{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,14]],"date-time":"2026-02-14T05:48:56Z","timestamp":1771048136051,"version":"3.50.1"},"reference-count":5,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2024,8,9]],"date-time":"2024-08-09T00:00:00Z","timestamp":1723161600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000133","name":"Agency for Healthcare Research and Quality","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000133","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cardiovasc electrophysiol"],"published-print":{"date-parts":[[2024,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>The Centers for Medicare &amp; Medicaid Services (CMS) required a shared decision\u2010making (SDM) interaction, with an \u201cindependent\u201d physician, before left atrial appendage closure (LAAC). The purpose of this study is to better understand how this requirement is implemented in clinical practice.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We surveyed LAAC\u2010performing centers. The characteristics of respondent and nonrespondent hospitals were compared using the CMS Provider of Services File for 2017.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We received 86 responses out of 269 surveys mailed (32%). Respondent and nonrespondent hospital affiliations were similar: mean hospital size 525 beds, 15% for\u2010profit, and 34% teaching hospitals. Thirty\u2010four respondents (39.5%) stated that the implanting physician conducts some or all of the SDM interactions. The percentage of patients who decide not to undergo LAAC after the SDM interaction was estimated at 8.1%. Out of 72 responses to an open\u2010ended question about the benefit of the SDM interaction, 44 (61%) described the requirement in negative terms, of which most felt the requirement was burdensome for patients and providers. Only 28 respondents (39%) described the requirement in positive or mixed terms.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>In violation of the letter of the CMS policy for LAAC, implanting physicians perform the SDM interaction at nearly 40% of responding hospitals. Most respondents felt the SDM requirement was burdensome for patients. More detailed guidance from CMS on how to comply with the policy may result in better alignment between the intent of the policy and how it is implemented.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jce.16395","type":"journal-article","created":{"date-parts":[[2024,8,9]],"date-time":"2024-08-09T20:24:48Z","timestamp":1723235088000},"page":"2058-2061","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Medicare\u2010mandated shared decision making for left atrial appendage closure in clinical practice"],"prefix":"10.1111","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4465-0414","authenticated-orcid":false,"given":"David H.","family":"Howard","sequence":"first","affiliation":[{"name":"Department of Health Policy and Management Emory University Atlanta Georgia USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Neal W.","family":"Dickert","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Cardiology Emory University School of Medicine Atlanta Georgia USA"},{"name":"Department of Epidemiology Emory University School of Medicine Atlanta Georgia USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Faisal M.","family":"Merchant","sequence":"additional","affiliation":[{"name":"Department of Medicine, Section of Cardiac Electrophysiology Emory University School of Medicine Atlanta Georgia USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2024,8,9]]},"reference":[{"key":"e_1_2_4_2_1","unstructured":"JensenTSCJ AshbyL LongK SchaferJ HakimJ.Decision Memo for Percutaneous Left Atrial Appendage (LAA) Closure Therapy (CAG\u201000445N). Accessed: February 8 2016.https:\/\/www.cms.gov\/medicare-coverage-database\/view\/ncacal-decision-memo.aspx?proposed=N%26NCAId=281"},{"key":"e_1_2_4_3_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2018.6617"},{"key":"e_1_2_4_4_1","unstructured":"Boston Scientific.WATCHMAN Medical Centers. Accessed: November 10 2019.https:\/\/wwwwatchmancom\/en-us\/find-a-centerhtml"},{"key":"e_1_2_4_5_1","unstructured":"AS CMS Provider of Services Hospital Data 1993\u20102017.2017.https:\/\/githubcom\/asacarny\/provider-of-services\/blob\/master\/READMEmd"},{"key":"e_1_2_4_6_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCOUTCOMES.119.004899"}],"container-title":["Journal of Cardiovascular Electrophysiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jce.16395","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,10,10]],"date-time":"2024-10-10T14:30:44Z","timestamp":1728570644000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/jce.16395"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,8,9]]},"references-count":5,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2024,10]]}},"alternative-id":["10.1111\/jce.16395"],"URL":"https:\/\/doi.org\/10.1111\/jce.16395","archive":["Portico"],"relation":{},"ISSN":["1045-3873","1540-8167"],"issn-type":[{"value":"1045-3873","type":"print"},{"value":"1540-8167","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,8,9]]},"assertion":[{"value":"2024-04-10","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-07-25","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-08-09","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}