Medicare requires a consultation with a non-implantation doctor prior to beneficiaries receiving the Watchman.
Medicare beneficiaries who have atrial fibrillation are not required to see an additional physician before receiving a specific treatment to make sure the decision is the best for them.
The Watchman treats patients with atrial fibrillation, and is implanted in the heart to prevent blood clots. The standard treatment involves blood thinners that come with side effects, such as bruising and excessive bleeding.
This process is intended to make sure patient needs are being heard, according to The Wall Street Journal. An opinion from a second physician may not be accurate since it would not be from a physician who implants the device, according to some physicians interviewed by the Journal.
A shared-decision making approach could likely lead to patients receiving the device only if necessary. This also prevents physicians from performing unnecessary surgeries to receive Medicare reimbursement.
Shared-decision making also increases a patient’s role in their own treatment. Without the involvement of the second physician, Medicare will not reimburse the provider for the surgery.
Currently, Medicare has only tied shared-decision making and reimbursement for 1 other treatment, but new technologies may be considered, according to the Journal.
However, some physicians may be hesitant to take this approach outside of the requirements, because they did not receive training on how to do so, or the patients have limited knowledge about alternative treatment options.
While Medicare believes that shared-decision making could prevent unnecessary surgeries and costs, the American College of Cardiology is concerned that requiring consultations with a physician who does not implant the device could prevent patients from receiving accurate information, the Journal reported.
Shared decision-making has the potential to improve patient outcomes, since it includes expert opinions and aligns them with professional medical opinions. However, in some cases, it could result in patients not receiving the treatment because of the second opinion.