Medicare Savings-Medical Discussion Guides

Third Way asked Avalere Health to examine the potential federal costs or savings of implementing a policy which would advance the use of medical discussion guides, also known as decision aids, for shared decisionmaking between doctors and patients in preference-sensitive care. The policy recommends that the use of decision aids be standard medical practical practice starting in areas where cost-saving potential has been documented and proposes five key strategies:1) create a verification process where health plans report on whether patients were offered decision aids in their decision-making process; 2) establish federal standards for decision aids; 3) require health professionals with substandard use of decision aids to seek pre-authorization of payments for services affected by decision aids; 4) engage health professionals in the shared decision-making process and use of decision aids through CME and medical school curriculum; and 5) reform state informed consent laws to reflect that shared decision-making and the use of decision aids is the standard for valid informed consent.

Avalere estimated the impact of DAs for four conditions that are prevalent among the Medicare population: breast cancer, ischemic heart disease, hip and knee osteoarthritis, and lower back pain. We estimate that the proposed policy would reduce federal spending by approximately $9 billion over the 2015-2024 federal budget window. This amount reflects the change in spending resulting from patients’ shifts from selective surgical treatment to the alternative procedure.

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