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The Joint Commission Core Measure of Tobacco Cessation Standards

The Joint Commission Core Measure of Tobacco Cessation Standards. Who is The Joint Commission?. Accredits 18,000 hospitals Voluntary accreditation Recognized nationally as a standard for excellence Recently tied accreditation to becoming tobacco free. Standards History.

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The Joint Commission Core Measure of Tobacco Cessation Standards

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  1. The Joint Commission Core Measure of Tobacco Cessation Standards

  2. Who is The Joint Commission? • Accredits 18,000 hospitals • Voluntary accreditation • Recognized nationally as a standard for excellence • Recently tied accreditation to becoming tobacco free

  3. Standards History • 1992 – First set of incentives for hospitals to address tobacco use in patients • 2004 – Implemented performance measures for tobacco cessation as it relates to: • Acute myocardial infarction • Congestive heart failure • Community acquired pneumonia • 2011 – New set of performance measures to address tobacco cessation for ALL hospitalized patients

  4. Standards Change • New standards, effective January 2012, based on 2008 Clinical Practice Guideline • Requires acute care hospitals to: • Screen, offer counseling, and medications to patients aged 18 or older • Cessation treatment during hospital stay • Follow-up with inpatients 30 days post discharge

  5. Why a Change in the Standards? • Significant health threat • Inconsistent clinician intervention • Presence of effective interventions • Smokers – higher hospitalization rates • Identification of tobacco users is not a priority for hospitals • Hospitalization is a captive moment for change – tobacco free hospitals • Affordable Care Act – higher priority on tobacco cessation • Incentives from Medicare and Medicaid

  6. Measure Set for Tobacco Cessation • Funding from Partnership for Prevention • Broadens the scope and replaces the current diagnosis-based standards • Based on scientific data

  7. Why Choose to Implement the Tobacco Core Measures? • Public Health Impact of Tobacco Use • Patient Health • Meaningful Use/Electronic Health Record • Commitment to Community Wellness & Hospital Mission • CMS Endorsement

  8. Implementation • Leadership Commitment • Assess Current Tobacco Treatment Services • Build Consensus and Buy-In • Educate the Staff • Provide the Screening, Treatment & Follow-Up • Monitor Performance/Evaluate • Reimbursement

  9. Leadership Commitment • Convene staff leaders from a variety of disciplines • Consider dual leaders from medicine and nursing • Review current tobacco cessation employee benefits

  10. Assess Current Tobacco Treatment Services • Assess current services & effectiveness • Are the Joint Commission measures already being met? • Determine where the services are being provided and obstacles for other areas • Determine where success is • Health plan coverage

  11. Build Consensus and Buy-In • Define goals and objectives • Establish quarterly goals • Policies & Procedures • Environmental support • Systematic approach

  12. Educate the Staff • Team approach • Educate in a variety of means • Offer continuing education on the 5 A’s • Select mentors & role models for staff • Evaluate performance and effectiveness

  13. Provide the Screening, Treatment & Follow-Up • Use the 2008 Clinical Practice Guideline • Ask – at time of admission and every encounter thereafter • Advise – clear, personalized message, individualized • Assess – willingness to quit • Assist – pharmacotherapy • Arrange – models for follow-up • Phone, IVR, Quitline, Email/web-based

  14. Monitor Performance/Evaluate • Collect data to assess goal attainment • Develop tracking systems/assess what already exists • Provide feedback to clinicians

  15. Reimbursement • Medicare – coverage for both counseling and medications • Medicaid – some coverage for counseling and/or medications but not comprehensive • Commercial health plans vary widely • Tobacco use in the hospital setting is a secondary diagnosis – ICD-9 codes: • 305.1 tobacco use disorder or • V15.82 personal history of tobacco use

  16. Reimbursement CPT codes • Medicaid – 2010 Affordable Care Act • Comprehensive cessation for pregnant women • Removal of tobacco cessation medications from the excluded list • Commercial Health Plans • 99406 - intermediate visit 3-10 minutes • 99407 – intensive visit 3-10 minutes • Medicare • G0436 – intermediate >3 < 10 minutes • G0437 – intensive > 10 minutes

  17. References • jointcommission.org website • 2008 Clinical Practice Guideline, Treating Tobacco Use and Dependence • Partners for Prevention, Helping Patients Quit accessed through the jointcommission.org website

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