CHESTCHEST NewsImproving access to tobacco cessation services

Improving access to tobacco cessation services

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.

From the proposed plan:

  • 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.

  • 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.

  • 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.