Clinic Volumes Increase with Shared Decision Making Program

Shared decision making is not a new idea. But it is receiving renewed attention as a health reform strategy—with potential to reduce overall U.S. healthcare spending. Some providers are also finding that shared decision making can help increase patient loyalty.

In shared decision making, nurses, physicians, and other staff provide the patient with balanced information about treatment options and incorporate the patient's preferences and values into the medical plan, according to the Foundation for Informed Medical Decision Making (FIMDM).

Preliminary data suggest that informed patients tend to make more conservative treatment decisions. For example, a 2007 study found that shared decision making improved patient knowledge and increased watchful waiting as a treatment option in men diagnosed with prostate cancer.

The ROI for providers that offer such programs include a potential increase in patient loyalty, which may translate into higher volumes. For example, Stillwater Medical Group increased patient loyalty among breast cancer patients by almost 20 percent.

All patients with a prostate cancer or breast cancer diagnosis at the large multispecialty practice receive coordinated support that helps them make treatment decisions. Before their initial consultation with a specialist, breast and prostate cancer patients meet with Joyce Kramer, RN, BA, BCC, a clinical care coordinator at the Stillwater, Minn. Clinic.

“My role is to assess their knowledge of the disease, review their treatment options, and help them coordinate their treatment after biopsy and navigate the system,” says Kramer, who was hired initially to work with breast cancer patients to help increase their loyalty to this large group practice that provides primary and subspecialty care.

Patients are given a DVD/booklet and additional information to review before their treatment planning session with the specialist. Kramer documents patients’ concerns in the medical record so that the specialist can review the information during the patient consult.

Currently, the services that Kramer provides are not billable. However, the clinic is seeing improved revenue through better patient retention. From 2007 to 2008, the clinic improved its retention of breast cancer patients from 70 percent to 91 percent. In addition, patient volumes increased by 10 percent over that time period. “The value of a nurse providing this service is very high, just in terms of keeping patients in the system,” she says.

Stillwater Medical Group is now starting to use shared decision making with primary care patients who have benign prostatic hyperplasia (BPH) through a demonstration project funded by the Foundation for Informed Medical Decision Making

Following the same process as with prostate cancer and breast cancer patients, men with BPH will meet with a nurse care coordinator to review videos and complete questionnaires before they return to their primary care physician to discuss their treatment options.

When starting with the BPH population, Stillwater focused on the primary care providers with the highest volumes in this population. “We found that there wasn’t a lot of consensus among providers on when to send patients with BPH to the urologist,” says Kramer says. “Our plan is to meet with patients after their initial diagnosis of BPH and before referral to a urologist. That’s actually good for urologists, who will see the more complex cases that require invasive treatments.”

The approach also allows primary care physicians to continue caring for those patients who choose less invasive treatments, such as watchful waiting or medications.

In the coming months, the Stillwater Medical Group plans to coordinate decision-making resources for patients with diabetes and back pain.

Interviewed for this case study: Joyce Kramer, RN, BA, BCC, is clinical care coordinator at Stillwater Medical Group, part of Lakeview Health (jkramer@lakeview.org).

This case study is excerpted from a series of articles on “Helping Patients Make Appropriate Medical Decisions” in the Fall 2009 issue of The Business of Caring, a free electronic resource. Read the entire article series.