Shared decision-making increases medical bills, study finds

Patients who join in decision-making cost $865 more

Patients who are hands on in medical decision-making are more likely to end up with longer hospital stays and higher bills than patients who leave the decisions to their physicians, according to a report published this week in JAMA Internal Medicine.

For the report, University of Chicago School of Medicine researchers surveyed 21,754 patients admitted to the university's medical center between July 2003, and August 2011. Participants were asked about their health, their health coverage, their education level, and their preference for participating in medical decisions. The researchers then linked the patients' responses to their administrative records.

More than 96% of the patients said they would like to receive information about their illnesses and treatment, but only about 29% said that they had a strong preference for making their own decisions about care.

Compared to patients who left decision-making up to their doctors, patients that preferred to be involved with their care decisions:

  • Tended to be better educated and have private insurance;
  • Stayed in the hospital, on average, a quarter of a day longer; and
  • Were billed $865 more per hospitalization.

"The result that everyone would have liked—that patients who are more engaged in their care do better and cost less—is not what we found in this setting," lead author David Meltzer said, adding that "[p]atients, as consumers, may value elements of care that the health care system might not."

Based on the researchers' calculations, patients' desire to be involved in decision-making adds 2.6 million extra hospital days and an additional $8.7 billion in costs to the U.S. health system each year (Brown, "Science Now," Los Angeles Times, 5/27; HealthDay/U.S. News & World Report, 5/28).

Thoughts from Megan Tooley, Cardiovascular Roundtable

There’s been a growing interest in shared decision making of late throughout clinical societies and the medical community, as well as federal regulators and policymakers. For example, shared decision making is a quality measure for ACOs participating in the Medicare Shared Savings Program, as well as a requirement for the NCQA’s patient-centered medical home and patient-centered specialty practice designations. Partly driving this recent push is growing evidence that provider-patient collaboration in care decisions can reduce the overall cost of care, as well as utilization of highly-intensive procedures.

Therefore, it’s no surprise the results of the University of Chicago study are generating widespread interest, as they appear to refute the notion that shared-decision making reduces costs and utilization. However, upon closer review of the study’s design and conclusion as published in JAMA Internal Medicine, it turns out the article only identified an association between patientpreference to be involved in care decisions and cost of care–it did not monitor whether or not shared decision making occurred in practice. Despite what some external media coverage of the study suggests, it would be a leap to infer the shared decision making process contributed to higher costs in the University of Chicago experience.

We're currently evaluating strategies for implementing shared decision making in practice, as part of the Cardiovascular Roundtable's broader research on enhancing patient-centered CV care. Register for an upcoming national meeting preview webconference to hear our initial insights from the research.


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