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Comments
Please note, comments are no longer published through this website. All previously made comments are still archived and available for viewing through select posts.
Chris
June 17, 2011 at 5:01 pmAll well and good (and it IS important information) but if two options are the same in outcomes but one costs more AND its the one the doctor recommends, what “value” does the patient bring to the discussion; isn’t cost an important value not brought to the table (i.e. a higher cost to the patient for the equal but more costly intervention.)
And then to make it really hard, what if the outcomes are the same except for time frame such as with back surgeries (i.e. surgical patients get better faster but at two years they’re the same as the non-surgical patients). Shouldn’t the patient, who has much to gain from a quicker recovery, be expected to pay extra for that?
Terry
June 20, 2011 at 9:36 amThe Fox News story was very well done. There is one more important element in shared decision making that needs to be discussed, as well. Every procedure and even every diagnostic test has risks. The decision about the importance of the risks should always be up to the patient. Back surgery for a herniated disc has a faster recovery rate than exercise and physical therapy but more risk. For some patients, the risk is acceptable, for others it is not.
Mike Pierce
June 29, 2011 at 8:28 pmExcellent exposure for SDM. I am curious why the providers and health practioners in those higher volume areas were not approached for commentary (they might be able to express legitimate concerns or not!).
It is great that individual patient empowerment is highlighted as a means to address the situation, but that alone won’t solve/curb the systemic issues inherent in the different incentive models being used in Minnesota. And while the disparities in procedure volume are made clear, the drivers of those differences are not. SDM adoption will struggle if fee-for-service models persist in those Minnesota enclaves outside of Mayo reach. If the physicians don’t adopt SDM within their clinics – and they are likely not to if it leads to lower utilization – then patients won’t ever get access to educational videos or balanced advice from their doctors.
Mark Asplunder
July 7, 2011 at 10:28 amThe vast majority of primary care happens via solo or small group practices – who will pay for the videos and 2 hour educational sessions? In other areas of the country were aggressive case management demonstration projects were tried that included shared decision making (RWJF funded project in Whatcom County) they were able to cut hospital visits but the specialists started to lose income so when the grant ran out they opted out of the project.
Without finance reform how can you implement a more educational model?
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