Administrative Memos

200317

FROM: Theodore O. Will, Chief Executive Officer
DATE: Jul 14, 2003
SUBJECT: Smoking Cessation
IPRO CONTACTS:

Charles Stimler, M.D., M.P.H., Medical Director, extension 634
Marguerite Shaffer, R.N., C.P.H.Q., Senior Director, extension 634

The Centers for Medicare & Medicaid Services (CMS) has placed special emphasis on the importance of smoking cessation for the Medicare population. Tobacco use is the leading avoidable cause of illness and death in the U.S., and is responsible for over 430,000 deaths nationally each year. The direct cost of smoking to our society exceeds 50 billion dollars, and indirect costs due to lost productivity exceed 47 billion dollars.

CMS strongly supports providing advice and counseling regarding smoking cessation for Medicare smokers during their hospital stay. To promote this activity, CMS has defined quality indicators for most of the inpatient topic areas that measure the proportion of patients who smoke that received advice or counseling about quitting smoking prior to hospital discharge. A quality indicator for this topic has been part of the Acute Myocardial Infarction (AMI) topic area since the sixth Scope of Work (SOW), and has now been added as a new indicator for Congestive Heart Failure (CHF) and Community Acquired Pneumonia (CAP) topic areas for the 7th SOW.

Remarkably, studies have shown that smoking cessation advice is frequently not provided to smokers. A recent Journal of the American Medical Association (JAMA) publication ¹ demonstrated that the median quality indicator rate for the interval 2000 - 2001 for inpatient smoking cessation advice across all states was 43%. New York State's rate of 36% was even lower than this national median. New York's rate represented a sharp drop from a baseline rate of 49% for the interval 1998 - 1999. Therefore there is a clear need for changing the direction of this indicator.

To assist hospitals in providing timely smoking cessation advice to patients during their hospital stay, IPRO is planning a major statewide initiative. This may include the development of a toolkit containing educational and intervention materials, the creation of a partnership across professional statewide organizations that share the same vision, and the development of a clinical study group to help organize and design an effective algorithm for initiating smoking cessation treatment prior to hospital discharge. Crucial to the success of this initiative will be the active participation of the hospitals that want to improve their process of care.

If your hospital is interested in collaborating in IPRO's smoking cessation effort, we ask that you fill out the attached activity worksheet and fax to 516-326-0434 attention Marguerite Shaffer.

Should you have any questions regarding this memorandum please contact Marguerite Shaffer at 516-326-7767, extension 410.

¹Jencks SF, Huff ED, Cuerdan T. Change in the Quality of Care Delivered to Medicare Beneficiaries, 1998-1999 to 2000-2001 JAMA January 15, 2003; 289: 305-312