Improving access to tobacco cessation services
September 9, 2022
Follow-up treatment to aid in cessation efforts occurs in less than
half of primary care visits because of inadequate reimbursement for and
availability of services. In a letter to Center for Medicare and
Medicaid Innovation (CMMI)—an entity within Centers for Medicare and
Medicaid Services—the American College of Chest Physicians (CHEST) and
the Association for the Treatment of Tobacco Use and Dependence (ATTUD)
call for an improved payment model and expanded access to
evidence-based clinical tobacco cessation services for Medicare and
dually-eligible beneficiaries (those covered by both Medicare and
Medicaid).
In a proposed plan, CHEST, ATTUD and other signing health care
organizations propose that CMMI test an episode-based payment that
recognizes tobacco use as a chronic condition.
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The episode-based payment model would deliver to eligible
Medicare tobacco users a combination of medication therapy
and intensive behavioral intervention services from a
tobacco treatment service (TTS) over a 6-month episode, and
providers would be reimbursed under a bundled payment—one
rate for standard risk patients and a separate, higher rate
for those who are at elevated risk.
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Integrated health systems and other providers and their
employed or contracted TTS practitioners would be eligible
to participate in the model and could earn
performance-based payments based on rates of tobacco
cessation achieved and performance on specified quality
metrics.
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A recent analysis completed by the Actuarial Research
Corporation of the cost savings associated with an
episode-based model indicates that Medicare could save
between $1,021 to $3,101 per individual treated over 5
years and between $4,498 to $13,663 per quitter over 5
years.
In addition, CHEST encourages taking innovative approaches that can
be applied to a variety of settings, assuring necessary follow-up
(including post-discharge) and integrating teams of health care
providers in the delivery of tobacco cessation services to those
served by the Medicare program.
Read the full letter to CMMI below.
August 24, 2022
Dr. Elizabeth Fowler, PhD, JD
Deputy Administrator and Director
Center for Medicare and Medicaid Innovation
Centers for Medicare and Medicaid Services200 Independence Avenue, SW
Washington, DC 20201
Re: Supporting a Medicare Alternative Payment Model for Clinical Tobacco
Cessation Services
Dear Dr. Fowler:
We, the undersigned, national health organization write to urge the Center
for Medicare and Medicaid Innovation (CMMI) to undertake an episode of care
bundled payment pilot program to assess an alternative approach to the
provision and payment of clinical tobacco cessation services to Medicare
beneficiaries. Alternative, innovative approaches must be taken to help
facilitate the delivery of tobacco cessation services to those served by
the Medicare program.
As you know, tobacco use remains the
leading preventable cause of disease, disability, and death
in the United States. Of particular concern is that tobacco use persists
across the lifespan,
with the Centers for Disease Control and Prevention reporting that nine
percent of people aged 65 and older report use of tobacco
. Moreover, individuals of color are more likely to report tobacco use than
their white counterparts; as such, efforts to advance health equity and
address health disparities must include a focus on tobacco cessation across
the lifespan for populations disproportionately affected by tobacco use and
associated disease.
In addition to the adverse health effects of tobacco use, it is also one of
the largest contributors to health care costs, accounting for 11.7% of
annual health care spending in the United States. Of the estimated $
225 billion spent annually on tobacco-related care
, approximately $45 billion is spent by the Medicare program.
Numerous government and non-governmental entities recommend that
individuals be provided a combination of counseling and pharmacologic
support in their efforts to cease the use of tobacco. Unfortunately, too
many people in need of clinical tobacco cessation services do not receive
them, including individuals in the Medicare program. In addition, the
manner in which Medicare currently pays for tobacco cessation services is
limited and does not facilitate access to the comprehensive clinical
tobacco cessation services that are proven effective in helping individuals
to cease their use of tobacco.
We support the CMMI’s new focus on “achieving equitable outcomes through
high-quality, affordable, person-centered care” and urge the agency to
advance a model that will help ensure more Medicare beneficiaries –
particularly those of color or with concomitant mental health issues – can
access the comprehensive clinical tobacco cessation services they need and
deserve.
Thank you for consideration of this request.