Should providers face Medicare penalties for failing to engage patients?

Hot debate over shared decision making, patient decision aides
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Although the Affordable Care Act encourages shared decision making and patient engagement, the Centers for Medicare & Medicaid Services could do more to implement patient decision aids, according to Thursday's article in the New England Journal of Medicine.

Authors from the Center for American Progress in Washington, D.C., go so far as to suggest that providers who do not use shared-decision tools could be docked Medicare payment, similar to readmission penalties.

"The care patients receive doesn't always align with their preferences," the article said.

According to a nationwide study published in October's Journal of the American Medical Association, 90 percent of patients want options and not only a best recommendation.

However, as a MedCity News opinion piece pointed out, a reimbursement requirement would simply become another box to check off in the electronic medical record.

A commentary in National Review Online called the idea bureaucratic.

"[D]octors and patients should already be engaged in 'shared decision making.'  … But I worry that government 'certified' patient education documents could easily be written to persuade patient's into making the bureaucrat-preferred decision--not necessarily the right decision for the individual."

A "sleeper provision" (Section 3506 of the ACA), as the NEJM authors called it, encourages shared decision making. The health reform law requires that the Center for Medicare and Medicaid Innovation test tools to help patients understand their medical decisions.

Healthcare Informatics called 2013 the year of patient engagement innovations. Stage 2 of Meaningful Use mandates that hospitals make patient data available, thus encouraging patients and their families to become members of the care team. For instance, with shared decision making in mind, Children's Hospital of Philadelphia expanded its hospital portal with appointment requests, test result viewing, health summaries and growth charts.

For more information:
- check out the NEJM article
- here's the MedCity News article
- read the National Review article
- see the Healthcare Informatics article

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