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February 6, 2018

CMS cancels Obama-era Direct Decision Support payment model

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    CMS on Friday announced that it will no longer test the Direct Decision Support (DDS) payment model that was proposed by the agency's Center for Medicare and Medicaid Innovation (CMMI) under former President Barack Obama's administration.

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    The move comes after CMS in November 2017 canceled a similar proposed model, called the Shared Decision-Making (SDM) model, Modern Healthcare reports. The SDM model would have allowed Medicare beneficiaries to consult with their clinicians to determine the best treatment plans. CMS cited insufficient interest among accountable care organizations as the reason for canceling SDM. 

    DDS details

    The DDS model was designed to engage patients in the decision-making process outside of the clinical setting. Under the model, decision support organizations would have contacted Medicare beneficiaries and provided them with access to a website or online form that detailed information about their conditions and treatment options. Patients then could have taken the information and discussed it with their physicians.

    At the time CMS proposed the model, the agency said DDS would have tested whether contacting beneficiaries outside of the clinical care setting would:

    • Help them to be more "informed, empowered, and engaged health care consumers;"
    • Increase beneficiaries' satisfaction with care decisions; and
    • Lower Medicare spending while improving or maintaining quality of care.

    Under the proposal, CMS would have partnered with up to seven decision support organizations that would have been assigned a geographic area that included about 100,000 Medicare beneficiaries. The organizations would have received a fixed per-beneficiary monthly payment for each beneficiary located in the geographic region they were assigned. CMS would have withheld 25% of an organization's total payment for the year, and would have paid those funds only if the organization met certain performance metrics.

    CMS says model would have been too 'burdensome'

    CMS said it will not move forward with launching the DDS model because of operational and technical issues related to the model's proposed design. CMS said it "determined that the design and operational changes necessary to continue with the DDS model would [have been] too significant and burdensome for participants, and would [have] require[d] a new solicitation" (Diamond, "Pulse," Politico, 2/5; Black, Healthcare Analytics News, 2/5; Gregory, Health Exec, 2/5; Dickson, Modern Healthcare, 2/5; Dietsche, MedCity News, 2/5).

    Next: Get the resources to help you engage in shared decision making


    Patient decision aids and motivational interviewing are essential tools for clinician collaboration. We've compiled our top resources to help medical group leaders train physicians to use these tools.

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