[email protected] http://www.informedmedicaldecisions.org/

About Michael J. Barry, M.D. Michael became president of the Informed Medical Decisions Foundation in 2009, but has been involved with the Foundation since its beginning and previously served as chief medical editor. He is a past president of the Society for Medical Decision Making (SMDM) and the Society of General Internal Medicine. Michael has led many prominent research studies including the Prostate PORT-II and is currently working on the CAMUS trial. His research interests have included: defining the outcomes of different strategies for the evaluation and treatment of prostate disease, decision analysis, health status measurement, clinical quality improvement and the use of decision aids to facilitate patients’ participation in decision making. Michael has published extensively in peer-review journals and other print media on topics such as prostate cancer, BPH, PSA testing and shared decision making. He has had many opportunities to present and teach on these topics and others, both nationally and internationally. Michael continues to practice primary care and serves as medical director of the John D. Stoeckle Center for Primary Care Innovation at Massachusetts General Hospital. He is also a clinical professor of medicine at Harvard Medical School and a master of the American College of Physicians. Michael holds an M.D. from the University of Connecticut Health Center, and completed his residency at Strong Memorial Hospital and his fellowship at Harvard Medical School. About the Informed Medical Decisions Foundation The Informed Medical Decisions Foundation has been working for over two decades to advance evidence-based shared decision making through research, policy, clinical models and patient decision aids. We are a Boston-based organization with a network of medical editors and clinical advisors from some of the most prestigious medical institutions in the world. On February 20, 2014, we announced our pending merger with Healthwise, the nonprofit with the world’s greatest reach in engaging patients. Healthwise brings exceptionally strong expertise in patient engagement technologies and plain language, as well as nationwide policy leadership in health information technology. By joining forces we will help ever-increasing numbers of people become meaningfully involved in their healthcare decisions. As one combined organization, we will inform patients and amplify each person’s voice to:

• Help people improve the care they provide for themselves and their families.
• Help people set and reach health behavior goals.
• Advocate for public policy that supports these goals.

Medical Travel Today (MTT): Give our readers some background on your professional experience in the industry. MB: Currently, I am president of the Informed Medical Decisions Foundation, as well as a primary care doctor by training at Massachusetts General Hospital in Boston, Massachusetts. The Informed Medical Decisions Foundation is in the process of merging with Healthwise, which will bring two nonprofit organizations together that collectively have 64 years of experience in helping people to make better health care decisions. Healthwise and the Foundation have very complementary strengths, making the merger an excellent decision. Both organizations possess a deep experience in shared decision making. Healthwise has a broad spectrum of patient education materials that are accessible to people in terms of health literacy, and we have extensive outreach and advocacy efforts to ensure that people are involved in their health decisions in ever-increasing numbers. We have a long research tradition of proving that what we do really works, and we think the pairing of the two organizations will only make us stronger. Regarding the focus of this newsletter, which is medical travel, alongside my professional experience, I would claim that there are two important steps to first remember for patients considering this option. First and foremost, it is so important that patients are absolutely positive that the care they will receive is the care that they actually need and want. After all, patient preferences and healthcare delivery do not always align. Based on geographic variation in rates of procedures, where a patient lives, as well as who the patient initially consults, may have more to do with what kind of care is received, or what kind of procedure is even offered, than that person’s clinical condition or preferences. Many patients who opt to undergo a particular treatment may not fully understand what a procedure entails. For example, an elective coronary revascularization, when done for stable angina, can help improve functional status and reduce angina, but it doesn’t prevent heart attacks or help people live longer. As a whole, our current informed consent process is broken. Both the Foundation and Healthwise have been working to ensure that people are truly informed and involved in their healthcare decisions. There is actually evidence that when patients are fully informed and educated on procedures, 20 percent fewer undergo major surgical procedures. MTT: In this informed decision making process, does the employer or the decision maker play a role? If they don’t, should they? MB: There is definitely an incentive for payers to be more active in this role. I think all parties should be involved, and in some cases, they are. Years ago, second opinion programs were very popular, and are still a great option to consider. There are accessible tools for patients now, such as decision aids, which can help to fully inform and involve patients. Currently, there are 115 randomized trials of people utilizing decision aids, proven to help patients choose appropriate options concerning procedures, such as elective surgeries. When patients are more informed, knowledge scores are better, risks are more accurately estimated, and more initiative is taken in the overall healthcare decision process. Again, I have to emphasize that before taking the step of deciding how and where a patient wants a procedure, the first basic step is to figure out whether the procedure is really necessary. For most medical problems, there is more than one reasonable treatment option. MTT: Does the informed medical decision extend to selecting the right place and the right doctors for having that procedure? MB: To date, we haven’t worked on helping people specifically choosing doctors. Primarily, we focus on informing prospective patients that the outcomes related to a certain choice are extremely important. For example, patients who have a blockage in a blood vessel to the brain may decide that a carotid endarterectomy is the right procedure to reduce the risk of stroke. Then, of course, where to receive treatment, and the stroke risk from the surgery itself, should be dominant factors in whether or not the informed patient decides to proceed with this treatment option and where. The Dartmouth Atlas of Health Care is a great source for patients to better understand that the likelihood of certain recommended procedures is going to depend upon where they live. As I said earlier, where a patient lives, and who a patient consults with, may have as much to do with a recommendation as their clinical condition and what matters to them. MTT: What is your take on domestic medical travel? Do you think it will impact better outcomes and lower costs? MB: Domestic medical travel may have an impact on better outcomes and lower costs because outcomes do vary from facility to facility, and higher volume centers often get better outcomes. So, in turn, traveling to higher volume centers might make sense. On the other hand, domestic medical travel can potentially remove the opportunity for a patient to be in a supportive environment at home while receiving treatment. Also, it may be more difficult to receive the necessary follow-up care, which is often easier to arrange closer to home. MTT: What about lower cost opportunity? MB: I think both cost and quality need to be examined. It has been documented for a long time that thekind of people who are willing and able to travel some distance for care are often in better physical shape, may have better socioeconomic status and are destined to have better outcomes than those who are treated locally. So comparisons of outcomes between medical travelers and folks who stay to be treated at home may be unfair. MTT: Do you see any hospitals in Massachusetts becoming Centers of Excellence — ones that employers nationwide would want to send their employees to access care? MB: Care in Massachusetts is relatively expensive, and I know many Massachusetts hospitals are working to become more cost-effective. On that note, facilities nationwide cannot just assume their care is excellent – it has to be proven through statistics and outcomes data. MTT: Is your model an international model? MB: Yes, we have an international model – poorly informed medical decisions know no boundaries. We are working with colleagues and partners in countries including the United Kingdom and Australia to improve medical decision-making.