On Thursday, the Centers for Medicare & Medicaid Services (CMS) announced that its Innovation Center is initiating a pair of five-year demonstration projects targeted at evaluating several different approaches to shared decision making between physicians and sufferers.
The SDM (Shared Decision Making) Model will concentrate on integrating this approach into clinical workflow in ACOs (accountable care organizations). The Direct Decision Support (DDS) Model, to be tested in the other project, will use outside "decision support organizations" to educate or inform sufferers about their treatment choices so they can have informed discussions with their doctors.
Fee-for-service Medicare beneficiaries will be included by both demonstrations who’ve one of the following "preference-sensitive" situations: hip or knee osteoarthritis, clinically localized prostate cancer, stable ischemic heart disease, herniated disk or spinal stenosis, and benign prostate hyperplasia. The decision support organizations — which CMS hasn’t completely described — will also be motivated to give decision support for "a broader range of acute and chronic conditions."
Expected to involve over 150,000 Medicare patients yearly, the SDM model will use patient decision aids in a four-step procedure. Three of the steps can be done by ACOs, involving identification of SDM-eligible beneficiaries, distributing patient decision aids to these sufferers, and tracking and reporting the impacts of shared decision making. Although, a physician or other provider must furnish the SDM service, which includes discussing the treatment options in depth with sufferers.
The SDM Model has been planned to be operated by CMS in an intervention group of practices participating in fifty ACOs nationwide, along with an equal number of comparison ACOs. To qualify, ACOs must engage in the Medicare Shared Savings Plan or the Next Generation ACO program. Two years of participation must be committed by ACOs and will be offered up to 3 year-by-year renewals if they meet performance criteria.
The ACOs will get $50 each SDM service delivered by their practitioners. It is possible, but not required, that they will pass this money onto physicians who participate in shared decision making (SDM) discussions.
CMS noted, currently not many physicians are doing so. The agency said, "In spite of the inherent value of shared decision making, the literature shows that practitioners have found it complicated to integrate shared decision making into their routine workflows.” Among the key reasons CMS mentioned are heavy workloads, inadequate training, insufficient information systems, and deficiency of consistent methods to measure either shared decision making is taking place.
"Vary significantly in their willingness to discuss treatment options with sufferers. The incentive to utilize a comparison tool in primary care is low when you are under time pressure”, says Glyn Elwyn, MD, director of the shared decision making research lab at the Dartmouth Institute for Healthcare Policy and Clinical Practice, Hanover, New Hampshire.
He said, primary care physicians mostly refer sufferers with critical medical issues to specialists who are more likely to conduct a test or process than engage in shared decision making,.
Although, if primary care doctors were paid $50 per service, he further added, they might spend the important time with sufferers to discuss their choices in depth.