Even when they provide advice to quit, physicians do not always bill for it. And in many cases, physicians may overlook treating patients with the best treatments available.
The National Health Interview Survey is the most reliable measure of physician performance. The most recent report showed Notes from the Field: Tobacco Product Use Among Adults — United States, 2017–2023 | MMWR that among smokers who tried to quit, only one out of three used medication or counseling, even though optimal treatment would be both. Data from multiple surveys Tobacco Use Assessment and Cessation Medication Orders Among Primary Care Patients by Ethnicity, Sex, and Acculturation Indicators | Journal of General Internal Medicine and Smoking Cessation Medication Prescribing for Smokers With and Without Mental Illness | Psychiatric Services show that the medication prescribed most often is nicotine patch or gum.
It is well recognized that varenicline is the most effective product, with an effectiveness that is 50% greater than the other medications. It was specifically identified as superior by most professional societies and the Surgeon Generals Report of 2020. For fifteen years, Chantix, the brand name for Pfizer’s varenicline, was the leading product. It was removed from the market in 2019 and the generic version although available at one tenth the cost, has never taken off.
Providing feedback to your doctors on their choice of medications can significantly improve their performance and your overall outcomes. The codes to perform this analysis yourselves are here Measurement of Tobacco Treatment — Edward Anselm, MD.
We want to highlight your success stories. Please send your comments, questions or suggestions to Dr. Anselm @ eanselm@msn.com / info@healthix.org.
Although New York has performed better than most other states in reducing the prevalence of cigarette smoking to 12% of adults, smoking in New York remains a major public health problem. Each year 28,200 adults die from tobacco related disease. Smoking kills more people than alcohol, AIDS, car crashes, illegal drugs, murders, and suicides combined. And there is an economic cost as well: the annual health care costs in New York directly caused by smoking are $12.07 billion and smoking-caused productivity losses in New York are estimated at $18.2 billion. Treatment of tobacco is the most direct way to continue progress in improving outcomes and controlling costs.
Unfortunately, national data shows that physicians are not providing effective treatment regularly. The National Commission for Quality Assurance (NCQA) will soon release a new HEDIS measure that will measure performance in screening and treating tobacco use. This new measure to be implemented in 2026 will allow insurers, health systems and practicing physicians to align incentives and improve overall performance.
“We have an extra-ordinary opportunity to help shape a win/win scenarios for participants in the Healthix collaborative and their patients,” says Dr. Edward Anselm, a retired health plan medical director now focused on systems change in tobacco treatment.
Healthix data can easily be organized into practice management and quality improvement tools to provide insights at the level of individual provider, clinic, and facility in a health system that can be benchmarked against other systems in the region.
Treatment of tobacco is the one of many types of quality improvement measures and public health indicators that can be shared collaboratively.
Dr. Anselm obtained his medical degree from the University of Health Sciences–The Chicago Medical School and completed an Internal Medicine Residency at Montefiore Medical Center. He has served in a variety of clinical and occupational settings including roles as Medical Director, Mount Sinai Health System, Center for Corporate Health; Corporate Medical Director/Vice President, Executive Health Group, National Health Services; Chief Medical Officer, HIP Health Plan of New York, and Chief Medical Officer FidelisCare New York. He retired from a position as Medical Director at Aetna in Florida.
Dr. Anselm continues to teach at the Mount Sinai School of Medicine where he holds the rank of Clinical Assistant Professor of Medicine. His areas of special interest are smoking cessation and tobacco control. Most recently, he has focused on reimbursement for tobacco cessation and has developed approaches to support medical practices in maximizing both outcomes and economic returns.
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