Integrating Tobacco Use Treatment Into Practice

Abstract

Balancing population-based efforts to modify the social and environmental factors that promote tobacco dependence with efforts to improve the delivery of case-based treatments is necessary for realizing maximum reductions in the cost and consequences of the disease. Public health antismoking campaigns following the 1964 Surgeon General's report on the health risks of smoking have changed social norms, prevented initiation among youth, and promoted abstinence among the addicted. However, the rate of progress enjoyed to date is unlikely to continue into the coming decades, given that current annual unassisted cessation rates among prevalent smokers remains fairly low. With more than 1 billion patient interactions annually, there is an enormous unrealized capacity for health-care systems to have an effect on this problem. Clinicians report a perceived lack of reimbursement as a significant barrier to full integration of tobacco dependence into health care. A more complete understanding of the coding and documentation requirements for successful practice in this critically important area is a prerequisite to increasing engagement. This paper presents several case-based scenarios illustrating important practice management issues related to the treatment of tobacco dependence in health care.CHEST 2016; 149(2):568-575KEY WORDS: addiction; reimbursement; smoking; tobacco Given that tobacco smoking remains responsible for a major portion of preventable death and disability, who, if not health-care providers, should be responsible for preventing that portion of preventable death and disability?Tobacco control is clearly one of the greatest public health achievements of the 20th century, preventing millions of smokingrelated deaths. 1,2 Consequently, the current "end-game" strategy relies heavily on extending gains made by policy initiatives and environmental modifications. [3][4][5][6] Relative to the emphasis placed on population-based controls, efforts to increase the ability of health-care systems to provide effective case ABBREVIATIONS: CPT = current procedural terminology; E/M = evaluation and management; ICD-9-CM = International Classification of Diseases, Clinical Modification 9

Building Systems to Address Tobacco Use in Oncology: Early Benefits and Opportunities From the Cancer Center Cessation Initiative

“…The program follows the requirements and definitions that govern reimbursement, using billing providers (eg, physicians) to perform face-to-face evaluation and management visits, assessment, and referral services, and certified tobacco treatment specialists to provide the intervention. 9 Additionally, we used the Consolidated Framework for Implementation Research (CFIR), 10 a leading implementation science framework, as a guide for building and implementing the program (Table 1). First, we ensured institutional commitment to the service, engaging with the cancer center director and senior leadership to keep them informed, integrate their feedback, and leverage their influence.…”

“…Ongoing work involves conducting key informant interviews with oncologists to help develop effective approaches to address clinician concerns, similar to our successful efforts to improve tobacco use treatment in primary care. 9 Furthermore, our reassessment period of 12 months is likely too short an evaluation period to be representative of potential impact. Long-term efforts will assess both oncologist engagement with the CDS tool across multiple patient encounters and smoking cessation rates among the patients in the TUTS program.…”

Billing Practices Among US Tobacco Use Treatment Providers

“…Participants were asked to specify their demographics, details of their educational and professional background, their work setting(s), years of experience providing TUT, typical hours and number of TUT patients per week, TUT treatment types (eg, counseling formats and styles), whether and which insurances they and/or their organization accepted, whether and how patients were billed and how much patients paid for TUT, whether and which billing codes (ie, Current Procedural Terminology [CPT] codes) were used for TUT, and whether their organization had a billing manager or team and if so their perception of the billing manager/team's level of knowledge and experience regarding billing and coding for TUT (rated on et al, 2016;Nolan and Warner, 2017). Indeed, the ACA does not specify TUT coding requirements and there are numerous ways in which TUT may be coded and documented, which may be contributing to confusion and lack of action (Leone et al, 2016). Leone et al (2016) have developed a useful TUT billing resource for physicians.…”

“…Indeed, the ACA does not specify TUT coding requirements and there are numerous ways in which TUT may be coded and documented, which may be contributing to confusion and lack of action (Leone et al, 2016). Leone et al (2016) have developed a useful TUT billing resource for physicians. Leone et al also provide a brief description of ''incident to'' billing in which a nonphysician provider bills under the supervising physician's name.…”

Strategic use of tobacco treatment specialists as an innovation for tobacco cessation health systems change within health care organizations

“…One way to address the lack of access to tobacco screening is to train members of the clinical team as tobacco treatment specialists (TTSs), or individuals specifically trained to provide services to help people stop using tobacco (Darville et al, 2018;Hughes, 2007;Leone et al, 2016;Sheffer et al, 2016Sheffer et al, , 2021. The integration and use of tobacco cessation health systems change, in particular the use of TTSs in the health care system setting, is a novel approach to tobacco treatment (Sheffer et al, 2021;Whittet et al, 2019).…”