As countless health care experts have said, comprehensive legislative health care reform requires attention to access, cost and quality issues. While much of the public debate grows around the best strategies for coverage expansion, new legislation to deliver patient decision aids offers a vehicle for improving the health care delivery system.

On May 21, Senator Ron Wyden (D-OR) introduced S.1133 — co-sponsored by Senator Judd Gregg (R-NH) — the Empowering Medicare Patient Choices Act, which was matched on the House side with H.R.2580 by Congressman Earl Blumenauer (D-OR). The main purpose of the legislation is to expand the use of shared decision making (SDM) in Medicare to help beneficiaries — in collaboration with their clinicians — make more informed treatment decisions based on an understanding of available options and each individual patient’s circumstances, beliefs and preferences.

SDM has an extensive scientific base demonstrating its potential for much better, more patient-centered care and reduction of unnecessary, costly procedures. For those interested in more background on SDM, the best resources are (in the US) the Foundation for Informed Medical Decision Making (founded by luminaries Jack Wennberg and Al Mulley) and (internationally) the Ottawa Health Research Institute (with SDM leadership by Annette O’Connor, the Tier 1 Canada Research Chair in Health Care Consumer Decision Support…don’t you think the US could use someone with that title?).

This program creates a three-stage phase-in of patient decision aids into Medicare. Phase I involves a pilot, during which an independent entity would create a process for developing consensus-based standards and a certification process to ensure decision aids are effective and provide unbiased information.

During Phase II, providers would be eligible to receive reimbursement for using certified patient decision aids. The final stage involves requirements to ensure that all Medicare beneficiaries receive patient decision aids prior to receiving treatment for a preference-sensitive condition. At that point, reimbursement can be reduced by 20% for providers whose patients are not getting their information therapy (Ix).

Based on estimates from Lewin, full SDM implementation just in the 11 conditions this bill targets would save $4.1 billion in 2010 and increase to annual savings of $7 billion by 2017. The program would distribute the savings in three ways:

• 50% to participating providers based on their performance
• 25% to expand provider participation through funding of SDM centers and providers
• 25% to be returned to the Medicare program.

The savings would phase out over time and ultimately become penalties, so there’s a nice blend of carrots in the early years and sticks later.

This federal legislation builds on innovative policy being developed in the states. Washington became the first state to pass an SDM law in 2007, and several other states — Vermont, Maine, Minnesota, and — have been working on similar legislation in 2009.

Prescribing decision aids to consumers is one of the great opportunities for achieving true delivery system improvements in quality and efficiency. These Ix tools will produce better outcomes at lower costs and result in a true participatory medicine environment. If we want to improve care delivery and have the money to cover the nearly 50 million uninsured Americans out there, we need common-sense system reforms like this one to be embedded into the broader health care reform legislation.

This entry was posted on Thursday, May 28th, 2009 at 12:56 pm and is filed under Consumer empowerment, Decision Support, Health Care Reform, Inside the Beltway, Participatory Medicine, Patient-Clinician Relationship. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.