Bronx BREATHES: Resources
and Technical Assistance for
Improved Tobacco Treatment
Barbara Hart, MPA
David Lounsbury, PhD
Claudia Lechuga, MS
Hal Strelnick, MD
Bronx 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(Fiore et al., 2008)
• However, providers face considerable
pressure to address multiple patient care
concerns during increasingly brief clinical
visits (Davis et al. 1995; Cabana et al., 1999)
• Facilities with tobacco screening systems are
associated with a 66% rate of clinician
intervention(Fiore et al., 2008)
• Bronx BREATHES is available to help
providers address these challenges
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
Strong dose response between counseling intensity (time)
and cessation success (Cromwell et al., 1997; Fiore et al., 2008)
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 $12.94
use cessation
counseling visit;
intermediate, greater
than 3 minutes up to 10
minutes
$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 Payment
99406
Smoking and tobacco Office: $10
use cessation
counseling visit;
APG Statewide average:
intermediate, greater
$20
than 3 minutes up to 10
minutes
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 Manager
Bronx BREATHES
Albert Einstein College of Medicine
1300 Morris Park Avenue
Mazer Building, Suite 100
Bronx, New York 10461
[email protected] e-mail
718.430.2601 phone
718.430.8816 fax
http://www.bronxbreathes.org web
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Medicare Medicaid Tobacco Cessation Coverage