Shared decisionmaking, which lets patients take a more active role in deciding their treatment, faces a number of challenges under fee-for-service Medicare, researchers told the Medicare Payment Advisory Commission.
“To best communicate with beneficiaries, Medicare must take into account how they learn and when information is most useful” in deciding treatment, Joan Sokolovsky, a principal policy analyst with MedPAC, said during a presentation. The concept has been used at Dartmouth-Hitchcock Medical Center, Lebanon, N.H., and Massachusetts General Hospital, Boston, and is being tested in Washington state at multispecialty group practices.
This care model “aims to improve decision quality and reduce unwarranted variation in care” and gives the patient the opportunity to express preferences on treatment while increasing their understanding of their condition, Sokolovsky said.
Concerns exist, however, that shared decisionmaking would disrupt office practices. “There are a lot of barriers to this,” including the extra time it would require of primary-care physicians, said MedPAC Commissioner Ron Castellanos. In addition, “I don’t know how this would fit into fee-for-service. There’s no compensation for this.”
MedPAC researchers sought feedback from commissioners under a long-term plan to develop a chapter on shared decisionmaking for one of MedPAC’s reports to Congress in 2010.
