Skip to main content
Subscribe
  • Sign Up Free
  • Login
  • Subscribe
  • News
    • Current News
    • Providers
    • Insurance
    • Government
    • Finance
    • Technology
    • Safety & Quality
    • Digital Health
    • Transformation
    • ESG
    • People
    • Regional News
    • Digital Edition (Web Version)
    • Patients
    • Operations
    • Care Delivery
    • Payment
    • Midwest
    • Northeast
    • South
    • West
  • Opinion
    • Bold Moves
    • Breaking Bias
    • Commentaries
    • Letters
    • Vital Signs Blog
    • From the Editor
  • Events & Awards
    • Awards
    • Conferences
    • Galas
    • Virtual Briefings
    • Webinars
    • Nominate/Eligibility
    • 100 Most Influential People
    • 50 Most Influential Clinical Executives
    • Best Places to Work in Healthcare
    • Excellence in Governance
    • Health Care Hall of Fame
    • Healthcare Marketing Impact Awards
    • Top 25 Emerging Leaders
    • Top Innovators
    • Diversity in Healthcare
      • - Luminaries
      • - Top 25 Diversity Leaders
      • - Leaders to Watch
    • Women in Healthcare
      • - Luminaries
      • - Top 25 Women Leaders
      • - Women to Watch
    • Digital Health Transformation Summit
    • ESG: The Implementation Imperative Summit
    • Leadership Symposium
    • Social Determinants of Health Symposium
    • Women Leaders in Healthcare Conference
    • Best Places to Work Awards Gala
    • Health Care Hall of Fame Gala
    • Top 25 Diversity Leaders Gala
    • Top 25 Women Leaders Gala
    • - Hospital of the Future
    • - Value Based Care
    • - Hospital at Home
    • - Workplace of the Future
    • - Digital Health
    • - Future of Staffing
    • - Hospital of the Future (Fall)
  • Multimedia
    • Podcast - Beyond the Byline
    • Sponsored Podcast - Healthcare Insider
    • Video Series - The Check Up
    • Sponsored Video Series - One on One
  • Data Center
    • Data Center Home
    • Hospital Financials
    • Staffing & Compensation
    • Quality & Safety
    • Mergers & Acquisitions
    • Data Archive
    • Resource Guide: By the Numbers
    • Surveys
    • Data Points
  • Newsletters
  • MORE+
    • Contact Us
    • Advertise
    • Media Kit
    • Jobs
    • People on the Move
    • Reprints & Licensing
MENU
Breadcrumb
  1. Home
  2. Physicians
February 02, 2013 12:00 AM

Obstacles ahead

Shared decisionmaking faces roadblocks, despite push, incentives

Maureen McKinney
  • Tweet
  • Share
  • Share
  • Email
  • More
    Reprints Print
    GETTY IMAGES
    Aids such as tablets, DVDs and online risk calculators can help doctors better prepare patients to make informed decisions.

    Driven by federal incentive programs and a growing body of research, providers are ramping up attempts to engage patients and promote shared decisionmaking. But those efforts could face significant obstacles, hindering one of the central tenets of the healthcare reform law.

    The overarching goal of such programs, said Dr. Nan Cochran, a primary-care physician and associate professor of medicine at Dartmouth University, Hanover, N.H., is to provide patients with the best tools and information so they can make decisions that align with their own preferences and priorities. Many experts also believe that shared decisionmaking can lead to lower utilization of services and a possible antidote to ballooning healthcare costs.

    Cochran cited a wide range of decision aids that physicians can provide to patients, including explanatory DVDs, paper-based health information and online risk calculators.

    For instance, when treating women with the bone disease osteoporosis, Cochran uses a calculator to explain each patient's individualized risk of fracture based on family history, age, alcohol use and other variables, and then to show how much that risk will be reduced by medication.

    “We want to make sure they're making an informed decision,” she said.

    Despite the ever-increasing focus on including patients in care—2013 has been referred to by many as the “year of patient engagement”—expense, physician acceptance, training and workflow still present thorny challenges, Cochran said.

    “The data has shown us that physicians do a notoriously bad job of predicting patients' preferences on their own,” she said. “Unfortunately, though, doctors have not been trained to respect patients' autonomy as much as they should. That requires real culture change.”

    Patient engagement is a cornerstone of the federal government's Medicare and Medicaid electronic health-record incentive program. The program's Stage 2 meaningful-use requirements, set to go into effect in October for hospitals and in January 2014 for physicians, require providers to communicate with patients using electronic messaging and provide them with timely access to health information. Patient engagement and shared decisionmaking are also emphasized in other federal programs, including the Medicare Shared Savings Program.

    Those programs will provide a much needed nudge, Cochran predicted, as will a September 2012 study from Seattle-based Group Health Cooperative, which showed that decision aids could reduce elective surgery rates and hold down costs.

    Dr. Richard Wexler, chief medical officer of the Informed Medical Decisions Foundation, Boston, contends that financial incentives will probably need to be much more explicitly tied to shared decisionmaking, however, in order to effect real change.

    “It's very hard to get shelf space for this because physicians have so many competing opportunities to do good things related to improvement,” Wexler said. “Unless we realign incentives to highlight shared decisionmaking and attach some real financial importance to it, I think we'll have trouble competing with the other things that are rewarded in our system.”

    Wexler is taking a wait-and-see approach to the EHR incentive program, particularly until the Stage 3 criteria are unveiled. “If meaningful use gets us there, that will be a very significant step,” he said.

    Office visits may be short, but physicians can be successful if they are equipped with the right decision aids and training, said Dr. Victor Montori, director of the Health Care Delivery Research Program in the Mayo Clinic Center for the Science of Health Care Delivery, Rochester, Minn. A leader in the field of patient engagement, Montori has developed and evaluated such aids for nearly a decade, making them available free of charge through the Mayo Clinic Shared Decision Making National Resource Center.

