forward after securing leadership’s
support, ideally people with an
understanding of organizational
change and enough influence and
administrative support to make
those changes happen.
Several suggestions for how
leadership can strategically support
a comprehensive cessation program included: personally sending
emails to the “right people” to get
a program going, then passing
off day-to-day responsibilities to
an internal champion; including
tobacco cessation as a quality
measure and/or specific goal for
the organization; and encouraging
physicians to refer to the services.
Another prevalent theme focused
on funding models for smoking
cessation programs and the
challenges presented by a lack of
funding. Participants described the
importance of making the business
case for investing in comprehensive smoking cessation programs
using language that hospital
Some participants suggested
changing the conversation from
dollars saved to potential revenue
earned because appropriate
surgeries—both elective (e.g. orthopedic, plastic) and life-saving (e.g.
transplants)—can be done with
few complications and improved
outcomes when smokers quit. They
noted that the role of smoking in
total cost of care can be a compelling talking point for hospital
administrators, especially as the
movement toward accountable care
organizations (ACOs) evolves.
While many health systems referenced a general perception that
smoking cessation programs are
“money losers,” multiple participants described their development
of financially sustainable models.
Funding sources for tobacco
treatment programs in each of
the health systems studied varied
widely, including: internal sources
(such as revenue from billing
for necessary medical services
population health management
programs, or the cancer center);
the state Tobacco Trust; a local
philanthropic organization; and
the Centers for Disease Control and Prevention. Important
strategies that health system
participants used for financial
F Implementing billing systems
that use templated documentation tools within the EHR, link to
specific billing codes, and provide
guidance on documentation
requirements for reimbursement
(e.g. using “smart phrases” within
the Epic EHR).
F Identifying and ordering medically appropriate billable
procedures (e.g. CO testing, spirometry testing, and pulmonary
screening for all smokers). One
health system noted that screening all smokers for pulmonary
diseases generated medically
appropriate revenue, identified
new cases of COPD, and had
biochemically confirmed quit
rates of over 50% at 12-month
F Instituting “bundled care” or
F Identifying potential savings by
lowering readmissions exacerbated by smoking (e.g. asthma,
COPD), particularly related to
Centers for Medicare & Medicaid Services (CMS) readmission
F Recognizing Certified Tobacco
Treatment Specialists (CTTSs)
and pharmacists as providers so
they can bill for their time. One
health system successfully negotiated with its local payer to allow
billing for CTTSs.
2009. As part of Meaningful Use (MU) regulation, the Centers for Medicare & Medicaid
Services incentivizes routine measurement of
patient smoking status as structured data in
EHRs, thereby greatly improving the potential
for targeting tobacco cessation interventions
to patients. 1-4
2012. The Joint Commission adds a “Tobacco
Use Performance Measure Set” to measure the
integration of evidence-based clinical tobacco
cessation interventions. 5 However, healthcare
systems are free to substitute one of 13 other
measure sets in lieu of the tobacco measure set.
2015. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) includes tobacco
use screening and cessation intervention in
the quality payment program. 6
1. R.G. Boyle, L.I. Solberg, and M.C. Fiore. 2010.
Electronic Medical Records to Increase the
Clinical Treatment of Tobacco Dependence:
A Systematic Review. American Journal of
Preventive Medicine, 39( 6), Suppl. 1: S77–S82
2. D.A. Greenwood, C.A. Parise, T.A. MacAller, et
al. 2012. Utilizing Clinical Support Staff and
Electronic Health Records to Increase Tobacco Use
Documentation and Referrals to a State Quitline.
Journal of Vascular Nursing, 30( 4): 107–111.
3. M. Blumenthal, D. Tavenner. 2010. The
“Meaningful Use” Regulation for Electronic
Health Records. New England Journal of
Medicine, 363: 501–504.
4. J.M. Schindler-Ruwisch, L.C. Abroms, S.L.
Bernstein, and C.L. Heminger. 2017. A Content
Analysis of Electronic Health Record (EHR)
Functionality to Support Tobacco Treatment.
Translational Behavioral Medicine, 7( 2): 148–156.
6. The Joint Commission. 2016. Joint
Commission Measures Effective
January 1, 2017. Accessed
February 6, 2019 at