Rocky Mountain Tobacco Treatment Specialist Certification - PowerPoint Presentation

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Rocky Mountain Tobacco Treatment Specialist Certification

(RMTTS-C) Program

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Documentation, Evaluation & Professional Resources

Module 9:

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M

aintaining

accurate

records Implementing a protocol to track follow-upStandardized methods for measuring outcomesAccepted coding practices and reimbursement for treatmentsIdentify community resources for referralProvide resources for individualsProfessional resources

Module 9:

Documentation, Evaluation & Professional Resources Objectives

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Maintaining Accurate Records

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Quality of care has been defined

as:

“

doing the right thing at the right time in the right way to the right person and having the best possible results” (AHRQ, 2004)

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Documentation

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Assess tobacco as part of normal assessment

and

screening

Add tobacco cessation to treatment plan

Integration

into

Standard

Practice

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Electronic Health Records

Save

time,

space and moneyIdentify high-risk individualsImprove the quality of careStrengthen the continuum of careCommunicate information more efficiently Reduce medical errorsImprove

legal and regulatory compliance

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Record Treatment Type & Referrals

Maintain record of services provided:

A brief intervention

(3-10 minutes)

More intensive treatment

(10+ minutes)

Medication prescription or referral

Referral (electronic or fax) to the state quitline or other community resources

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Screening:

ID smoking status

Treatment:

Offer counseling

Treatment:

Offer medications

Tobacco Use Screening

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Regulatory Requirements

Joint Commission

(Hospitals)

Affordable Care Act (Insurance)Meaningful Use (Hospitals and Clinics)Health Resources and Services Administration (Community Health Clinics)National Commission for Quality Assurance (Patient-Centered Medical Home)

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Utilizing Standardized Outcome Measures

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Common Measures:

Behavioral Risk Factor Surveillance System

Fixed core questions on tobacco use:

Have you smoked at least 100 cigarettes in your entire life?Do you now smoke cigarettes every day, some days, or not at all?During the past 12 months, have you stopped smoking for one day or longer because you were trying to quit smoking?How long has it been since you last smoked a cigarette, even one or two puffs?

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Common Measures:

Long-Term Outcomes

Abstinence at 6 or 12 months after

quit date7- or 30-day point prevalence abstinenceContinuous abstinence

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The Fagerström Test for

Nicotine

Dependence

How soon after you wake up do you smoke your first cigarette?Within 5 minutes (3 points)5 to 30 minutes (2 points)31 to 60 minutes (1 point)After 60 minutes (0 points)Do you find it difficult not to smoke in places where you shouldn't, such as in church or school, in a movie, at the library, on a bus, in court or in a hospital?Yes (1

point) / No

(0 points)

Which

cigarette would you most hate to give up; which cigarette do you treasure the

most?

The

first one in the morning (1 point)

Any

other one (0 points

)

How

many cigarettes do you smoke each

day?

10

or fewer (0 points)

11

to 20 (1 point)

21

to 30 (2 points)

31

or more (3 points)Do you smoke more during the first few hours after waking up than during the rest of the day?Yes (1 point) / No (0 points)Do you still smoke if you are so sick that you are in bed most of the day, or if you have a cold or the flu and have trouble breathing?

Yes (1 point) / No (0 points)

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Biologic Outcomes: Spirometry

Measures

lung

functionAmount (volume) and/or speed (flow) of air that can be inhaled and exhaled Assessing conditions such as asthma, pulmonary fibrosis, cystic fibrosis and COPD

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Biologic Outcomes:

Carbon Monoxide Monitor

Non-invasive

Visual motivational toolReality checkSeverity of dependence Likelihood of cravings

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Biologic Outcomes: Cotinine

Primary metabolite of nicotine

Sample collected by blood, urine, saliva or hair

Longer half life than nicotineNRT users will test positive

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Biologic Outcomes: Anabasine

An alkaloid found in tobacco plants that is similar in structure to nicotine

N

ot found in NRT medicationsPositive tests = using tobacco products

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The Joint Commission

Optional indicator

Apply to all

patients 18 years or olderTreatment defined as counseling and medication

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HITECH Act and Meaningful

Use

Incentives for hospitals and providers to adopt certified EHR systems

Includes clinical quality measures that must be reportedTobacco is one of 64 Core Quality Measures that can be reported on

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Healthcare Reform, Coding Services & Reimbursement

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Individual Coverage

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What Do We Know About Coverage?

