Helping seniors quit smoking: Medicare's wise policy decision

Medicare's intent to cover this intervention is applauded by medical groups and public health advocates.

Posted Jan. 31, 2005.

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Sometimes people dismiss as unlikely the possibility that a lifelong smoker could want to quit. After all, someone's been at it for 40 or 50 years. Maybe that individual is simply too old to take such a step. And, even if it's possible, hasn't the damage already been done?

Absolutely not.

Both science and statistics show these lines of thinking to be wrong.

The Centers for Disease Control and Prevention estimated in 2002 that 57% of smokers age 65 and older reported a desire to quit. Currently, about 10% of them stop smoking each year. And the relapse rate among this population is only 1%.

And although many might think those older than 65 who kick the habit fail to reap health benefits, the U.S. surgeon general reported that even these quitters experience lower blood pressure, improved lung function and lowered risks for heart attack.

That's why a recent Medicare decision to provide coverage of tobacco cessation counseling to certain Medicare beneficiaries is especially meaningful. The American Medical Association was part of a coalition that supported the request for this expansion. Now the AMA, which has long-standing policy to advance anti-smoking efforts, and a multitude of other public health and medical organizations applaud the action.

The move is viewed as further evidence of Medicare's effort to become a prevention-oriented program. With this in mind, the AMA has reminded CMS that as this change brings more patients to their physicians' offices to stop smoking -- thus creating savings for the Medicare program in the long term -- the shorter-term costs of the increased utilization should not result in Medicare pay cuts.

Overall, Medicare coverage will target beneficiaries who have an illness caused or complicated by smoking, including heart disease, cerebrovascular disease, lung disease, weak bones, blood clots and cataracts. These diseases account for the bulk of Medicare spending. The decision also would apply to beneficiaries who take any of the many medications whose effectiveness is complicated by smoking.

It's an important expansion for a number of reasons.

First, it will meet a demand. Many Medicare beneficiaries want to stop smoking and improve their health and quality of life.

An estimated 9.3% of people 65 and older smoke cigarettes, according to the CMS. About 300,000 of the 440,000 people who die annually from smoking-related illness are in this age group. By aiding them in their efforts to quit, premature death could be averted. The Partnership for Prevention predicts that this new Medicare benefit could result in as many as 95,000 years of life saved over the next 10 years.

Second, tobacco cessation counseling works. Randomized controlled trials indicate that quit rates increase by 30% when this intervention is applied compared with rates involving no such assistance. More intense counseling produces even better outcomes.

But physicians need to be reminded that there is a difference between actual counseling and simply offering advice to quit. According to the partnership, physicians might sometimes miss opportunities to help smoking patients to break the grip. Medicare's decision will encourage change by offering more incentives to practices to have the necessary systems in place -- established tobacco-cessation protocols, staff expertise and referrals.

Third, it sets a powerful example. CMS has made clear its hope that this decision, which will be finalized over the next months, will complement the 2006 launch of the Medicare drug benefit, which includes physician-prescribed nicotine replacement treatments.

Such coverage, though, is not nearly as widespread as it should be. A partnership survey of employees found that only 10% of employer-sponsored health plans cover tobacco-cessation treatments combining medications with counseling. By following Medicare's lead, insurers could significantly contribute to the improved health of Americans.

For now, though, it is important for physicians to remember the critical role that they will play in helping their older patients succeed. Although Medicare has not stipulated the medical professionals who can provide tobacco cessation counseling, a CMS memo indicates that physicians have the best luck helping their patients.

Ultimately, there is so much to be gained when patients and physicians take advantage of this cessation tool. Breathing easier. Feeling better. Living longer. These are benefits to savor at any age and made more possible by Medicare's wise decision to help older smokers quit.

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External links

Details on the Medicare coverage decision from AMA communications (link)

Dept. of Health and Human Services statement on Medicare's coverage of smoking cessation counseling (link)

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