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HRMR Annual 2016-17

commitment from senior leadership. Policies and procedures must �������������� ������ ���������������� �������� ���������������������� ���� �� �������� �������������������������� ������ �������������� patients in shared decision-making and to respect patient choices once they have been made. Training in communication may assist providers in becoming more adept at facilitating these sensitive conversations. The following are tips to facilitate communication around shared decision-making: • Inform patients about their medical condition in a manner that matches their level of understanding. The use of interactive technology such as videos has been shown to enhance this process. • �������������������������������������������������������������������������������������������������������������������������������������� that patients make regarding their healthcare. Recognize that �������������������������������������������������������������������������������������������������������������������������������������� choices that are not issues the provider may deem important. (One of the most important aspects of shared decision-making is training the provider to appreciate the importance of respecting patient’s values, preferences, and expressed needs.) �������������� ���������������� ������������������������ ���������������������� �������������������������������� �������� ���������������� �������������������� ������ �������������������� ������������������ �������������������� �������������������� �������������� or concerns of family members or loved ones, and fear of the ���������������������������������������������������������������������������������������������������� • Recognize that too much information may be overwhelming. The key is to tailor what is provided to the patient and to make ������������������������������������������������������������ ���������������������������������������������������������������������� her to make. AN OPPORTUNITY TO ENHANCE REIMBURSEMENT It is rare that hospitals and providers can earn additional revenue at a time when so many attempts are being made to decrease reimbursement or limit care. As of January 2016 shared decision-making or advanced care planning not only provides the opportunity to improve patient satisfaction and but also allows a provider to bill for those discussions. SUMMARY The concept of shared decision-making or advanced care planning has been discussed for many years, and although many recognized its ������������������������������������������������������������������������������������������������������������������������������������������������������������ reimbursement in place to recognize the value of these discussions and �������������������������������������������������������������������������������������������������������������������������������������������������� time to educate providers on how to implement shared decision-making into their discussions with patients. It is also the time for organizations to recognize that changes in policies and practices will be necessary to assure that these discussions, once they do occur, are available to all providers so that patients’ wishes can be honored. �� Barbara Youngberg is a consultant for Beecher Carlson. Annual 2016 | HEALTHCARE RISK MANAGEMENT REVIEW | 11 “Shared decisionmaking or advanced care planning recognizes the many variables in a person’s life that may infl uence the type of care he or she ultimately wishes to receive.” it. It does not replace procedural informed consent, although some of the treatments that may be discussed as part of the informed consent process may also be part of shared decision-making or advanced care planning discussions. Finally, as previously stated, it is not limited to end of life discussions but rather seeks to provide guidance to the healthcare team and ������������������������������������������������������������������������������������������������������������������������������������������������ ������������������������������������������������������������������������������������������������������������������ CHANGING THE LEVEL OF COMMUNICATION BETWEEN THE PATIENT AND PROVIDER A cultural change in the manner in which healthcare is delivered may be necessary to maximize the value of shared decision-making or advanced care planning. Providers are accustomed to being regarded as experts and may be uncomfortable in a role where they are asked to consider factors other than those traditionally discussed when obtaining an informed consent. In addition, many physicians are unaware of the types of questions to ask to elicit responses that may help guide them to present appropriate options to patients. Providers may not wish to go along with what they feel is a poor choice made by the patient, and providers must realize that there may be instances when what the patient is asking from them may not be appropriate or at times even legal. Patients may not want to be involved in the decision-making process or may not see the connection between personal values and healthcare choices. INITIATING THE PROCESS OF SHARED DECISION-MAKING As with any other process change undertaken in a healthcare organization, instituting shared decision-making initially requires


HRMR Annual 2016-17
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