    “When properly supported by point-of-care tools, we find clinicians are able to do this fairly painlessly,” Montori said in an e-mail. “We have done successful work now in the emergency department, so the issue of time can clearly be overcome.”

    Physicians who embrace shared decisionmaking need to do so because they believe in patient empowerment and not because they expect a financial carrot, he added.

    “If an organization engages in shared decisionmaking to look good, make more money, save money or improve outcomes, they may be disappointed,” he said in the e-mail. “Shared decisionmaking is a manifestation of your commitment to the patient.”

    Even if the “it's the right thing to do” argument resonates with physicians, integrating a new tool or process into their workflow can present a significant hurdle, said Dr. Glyn Elwyn, a visiting professor and senior scientist at the Dartmouth Center for Health Care Delivery Science. Elwyn and his colleagues have been working on one-page aids called option grids, which briefly review common questions and compare treatments.

    The option grids, also available free of charge, cover diseases and conditions such as breast cancer, Crohn's disease and sciatica, with more tools coming soon for angina, carpal tunnel syndrome and others, he said.

    Like Wexler, of the Informed Medical Decisions Foundation, Elwyn says the current financial incentive framework is not well aligned with shared decisionmaking. Even so, he said, clinicians' interest is booming.

    “I've never seen demand like this, and that tells me something.”

    Letter
    to the
    Editor

    Send us a letter

    Have an opinion about this story? Click here to submit a Letter to the Editor, and we may publish it in print.

    Recommended for You
    healthcare workers burnout
    Physicians left their jobs by the hundreds of thousands in 2021: report
    careallies patient care
    Physician assistant role sees record growth in 2021
    Most Popular
    1
    More healthcare organizations at risk of credit default, Moody's says
    2
    Centene fills out senior executive team with new president, COO
    3
    SCAN, CareOregon plan to merge into the HealthRight Group
    4
    Blue Cross Blue Shield of Michigan unveils big push that lets physicians take on risk, reap rewards
    5
    Bright Health weighs reverse stock split as delisting looms
    Sponsored Content
    Get Newsletters

    Sign up for enewsletters and alerts to receive breaking news and in-depth coverage of healthcare events and trends, as they happen, right to your inbox.

    Subscribe Today
    MH Magazine Cover

    MH magazine offers content that sheds light on healthcare leaders’ complex choices and touch points—from strategy, governance, leadership development and finance to operations, clinical care, and marketing.

    Subscribe
    Connect with Us
    • LinkedIn
    • Twitter
    • Facebook
    • RSS

    Our Mission

    Modern Healthcare empowers industry leaders to succeed by providing unbiased reporting of the news, insights, analysis and data.

    Contact Us

    (877) 812-1581

    Email us

     

    Resources
    • Contact Us
    • Advertise with Us
    • Ad Choices Ad Choices
    • Sitemap
    Editorial Dept
    • Submission Guidelines
    • Code of Ethics
    • Awards
    • About Us
    Legal
    • Terms and Conditions
    • Privacy Policy
    • Privacy Request
    Modern Healthcare
    Copyright © 1996-2023. Crain Communications, Inc. All Rights Reserved.
    • News
      • Current News
      • Providers
      • Insurance
      • Government
      • Finance
      • Technology
      • Safety & Quality
      • Digital Health
      • Transformation
        • Patients
        • Operations
        • Care Delivery
        • Payment
      • ESG
      • People
      • Regional News
        • Midwest
        • Northeast
        • South
        • West
      • Digital Edition (Web Version)
    • Opinion
      • Bold Moves
      • Breaking Bias
      • Commentaries
      • Letters
      • Vital Signs Blog
      • From the Editor
    • Events & Awards
      • Awards
        • Nominate/Eligibility
        • 100 Most Influential People
        • 50 Most Influential Clinical Executives
        • Best Places to Work in Healthcare
        • Excellence in Governance
        • Health Care Hall of Fame
        • Healthcare Marketing Impact Awards
        • Top 25 Emerging Leaders
        • Top Innovators
        • Diversity in Healthcare
          • - Luminaries
          • - Top 25 Diversity Leaders
          • - Leaders to Watch
        • Women in Healthcare
          • - Luminaries
          • - Top 25 Women Leaders
          • - Women to Watch
      • Conferences
        • Digital Health Transformation Summit
        • ESG: The Implementation Imperative Summit
        • Leadership Symposium
        • Social Determinants of Health Symposium
        • Women Leaders in Healthcare Conference
      • Galas
        • Best Places to Work Awards Gala
        • Health Care Hall of Fame Gala
        • Top 25 Diversity Leaders Gala
        • Top 25 Women Leaders Gala
      • Virtual Briefings
        • - Hospital of the Future
        • - Value Based Care
        • - Hospital at Home
        • - Workplace of the Future
        • - Digital Health
        • - Future of Staffing
        • - Hospital of the Future (Fall)
      • Webinars
    • Multimedia
      • Podcast - Beyond the Byline
      • Sponsored Podcast - Healthcare Insider
      • Video Series - The Check Up
      • Sponsored Video Series - One on One
    • Data Center
      • Data Center Home
      • Hospital Financials
      • Staffing & Compensation
      • Quality & Safety
      • Mergers & Acquisitions
      • Data Archive
      • Resource Guide: By the Numbers
      • Surveys
      • Data Points
    • Newsletters
    • MORE+
      • Contact Us
      • Advertise
      • Media Kit
      • Jobs
      • People on the Move
      • Reprints & Licensing