1. 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

2. Declining Rates of Smoking in NYC

3. 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)

4. 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

5. Brief Counseling Intervention: The 5As (Fiore et al., 2008)

6. Motivational Intervention for Patients Not Ready to Quit: The 5Rs (Fiore et al., 2008)

7. 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)

8. Medicare Codes and Reimbursement CodeDescriptionMedicare Payment FacilityNon-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 94240/50Billing for expired CO measure N/A$48.77 $33.69

9. Medicaid Codes and Reimbursement CPT CodeDescriptionMedicaid Payment 99406Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes Office: $10 APG Statewide average: $20 99407Smoking 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

10. 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

11. 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

12. 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 bhart@aecom.yu.edubhart@aecom.yu.edu e-mail 718.430.2601 phone 718.430.8816 fax http://www.bronxbreathes.org web http://www.bronxbreathes.org