Should Lack of Shared Decision-Making Be Penalized Like Readmissions?

Shared decision-making enhances patients' engagement in their care and can result in improved outcomes and reduced costs, according to a perspective piece in the New England Journal of Medicine.

While the Patient Protection and Affordable Care Act has a provision — Section 3506 — to encourage shared decision-making, healthcare providers have not made much progress on this measure, according to the authors. The authors made several suggestions for encouraging shared decision-making, including having CMS require the use of decision aids such as written materials, videos or interactive electronic presentations in Medicare and Medicaid programs.


The authors wrote that CMS could enforce this requirement by cutting reimbursement for hospitals that do not use decision aids, similar to penalizing hospitals for unnecessary readmissions through CMS' Readmissions Reduction Program.

"Providers who did not document the shared-decision-making process could face a 10% reduction in Medicare payment for claims related to the procedure in year 1, with reductions gradually increasing to 20% over 10 years. This payment scheme is similar to that currently tied to hospital-readmissions metrics," the authors wrote.

The authors suggested additional actions CMS could take to promote shared decision-making, including the following:
•    Add shared decision-making as a quality metric in patient-centered medical homes and accountable care organizations.
•    Make the use of shared decision making and patient decision aids a criterion for receiving incentives through the Medicare and Medicaid Electronic Health Record Incentive Program.
•    The Patient-Centered Outcomes Research Institute could incorporate research into certified decision aids.

More Articles on Healthcare Quality:

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Study: More Than a Third of Physicians Give in to Patients' Demands for Brand-Name Drugs

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