Bronx BREATHES: Resources and Technical Assistance for Improved Tobacco Treatment

Barbara Hart, MPA

David Lounsbury, PhD

Claudia Lechuga, MS

Hal Strelnick, MDBronx Einstein Alliance for Tobacco-free Health

MMG QA Council Meeting 5.21.09

Declining Rates of Smoking in NYC

The Role of Primary Care Providers in Tobacco Treatment

• Brief counseling intervention by health care providers has been shown to effectively promote smoking cessation

• However, providers face considerable pressure to address multiple patient care concerns during increasingly brief clinical visits

• Facilities with tobacco screening systems are associated with a 66% rate of clinician intervention

• Bronx BREATHES is available to help providers address these challenges

(Fiore et al., 2008)

(Davis et al. 1995; Cabana et al., 1999)

(Fiore et al., 2008)

Efficacy of Tobacco Counseling Interventions

Brief counseling• 3-10 minutes

• Targets smokers who are willing (5 As), unwilling (5 Rs), and those who recently quit (relapse prevention)

Intensive counseling• Total clinician-client time > 30 minutes with at least 4 sessions

• Tend to be coordinated by tobacco dependence specialists

• Multiple clinician types

(Cromwell et al., 1997; Fiore et al., 2008)Strong dose response between counseling intensity (time) and cessation success

Brief Counseling Intervention: The 5As

(Fiore et al., 2008)

Motivational Intervention for Patients Not Ready to Quit: The 5Rs

(Fiore et al., 2008)

The Utility of Performance Monitoring and Feedback

Academic Detailing (educational office visits) are a promising way to change provider behaviors

Combined strategies, namely individual instruction with peer review & feedback about performance, were among the most effective interventions for medical professionals:– Typically target drug prescribing behaviors

– No clear association between number of visits and impact on practice change

(O’Brien et al, 2006 – Cochrane Review)

Medicare Codes and Reimbursement

Code Description Medicare Payment Facility Non-Facility

99406. Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes

$12.94 $13.93

99407. Smoking and tobacco use cessation counseling visit; intensive, greater than 10 minutes

$25.73 $27.21

94240/50 Billing for expired CO measure

N/A $48.77$33.69

Medicaid Codes and Reimbursement

CPT Code Description Medicaid Payment99406 Smoking and tobacco

use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes

Office: $10

APG Statewide average: $20

99407 Smoking and tobacco use cessation counseling visit; intensive, greater than 10 minutes

Office: $19

APG Statewide average: $20

To be used with one of these ICD-9 Codes:630-677, V22, V23, V2

Bronx BREATHES:Support Services for Clinicians

• Training and follow-up for providers

• Design and implement systems to identify and monitor tobacco users at each patient visit

• Foster patient referral to intensive smoking cessation services in the Bronx

Bronx BREATHES:Additional Resources

NYS Quitline: 866-NYQUITS

•Free telephone counseling in English, Spanish, and several other languages

•Free NRT

•Referrals to local counseling programs

•Free educational materials

Fax-To-Quit

•Patients that providers refer are contacted by Quitline specialists and offered same services as above

•Progress report sent back to you

Thank you!Barbara Hart, MPA, Project ManagerBronx BREATHESAlbert Einstein College of Medicine

1300 Morris Park AvenueMazer Building, Suite 100Bronx, New York 10461

bhart@aecom.yu.edu e-mail

718.430.2601 phone

718.430.8816 fax

http://www.bronxbreathes.org web