I 
111TH CONGRESS 
1ST SESSION H. R. 2580 
To amend title XVIII of the Social Security Act to provide for the establish-
ment of shared decision making standards and requirements and to 
establish a pilot program for the implementation of shared decision 
making under the Medicare Program. 
IN THE HOUSE OF REPRESENTATIVES 
MAY 21, 2009 
Mr. BLUMENAUER introduced the following bill; which was referred to the 
Committee on Ways and Means, and in addition to the Committee on En-
ergy and Commerce, for a period to be subsequently determined by the 
Speaker, in each case for consideration of such provisions as fall within 
the jurisdiction of the committee concerned 
A BILL 
To amend title XVIII of the Social Security Act to provide 
for the establishment of shared decision making stand-
ards and requirements and to establish a pilot program 
for the implementation of shared decision making under 
the Medicare Program. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Empowering Medicare 
Patient Choices Act’’. 
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SEC. 2. FINDINGS. 
Congress makes the following findings: 
(1) The Dartmouth Atlas Project’s work docu-
menting regional variations in medical care has 
found both underuse, or the failure to deliver needed 
evidence-based care, and overuse, or the delivery of 
unnecessary supply-sensitive care. 
(2) The Dartmouth Atlas Project has also 
found that many clinical decisions physicians make 
for elective medical treatments are driven by local 
medical opinion, rather than sound science or the 
preferences of well-informed patients. For example, 
the Dartmouth Atlas Project found that, among the 
306 Hospital Referral Regions in the United States 
during the period of 2002 through 2003, the inci-
dence of surgery for back pain-related conditions 
and joint replacement for chronic arthritis of the hip 
and knee varied 5.9-, 5.6-, and 4.8-fold, respectively, 
from the lowest to the highest region. 
(3) Discretionary surgery for the following com-
mon conditions accounts for 40 percent of Medicare 
spending for inpatient surgery: early stage cancer of 
the prostate; early stage cancer of the breast; osteo-
arthritis of the knee; osteoarthritis of the hip; osteo-
arthritis of the spine; chest pain due to coronary ar-
tery disease; stroke threat from carotid artery dis-
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ease, ischemia due to peripheral artery disease; gall 
stones; and enlarged prostate. 
(4) Decisions that involve values trade-offs be-
tween the benefits and harms of 2 or more clinically 
appropriate alternatives should depend on the indi-
vidual patient’s informed choice. In everyday prac-
tice, however, patients typically delegate decision 
making to their physicians who may not have good 
information on the patient’s true preferences. 
(5) The current standard of medical care in the 
United States fails to adequately ensure that pa-
tients are informed about their treatment options 
and the risks and benefits of those options. This 
leads to patients getting medical treatments they 
may not have wanted had they been fully informed 
of their treatment options and integrated into the 
decision making process. 
(6) Patient decision aids are tools designed to 
help people participate in decision making about 
health care options. Patient decision aids provide in-
formation on treatment options and help patients 
clarify and communicate the personal value they as-
sociate with different features of treatment options. 
Patient decision aids do not advise people to choose 
one treatment option over another, nor are they 
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meant to replace practitioner consultation. Instead, 
they prepare patients to make informed, value-based 
decisions with their physician. 
(7) The Lewin Group estimated that the change 
in spending resulting from the use of patient deci-
sion aids for each of 11 conditions using per-proce-
dure costs estimated for the Medicare population 
studied, assuming full implementation of such pa-
tient decision aids in 2010, would save as much as 
$4,000,000,000. 
SEC. 3. DEFINITIONS. 
In this Act: 
(1) ELIGIBLE PROVIDER.— 
(A) IN GENERAL.—The term ‘‘eligible pro-
vider’’ means the following: 
(i) A primary care practice. 
(ii) A specialty practice. 
(iii) A multispecialty group practice. 
(iv) A hospital. 
(v) A rural health clinic. 
(vi) A Federally qualified health cen-
ter (as defined in section 1861(aa)(4) of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
1395x(aa)(4)). 
(vii) An integrated delivery system. 
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(viii) A State cooperative. 
(B) INCLUSION OF MEDICARE ADVANTAGE 
PLANS.—Such term includes a Medicare Advan-
tage plan offered by a Medicare Advantage or-
ganization under part C of title XVIII of the 
Social Security Act (42 U.S.C. 1395w–21 et 
seq.). 
(2) PATIENT
DECISION
AID.—The term ‘‘pa-
tient decision aid’’ means an educational tool (such 
as the Internet, a video, or a pamphlet) that helps 
patients (or, if appropriate, the family caregiver of 
the patient) understand and communicate their be-
liefs and preferences related to their treatment op-
tions, and to decide with their health care provider 
what treatments are best for them based on their 
treatment options, scientific evidence, circumstances, 
beliefs, and preferences. 
(3) PREFERENCE SENSITIVE CARE.—The term 
‘‘preference sensitive care’’ means medical care for 
which the clinical evidence does not clearly support 
one treatment option such that the appropriate 
course of treatment depends on the values of the pa-
tient or the preferences of the patient regarding the 
benefits, harms, and scientific evidence for each 
treatment option. The use of such care should de-
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pend on informed patient choice among clinically ap-
propriate treatment options. Such term includes 
medical care for the conditions identified in section 
5(g). 
(4) SECRETARY.—The term ‘‘Secretary’’ means 
the Secretary of Health and Human Services. 
(5) SHARED
DECISION
MAKING.—The term 
‘‘shared decision making’’ means a collaborative 
process between patient and clinician that engages 
the patient in decision making, provides patients 
with information about trade-offs among treatment 
options, and facilitates the incorporation of patient 
preferences and values into the medical plan. 
(6) STATE COOPERATIVE.—The term ‘‘State co-
operative’’ means an entity that includes the State 
government and at least one other health care pro-
vider which is set up for the purpose of testing 
shared decision making and patient decision aids. 
SEC. 4. ESTABLISHMENT OF INDEPENDENT STANDARDS 
FOR PATIENT DECISION AIDS. 
(a) CONTRACT WITH ENTITY TO ESTABLISH STAND-
ARDS AND CERTIFY PATIENT DECISION AIDS.— 
(1) CONTRACT.— 
(A) IN GENERAL.—For purposes of sup-
porting consensus-based standards for patient 
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decision aids and a certification process for pa-
tient decision aids for use in the Medicare pro-
gram and by other interested parties, the Sec-
retary shall identify and have in effect a con-
tract with an entity that meets the require-
ments described in paragraph (4). Such con-
tract shall provide that the entity perform the 
duties described in paragraph (2). 
(B) TIMING
FOR
FIRST
CONTRACT.—As 
soon as practicable after the date of the enact-
ment of this Act, the Secretary shall enter into 
the first contract under subparagraph (A). 
(C) PERIOD
OF
CONTRACT.—A contract 
under subparagraph (A) shall be for a period of 
18 months (except such contract may be re-
newed after a subsequent bidding process). 
(D) COMPETITIVE
PROCEDURES.—Com-
petitive procedures (as defined in section 4(5) 
of the Office of Federal Procurement Policy Act 
(41 U.S.C. 403(5))) shall be used to enter into 
a contract under subparagraph (A). 
(2) DUTIES.—The following duties are de-
scribed in this paragraph: 
(A) OPERATE AN OPEN AND TRANSPARENT 
PROCESS.—The entity shall conduct its business 
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