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Shared decision-making part of ACA but has a long way to go

January 03, 2013

Quick quiz – do you know what ACA Section 3506 is? No worries, most people don’t. It is this beautifully eloquent and quiet requirement of the ACA that calls for shared decision-making. Those of us familiar with common mental health practice in public settings know that the care clients receive does not always align with what they want. A study just published in the New England Journal of Medicine looked at more than 1000 office visits in which more than 3500 medical decisions were made, less than 10% of decisions met the minimum standards for informed decision making. Now, they were not looking at mental health care for youth and their families but one can infer a correlation. How high a correlation? What a great research project for the research oriented Network faithful among us!

Bottom line is this. The Affordable Care act calls for shared decision-making in Section 3506. Here is the language:

  • Sec. 3506 – Program to Facilitate Shared Decision Making
    Under Sec. 3506, the Secretary of the Department of Health and Human Services (HHS) is required to establish a program that develops, tests and disseminates certificated patient decision aids. These educational tools help patients and caregivers better understand and communicate their preferences about reasonable treatment options.
  • The Facts
    • This provision calls for the HHS to contract with an entity to develop independent standards for educational tools known as “patient decision aids” for preference-sensitive care.
    • This provision requires the Secretary of the HHS, the CDC, the NIH and other agencies to establish a program to award grants or contracts to develop, update and produce patient decision aids for preference-sensitive conditions to assist in educating patients and others about the relative safety, effectiveness and cost of treatment. The program would be required to test materials to ensure they are balanced and evidence-based.
    • The legislation includes a definition of patient decision aids and preference-sensitive care.
    • This provision outlines general design requirements for patient decision aids, including that they:
      • Be designed to engage patients, caregivers and authorized representatives in informed decision making with health care providers;
      • Present up-to-date clinical evidence about the risks and benefits of treatment options in a form and manner that is age-appropriate and can be adapted for patients, caregivers and authorized representatives from a variety of cultural and educational backgrounds, thereby reflecting the varying needs of consumers and diverse levels of health literacy;
      • Where appropriate, explain why there is a lack of evidence to support one treatment option over another; and,
      • Address health care decisions across the age span, including those affecting vulnerable populations.

      Unfortunately, Sec. 3506 is one of many provisions of the ACA that were authorized, but not funded. Given the federal fiscal crisis, unfunded provisions are unlikely to be implemented at this time.

Okay Network faithful, especially the family advocates among us, use this information to your advantage and get busy. Don’t let the “authorized, but not funded” part deter you and start rattling some cages. Extrapolate the findings from the NEJM article to the work you do with youth and families. There is opportunity to make positive change here.

  • Read the New England Journal of Medicine article here.
  • Learn more about Shared Decision Making policy here.
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