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Medicare's Shared Decision-Making: Now the RACs Will Decide

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Medicare's share decision-making for ICDs and Watchman procedures is required. If not shared correctly, Recovery Audit Contractors will decide as shared-decision making for these procedures has been approved for complex reviews.

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Product Code: AR100418

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Description Biography

Suppose a cardiologist at your facility tells a patient that she needs a defibrillator because she is at risk for a fatal heart arrhythmia and schedules the procedure. But later, the patient goes home and reads about the procedure and decides that dying suddenly of a heart arrhythmia is more appealing to her than another surgery and having a device that would require a hospital stay, frequent doctor visits and a risk of infection especially since it would not improve her current quality of life. She discusses this with the doctor and elects not to have the procedure performed. That's Medicare's Shared Decision-Making.

Today, doctors and patients need to share in this decision-making process for ICDs and Watchman procedures. And if shared decision-making isn't shared correctly— or at all— the Recovery Audit Contractors (RACs) will decide because shared decision-making for these procedures is approved for complex reviews by the RACs.

Historically, physicians gave orders and patients followed them. But, there's been a paradigm shift. The Centers for Medicare & Medicaid Services (CMS) upended this tradition by adopting new coverage guidelines for implanted defibrillators and left atrial appendage closure devices. Now physicians and patients need to share in the decision-making process for ICDs and Watchman procedures. And for some doctors, that's not an easy conversation to have. But not sharing could result in a denial.

So, instead of the physician simply ordering a test or performing a procedure, the patient and physician need to discuss the plan, review the benefits of performing the procedure, review the data on related successes, discuss the cost and risks, while considering the patient's goals and expectations before deciding on a course of action.

But shared decision-making needs to be shared among the care team for all the care that we provide our patients. Case managers and social workers, and others. Together, they need to ensure that patients are given choice and know that they can ask questions and even say no. It is often the RN who actually explains to the patient what is being done and why; they are therefore obligated to ensure the patient is making a truly informed decision and that the patient's values and desires are being respected.

During this remarkable webcast, Dr. Ronald Hirsch will explain the process of shared-decision making. He will illustrate his presentation with actual case studies and he'll augment his presentation with tools you'll need to ensure compliance with the regulations and, moreover, be prepared for more widespread adoption of this patient-centered concept.

Why This is Relevant:

There's a movement taking place to ensure that medical care must be medically necessary for the patient, but also that the patient wants it performed. This is known as shared decision-making. For years the practice was that a patient was seen, a doctor ordered a test or recommended a procedure and the patient had it done. But as our treatments have become more complex, most costly, and potentially not as effective as advertised, patients and payers have insisted that the process become one that is more interactive and honors the patient's goals of their care. The decision to do something or not should not be that of the physician alone, it should be shared between the physician and the patient, hence shared decision-making.

Learning Objectives:

From this exclusive RACmonitor webcast you will…

  • Learn the definition of shared decision-making
  • Benefit from learning about case studies
  • Learn the CMS regulations on the use of shared decision-making
  • Receive shared decision-making resources.

Who Should Attend:

RAC coordinators, compliance professionals, case managers, UR staff, physicians, chief medical officers, social workers, and patient advocates.