Offering tobacco cessation services

More than four decades after the first report of the Surgeon General's Advisory Committee on Smoking and Health, tobacco use continues to be the leading cause of preventable morbidity and mortality in the United States. According to 2010 figures released by the Centers for Disease Control and Prevention, some 46.6 million adults in the United States smoke, despite the fact that upward of 443,000 people die from smoking or exposure to secondhand smoke each year. Another 8.6 million have a serious tobacco-related illness.

Smoking cessation treatment and counseling, however, haven't been top concerns for many physicians because presenting problems take priority, patient behavior often relapses, and reimbursement-especially if the patient did not have a tobacco-related condition-has been paltry to nonexistent. That calculus is changing, however: Medicare recently began paying doctors for helping patients kick a nicotine habit, even if the tobacco use hasn't yet resulted in illness, and some private insurers have jumped on that bandwagon. Moreover, the Patient Protection and Affordable Care Act, passed in 2010, stipulates that all health plans must cover tobacco cessation treatment and counseling by 2014.

Here's how to set up a tobacco cessation service that benefits both your patients and your practice.

If you're going to facilitate smoking cessation, you'll be more effective if you follow a step-by-step model, says Sarah Mullins, MD, a family physician with Stoney Batter Family Medicine, a six-physician practice in Wilmington, Delaware. Mullins, a member of the American Academy of Family Physicians (AAFP) Tobacco Cessation Advisory Council, recommends the AAFP's Ask and Act program (see "Resources" for information about programs and publications mentioned in this article), which encourages physicians to identify tobacco users and then provides a variety of Web-based resources-including patient education materials, a pharmacologic product guide, and information on coding, reimbursement, and continuing medical education (CME)-to help physicians activate a tobacco cessation ancillary service.

Post signs at the front desk and posters in exam rooms signifying that you're interested in talking to patients about smoking. These nonverbal cues indicate to patients that the topic can and should be addressed. If your nurse, medical assistant, or another person in your practice shows patients to exam rooms, have him or her ask the "Do you smoke?" question, and note the answer in the record. You can start the conversation with, "I see you're a smoker. Have you ever thought about quitting?" Even if the answer is no, "raising the topic substantially improves the chances that this person will turn to you when he or she is ready to quit," Houston says.