lower costs of care, it’s not widely used by physicians. Some reasons as to why include  physicians are very busy and don’t have time or can’t easily access patient decision aids, and they haven’t been trained to share the decision making process with patients and their families.

Another reason is little has been done through the ACA to promote shared decision making. The researchers believe the Centers for Medicare & Medicaid Services (CMS) should start certifying and implementing patient decision aids, as well as trying to achieve the following goals:

  • promote an ideal approach to clinician–patient decision making
  • improve the quality of medical decisions, and
  • reduce costs.

An independent entity is funded by Section 3506 of the ACA to develop consensus-based standards and certify patient decision aids for use by federal health programs and other interested parties. In addition, the secretary of health and human services is empowered to fund, through grants or contracts, the development and evaluation of these tools. The ACA also allows CMS to test payment models that reimburse Medicare providers for using patient decision aids. However, implementation of this has been very slow.

Positive benefits

A 2011 Cochrane Collaborative review of 86 studies  set out to determine how well decision aids prepare people to participate in decisions that involve weighing benefits, harms and scientific uncertainty. What the researchers found was that decision aids not only improve the individual’s knowledge of their options, but they also assist people in reaching choices that are more consistent with their values, while fostering collaboration with their provider. And fewer patients were passive in the decision-making process which is essential for patients’ adherence to therapies.

Studies also show the potential for reducing costs. Twenty percent of the patients who participate in shared decision making choose less invasive surgical options and more conservative treatment.

In 2008, the Lewin Group estimated that if shared decision making was used for just 11 procedures, it would yield more than $9 billion in savings nationally over 10 years.

A 2012 study by Group Health in Washington State found that providing decision aids to patients eligible for hip and knee replacements substantially reduced both surgery rates and costs — with up to 38% fewer surgeries and savings of 12% to 21% over six months.

With such positive benefits, the researchers believe it’s critical for the Department of Health and Human Services to launch pilot programs for shared decision making and work to standardize and certify decision  aids. They also noted that it’s critical for CMS to require the use of decision aids for the 20 most frequently performed procedures.  Since there are already a number of decision aids that exist, it would be easy for CMS to quickly certify them and require their use in Medicare and Medicaid programs.

Requiring that the documentation of using decision aids be in a patient’s medical record for certain procedures or else the provider would receive full reimbursement would give the requirement power. However, implementation of ACA Section 3506 has been slow.

 

 

 

 

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Comments

  1. Natalie Gauthier says:

    Renee, We, at Decisive Health, completely agree with your message. Decisive Health has created an interactive decision support tool that allows patients and physicians to engage in shared decision-making about their treatment options. I would love to discuss this topic more with you! My email address is natalie@decisivehealth.com

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  1. […] shown to cut down costs by lowering the amount of elective procedures: conservative estimates of $9 billion were previously projected before the Affordable Care Act was instated. An average of 12.5% fewer […]

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