Mandatory Shared Decision Making by the Centers for Medicare & Medicaid Services for Cardiovascular Procedures and Other Tests

The recently revised Medicare coverage policy for implantable cardioverter-defibrillators (ICDs) requires patients to participate in a shared decision-making interaction with their physician or a designated nonphysician practitioner before undergoing a primary prevention implantation.¹ This is the third instance in which the Centers for Medicare & Medicaid Services (CMS) has required shared decision making as a condition of coverage. CMS mandated shared decision making in 2015 for lung cancer screening with low-dose computed tomography and in 2016 for left atrial appendage closure (LAAC) for stroke prophylaxis in atrial fibrillation.² CMS seems poised to extend mandatory shared decision making to other treatments and tests.