Most public health advocates agree on the importance of helping people quit smoking, the leading preventable cause of death in the U.S. Upcoming changes to Medicare’s physician fee schedules could soon provide doctors with more motivation to assist in this effort.
Under the proposed changes detailed in a 1,592-page document released this week, doctors offering counseling to help patients quit smoking or using tobacco products would see a 19% increase in reimbursement. This increase would also extend to assessments and interventions for alcohol and substance misuse during medical visits.
The Centers for Medicare and Medicaid Services explain in their proposal that these services play a crucial role in preventing and managing chronic disease, and the valuation should more accurately reflect the clinical effort and time involved. Feedback on the proposal is welcome until Sept. 14.
Anne DiGiulio, senior director of nationwide tobacco cessation and health policy at the American Lung Association, expressed enthusiasm: “The prioritization of cessation as a service is long overdue, and we’re very excited about it.”
Ned Sharpless, a professor at the University of North Carolina School of Medicine, noted that the change could have significant implications not only for Medicare and Medicaid recipients but also for those with private insurance, as private insurers often follow Medicare and Medicaid’s lead. These programs cover about 2 in 5 Americans.
Sharpless, who has long advocated for this policy change, remarked, “We have something to offer these patients, and we need to incentivize doctors to do this.”
Previously, doctors earned roughly $10 for tobacco cessation counseling, according to Sharpless. With competing demands on primary care and internal medicine doctors, in-depth discussions about quitting smoking often take a back seat. The nearly 20% increase in reimbursement may not make anyone wealthy, Sharpless noted, but it aligns these services with other medical activities.
Most individuals attempting to quit smoking on their own tend to relapse, with success rates below 10%. However, success rates significantly improve when individuals receive a combination of behavioral support and treatments like varenicline, nicotine patches, or bupropion. Yet, only 5% of people who recently tried to quit received both counseling and medication, according to 2022 CDC data.
Research also indicates that even brief advice during a doctor’s visit can enhance quitting rates. A survey of Medicaid claims in 20 states found that 2.7% of people who smoked and had recently tried to quit received cessation counseling.
Alcohol screening and counseling in medical offices are also crucial but underutilized. A study showed that while 70% of people with alcohol use disorder were asked about their drinking, only 12% received brief interventions, and merely 5% were referred or informed about treatment options.
Adam Goldstein, a professor and director of tobacco intervention programs at UNC School of Medicine, pointed out that while many clinicians recognize the health risks of tobacco use, patients often receive only minimal advice like “You should quit” instead of comprehensive treatment plans.
Goldstein emphasized the need for structured discussions covering motivations, triggers, and medications to ease cravings and withdrawal. Regular follow-up support is vital, but frequent check-ins are impractical for doctors. Sharpless and Goldstein advocate for the involvement of tobacco treatment specialists, akin to diabetes educators, who could support patients and be reimbursed by Medicare.
Goldstein believes the reimbursement increase is significant, though the per-visit increase might not be enough to prompt most practices to offer comprehensive quitting services.
Goldstein suggested that the most significant impact would come from combining the payment change with effective tobacco-use screening, electronic-health-record prompts, medication protocols, trained staff, quitline referral systems, and follow-up.
The potential impact on alcohol screenings, interventions, and referrals remains uncertain, according to Tim Clement, vice president of federal government affairs at Mental Health America. While low reimbursement is a factor, other issues may also contribute.
Sharpless maintains that the change is a positive step forward.
“Every once in a while,” he concluded, “it’s good to have a good story.”
Isabella Cueto contributed reporting.
STAT’s coverage of chronic health issues is supported by a grant from Bloomberg Philanthropies. Our financial supporters are not involved in any decisions about our journalism.
