In an article just published in the New England Journal of Medicine, former Obama adviser Ezekiel Emanuel (infamous for his “complete lives system”) and Emily Oshima Lee of the Center for American Progress have an idea on how to cut costs: “share” in patients’ decisions to request expensive treatments by providing patients with “certified” decision aids. Lee and Emanuel write:
Section 3506 of the ACA aims to facilitate shared decision making. Primarily, it funds an independent entity that would develop consensus-based standards and certify patient decision aids for use by federal health programs and other interested parties.
Not surprisingly, “shared decision making” (as opposed to ordinary decision making), is proven to cut costs:
In 2008, the Lewin Group estimated that implementing shared decision making for just 11 procedures would yield more than $9 billion in savings nationally over 10 years.
The authors suggest that HHS can bypass Congress in making the tools mandatory:
For approaches that provide savings or improve quality of care, implementation can be mandated throughout Medicare without additional legislation.
Lee and Emanuel do not offer specific examples of patient decision aids, but one that comes to mind is a video tool that made news in 2009. Researchers affiliated with Harvard Medical School, Massachusetts General, and Boston University created a video of a woman with advanced dementia who could not talk or eat. After viewing the video, almost all dementia patients (96%) declined life-saving treatment, while in the control group (decision-making without the video) only 86% chose to forgo life-saving measures. (Read about the study: Video Images of Advanced Dementia Help Patients Plan Care. The study and video are online: Volandes, Angelo E et al. “Video Decision Support Tool for Advance Care Planning in Dementia: Randomised Controlled Trial.” BMJ 2009;338:b2159)
Don’t worry; CMS can get started even without the independent entity in place. International guidelines are available:
The Department of Health and Human Services could quickly launch pilot programs for shared decision making while it works to standardize and certify decision aids. The International Patient Decision Aid Standards Collaboration has developed evidence-based guidelines for certification indicating that decision aids should include questions to help patients clarify their values and understand how those values affect their decisions . . .
The Center for American Progress urges immediate action.