Medicare Pays to Treat Heart Patients Who Smoke, but Doesn’t Help Them Quit
Cardiac patients who continue to smoke face a risk of death that is up to five times as high as those who quit, according to The American Journal of Cardiology. The longer a cardiac patient abstains from smoking, the better their odds of survival. But most don’t quit for long. Nearly two-thirds (63%) of cardiac patients who quit start again. More than half start smoking within three weeks of leaving the hospital.
Experts quoted by Reuters explain that comprehensive smoking cessation programs for heart attack patients could save thousands of lives annually at a low cost. Indeed, quitting smoking has a similar lifesaving effect as taking medications such as those used to lower cholesterol and blood pressure.
Yet, Medicare pays a lot for drugs, but little for counseling. According to the Happy Hospitalist Blog:
You know how much Medicare pays for a ten minute consultation to help cardiac patients quit smoking right now? About $20. You know how much they pay for Plavix + Lipitor? Over $3,000 a year.
And what about the cost of those who don’t quit?
And I’m sure these folks all landed themselves back into the hospitals for a very expensive dying process.
Typical absence of any cost-benefit thinking in a bureaucratic program.
Medicare pays $20 for a 10-minute smoking cessation consultation with heart patients? I doubt if 10 minutes is actually of any benefit. Plus, $20 isn’t enough to warrant any effort on the part of the physician. There are other activities that pay better so expect doctors to engage in those rather than advice on smoking.
The spin here is making me dizzy.
Medicare already pays for both brief and intensive counseling for 2 smoking quit tries a year up to 8 sessions in 12 months. It also pays for prescription drugs to support quitting. The problem, of course, is that counseling for quitting has a dismal success rate.
NICE evidence-based guidence for people with cardiovascular disease who smoke says that patients should be offered along with “prescriptions of NRT, varenicline or bupropion, according to clinical judgement” and behavioral support.
According to the article abstract, this study did not study evidence-based treatment. It simply says “All patients received a brief in-hospital smoking cessation intervention consisting of repeated counseling sessions.”
With repeated counseling, the relapse rate was 62.8 percent. But we know that pharmacological support is recommended and paid for by Medicare. Why wasn’t this done?
The probability of death for these patients was 0.075 after a year. The abstract doesn’t say how much resuming smoking increased that probability. It just gives a hazard ratio.
Based on this we are supposed to say Medicare doesn’t do enough and lavish even more money on counseling of dubious worth?
I have a radical idea: Stop paying for preventable disease. Government cannot force people to diet, exercise, quit smoking, etc. Encourage it, maybe, but (tens?) of millions will ignore even the best campaign. So we need a stick. Stop paying for these preventable conditions. Or at least drastically increase the co-payment. Americans need to take some personal responsibility for their (in)actions
@JJ—It has been fairly well established that smokers have shorter lifespans. This means that they draw fewer Social Security benefits and are far less likely to need expensive long-term care than nonsmokers. Over their lifetime they may end up costing less than people who do not smoke when the additional taxes they pay are included.
In general, do you really want government to monitor behavior in order to decide who gets health care? The saying about the cure being worse than the disease comes to mind here.
They may very well cost less, especially if they use hospice care, die suddenly, etc. But the point is that we need incentives to encourage better behavior at the individual level.
The government is already making huge decisions about who gets health care and what level of coverage. That will only grow per the ACA: what preventive services are “free,” what services are covered on the three levels of benefits in our exchanges, etc.
If one wants better incentives one would repeal ObamaCare and deregulate the U.S. health care system. Arguing for more intervention just because the government is already intervening is not particularly convincing.
As the experience with consumer directed health care has shown, maximizing cash for care promotes all kinds of good behavior.
Allowing insurers and employee health plans to charge actuarial fair rates to smokers and enrollees who pursue unhealthy lifestyles would be a good start. At least those causing the problem would pay their own way. ObamaCare allows employers to differential premiums for participation in wellness plans. But it does not allow employers to differential premiums based on outcomes – only participation.
I’m constantly amazed by bureacracies who just put bandaids on problems and never address the systemic issues. Has no one learned yet?