- CMS has announced that it will not pilot the Shared Decision Making (SDM) and the Direct Decision Support (DDS) Models, two initiatives aimed at supporting shared decision-making and patient engagement in healthcare.
The agency cited operational and technical issues with the original DDS program design.
“After careful consideration and review of all available options, CMS determined that the design and operational changes necessary to continue with the DDS Model would be too significant and burdensome for participants, and would require a new solicitation,” CMS wrote in a public statement.
The SDM reportedly did not garner enough interest from qualifying accountable care organizations (ACOs), rendering the program ineffective, the agency said.
“After careful consideration, the Centers for Medicare & Medicaid Services (CMS) is announcing its decision to not test the Shared Decision Making (SDM) Model because an insufficient number of Accountable Care Organizations (ACOs) were interested in participating in the Model,” CMS wrote in a separate statement.
Both the DDS and SDM models were launched by CMS and the Agency for Healthcare Research and Quality (AHRQ).
As a part of the Beneficiary Engagement and Incentive (BEI) models, SDM introduced a four step system for incorporating patients into the decision-making process.
This strategy was to include “identifying SDM eligible beneficiaries, distributing the PDA to eligible beneficiaries, furnishing the SDM Service, and SDM tracking and reporting,” according to a previous CMS fact sheet.
DDS aimed to empower individuals receiving outpatient care using enhanced patient education materials.
CMS and AHRQ was set to enlist Decision Support Organizations to create and disseminate these educational materials. These entities would not be in charge of delivering clinical care to patients, but instead with arming patients with the information necessary to make a fully-informed medical decision.
“It will use patient-friendly material to educate patients about their condition and encourage them to have a conversation with their practitioners about care options to determine what care is best for them,” wrote Patrick Conway, MD, Acting Principal Deputy Administrator of CMS and Andy B. Bindman, MD, Director of AHRQ in a 2016 blog post.
“Providing information directly to patients about their health decisions acknowledges that patients make decisions about their medical conditions outside of, as well as inside, their doctor’s office,” the pair added.
CMS has reportedly decided to terminate the DDS program’s rollout because the program posed more questions than answers. The program did not have the technical or logistical support necessary to begin a pilot, the agency said.
CMS did not specify what technical or operational pitfalls the program had prior to termination. The agency also did not disclose any future plans for supporting shared decision-making among their Medicare and Medicaid beneficiaries.
Although there is no concrete evidence of the efficacy or ineffectiveness of the SDM and DDS models, separate research has indicated that shared decision-making can bring clinical value to patient care. When patients are better informed, they obtain the agency to make care decisions themselves. This in turn can improve value-based outcomes, experts agree.
A December 2016 report found that shared decision-making can reduce cardiac hospital admissions. A shared decision-making tool prepared patients to make decisions about hospital admission alongside their providers. Because traditional tests for chest pain often result in false positives, ED visits can result in unnecessary hospital admissions.
The tool in question reduced the frequency of unnecessary hospital admissions for chest pain.
The recent CMS announcements did not deny the potential benefits of shared decision-making in healthcare. Instead, the agency stated that its current programs for supporting shared decision-making in patient care did not have the proper support for successful rollout. It remains to be seen whether CMS implements a new strategy for supporting shared decision-making in healthcare.