Who will pay the bill for shared decision making? At present, most of these programs are funded by research efforts.
One potential obstacle for adoption of shared decision making is the current reimbursement system. Typically, in-depth patient education activities in hospitals and clinics are not billed. (However, evaluation and management CPT codes allow billing for patient counseling by a physician. Also, education and training codes allow billing for education related to self management.)
Some advocates of shared decision making advocate for reimbursement of in-depth patient education activities. More than 60 percent of physicians in a Foundation for Informed Medical Decision Making (FIMDM) survey said they would be “much more” interested in using decision aids if they were reimbursed for the time spent discussing information with patients. They would also support reimbursement for support staff—such as nurses—engaged in shared decision-making with patients (Informing and Involving Patients in Medical Decisions: The Primary Care Physician’s Perspective, FIMDM, February 2009).
Stay tuned to see if the current health reform debate ends up including reimbursement for patient education.
In the meantime, how can nurse leaders come up with a financial argument for committing resources to shared decision making? Start by consulting with your liaison(s) in the finance department and other relevant departments. Together, clinical and business experts can identify all the pros and cons. Here are a few potential benefits.
Reduced malpractice suits. Washington state’s law on shared decision making states that if a patient “signs an acknowledgement of shared decision-making … such acknowledgement shall constitute prima facie [first impression] evidence that the patient gave his or her informed consent to the treatment administered and the patient has the burden of rebutting this by clear and convincing evidence.” In other words, the burden of proof shifts from the physician to the patient in malpractice cases.
Increased patient loyalty—which could translate into higher volumes. Stillwater Medical Group increased patient loyalty among breast cancer patients by almost 20 percent by using shared decision making.
Increased physician satisfaction. In one FIMDM survey, 93 percent of physicians surveyed said they thought shared decision making sounded like a very or somewhat positive experience.