Coverage of evidence-based treatment leads to:

Increases in quit attempts

Use of cessation treatmentsSuccessful smoking cessation Coverage provisions that pose barriers:CopaymentsPrior authorizationLimitations on number/duration of treatments Requiring counseling to obtain medicationsStepped or “fail-first” care

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Healthcare Reform: Some Basics (Affordable Care Act)

Traditional Medicaid: Up to 100% FPL

Medicaid Expansion: Up

to 138% FPLHealthcare Exchange: 139%-400% FPLKey Questions:Is traditional Medicaid being rolled into expansion?Is tobacco use considered a substance abuse disorder?

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Essential Health Benefit

Under the healthcare exchange, the

E

ssential Benefit must include: MH/SA treatment (including meds)Preventive and wellness services for tobaccoAt least 2 attempts per year4 counseling sessions (individual, group, or telephonic)90 days of FDA medicationNo cost sharingNo prior authorization

This also applies to Medicaid expansion and third-party insurance

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Prior Authorization Form

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Medicare Providers

Medicare Part B covers tobacco use treatment multiple

times each

year8 visits per year (4 sessions per attempt)At intermediate (3 to 10 min) or intensive (>10 min) levels Medicare Part D covers cessation medications

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Disorders

DSM-5

ICD-10

Tobacco Use DisorderMildModerate/Severe305.1Z72.0F17.200Tobacco Withdrawal

292.0

F17.203

Unspecified Tobacco-Related Disorder

292.2

F17.209

Other Tobacco-Induced

Disorders

No

code

No code

Billing Treatment Codes

Treatment

Duration

CPT Code

Symptomatic

Tobacco Use Counseling

3-10

min

99406

Symptomatic Tobacco Use Counseling

>10 min

99407

Asymptomatic Tobacco Use Counseling3-10 minG0436Asymptomatic Tobacco Use Counseling>10 minG0437

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Military and Veterans

TRICARE benefit for military

personnel, families and

retireesNo-cost cessation medicationsCounselingAccess to a toll-free quitline that is available 24 hours a day, 7 days a weekAccess to print and web-based tobacco cessation materialsThe Department of Veterans Affairs also offers cessation services

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Referrals & Resources

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State and County Healthcare

State tobacco programs

County services

State Medicaid officeState and local behavioral health agenciesSchool-based programs

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State Quitlines

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Fax-to-Quit Referral Process

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The

Health Consequences of

Smoking:

50 Years of ProgressA Report of the Surgeon General

1964

2014

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Examples of resources available at the CDC website

Tips From Former Smokers

Campaign

Best Practices for Comprehensive Tobacco Control Programs—20142014 Surgeon General's Report2012 Tobacco Control State Highlightshttp://www.cdc.gov/tobacco/index.htm

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Evidence-Based Tobacco Cessation

C

ontains

strategies and recommendations to assist clinicians, tobacco dependence treatment specialists, healthcare administrators, insurers & purchasers in delivering and supporting effective treatments for tobacco use and dependence.Contains strategies for reducing exposure to environmental tobacco smoke, increasing tobacco cessation and reducing initiation in communities and health care systems.Clinical Practice Guideline

Guide to Community Preventive Services

http://www.thecommunityguide.org/tobacco/cessation/index.html

http://

www.ahrq.gov/path/tobacco.htm

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Archived resources

Opportunities for continuing education

Large network of national partners

http://smokingcessationleadership.ucsf.edu/

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An

organization of providers dedicated to the promotion of and increased access to evidence-based tobacco treatment for the

tobacco user

Listserv provides up-to-date discussion and expert informationhttp://www.attud.org

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http://www.thenationalcouncil.org/consulting-best-practices/national-behavioral-health-network-tobacco-cancer-control

/

Promotes

evidence-based approaches and best practices to prevent tobacco use and cancer among behavioral health populations

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Documentation, Evaluation and

Resources

Discussion