Medicare coverage aims to snuff out smoking

The medical community applauds the move as a boon in the battle against tobacco-related illnesses.

By David Glendinning — Posted Jan. 17, 2005

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Washington -- Medicare soon will begin chipping in for counseling aimed at fighting some of the leading causes of seniors' premature deaths.

In what the Centers for Medicare & Medicaid Services is billing as a major program expansion, the agency is proposing that the government cover smoking cessation services for eligible beneficiaries. The coverage, which could start as soon as March, would be available to roughly 4 million seniors who have certain tobacco-related illnesses or who take medicines that could be compromised by smoking.

CMS' move comes after the Partnership for Prevention, a coalition that includes groups such as the American Medical Association and the American Cancer Society, lodged a formal request with the agency. Decisions on whether to pay for smoking cessation previously had been up to individual local Medicare carriers.

The organizations pushing for the expansion said physicians had found tangible benefits from counseling, even for seniors who have been using tobacco for much of their lives.

"It is never too late to quit smoking," said AMA Trustee Ronald M. Davis, MD. "Studies have shown that seniors who try to quit smoking are 50% more likely to succeed than all other age groups, and seniors who quit can reduce their risk of death from heart disease to that of nonsmokers within two to three years after quitting."

Cessation counseling not only combats tobacco-related illnesses such as heart disease, lung cancer and stroke but also helps prevent aging problems tied to smoking such as hip fractures, cataracts and wrinkles, he noted.

Although CMS made its decision based on medical evidence and not cost-effectiveness reports, backers of the new coverage predicted that the initiative eventually would more than pay for itself. "By covering counseling to help smokers quit, Medicare will save money within nine years of beginning coverage," said John M. Clymer, president of the Partnership for Prevention. Smoking cost Medicare more than $14 billion in 1993 -- about 10% of the program's entire budget.

Physicians who treat elderly smokers already should be familiar with the existing limited coverage. Medicare pays for minimal counseling as part of standard evaluation and management visits. But the new coverage goes beyond the two or three minutes incorporated into the E&M. For patients who meet eligibility requirements, Medicare will pay for up to two rounds of four cessation meetings with a professional per year.

CMS estimated that more than 400,000 of the 4 million eligible beneficiaries will take advantage of the offering in 2005. The counseling sessions are relatively inexpensive in terms of Medicare benefits and are expected to cost the federal government just over $10 million this year.

Myriad programs exist, and the government has not established a preferred treatment. Medicare also does not differentiate between the types of medical professionals who run the programs, but a CMS memo notes that physicians have proven more successful at getting patients to quit than nurses or other counselors.

CMS hopes the new effort will dovetail with the 2006 launch of the Medicare drug benefit, which for the first time will cover nicotine replacement prescriptions.

The agency has a 30-day comment period on the proposal, after which officials will draft a final decision.

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Kicking the habit

Medicare soon will cover cessation counseling for millions of seniors whose smoking habit is threatening their lives. The sessions will be available to beneficiaries who have certain tobacco-related diseases or are taking certain medicines.

Eligible conditions: Heart disease, stroke, cancer, respiratory disease, gastrointestinal disease, cataracts and osteoporosis.

Eligible drugs: Any regimen whose metabolism or dosing is affected by tobacco use under Food and Drug Administration guidelines. Includes certain insulins and treatments for hypertension, seizure, blood clots and depression.

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External links

Centers for Medicare & Medicaid Services' draft decision memo on smoking and tobacco use cessation counseling (link)

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