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
• 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
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
Why a Change in the Standards?
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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
Measure Set for Tobacco
Cessation
• Funding from Partnership for Prevention
• Broadens the scope and replaces the
current diagnosis-based standards
• Based on scientific data
Why Choose to Implement the
Tobacco Core Measures?
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Public Health Impact of Tobacco Use
Patient Health
Meaningful Use/Electronic Health Record
Commitment to Community Wellness &
Hospital Mission
• CMS Endorsement
Implementation
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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
Leadership Commitment
• Convene staff leaders from a variety of
disciplines
– Consider dual leaders from medicine and
nursing
• Review current tobacco cessation
employee benefits
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
Build Consensus and Buy-In
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Define goals and objectives
Establish quarterly goals
Policies & Procedures
Environmental support
Systematic approach
Educate the Staff
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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
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
Monitor Performance/Evaluate
• Collect data to assess goal attainment
• Develop tracking systems/assess what
already exists
• Provide feedback to clinicians
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
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
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