a powerful evidence base that is moving the private sector to support this. Part of the progress we see in this area rests purely on economic grounds,” he said.

Cummings added, “It is cheaper to treat smoking than to provide $10,000 a month on chemotherapy. It makes you wonder why we are pinching pennies to find treatments for smoking cessation in cancer patients.” This is especially true in light of the estimate by Warner that smoking causes as much as 10 percent of all health care costs in the United States (Warner et al., 1999). Warren noted that his institution, Roswell Park, built a new tobacco cessation program that provides treatment for about 2,000 people a year at a cost of $240,000 per year. “I need to save 80 ICU days in 2,000 smokers per year to break even. I feel comfortable that I am going to reduce those hospitalizations due to fewer wound infections, pulmonary complications, and other complications of treatment,” he said. Cummings pointed out that once treatment programs are established, they can seek insurance reimbursement for their services. Cummings also stressed that until cessation therapy becomes the standard of care for all patients who smoke, insurance reimbursement will not be guaranteed.

There was some discussion on the coding of tobacco cessation therapy for the purposes of billing and reimbursement. According to Cummings, many clinicians do not document the diagnosis of a tobacco use disorder via the International Classification of Diseases, Ninth Edition (ICD-9) code, 301.5. Toll noted that the Yale Cancer Center provides psychotherapy or psychiatric codes for tobacco cessation therapy, and is reimbursed accordingly. But this requires having psychologists, psychiatrists, or other personnel who can be reimbursed for such coded treatment. The 2008 clinical practice guideline provides examples of codes used for the diagnosis and billing of tobacco dependence treatment, and the guideline recognizes that “it is difficult to accurately document and obtain reimbursement for this treatment” (Fiore et al., 2008).

Legal Challenges

A great deal of discussion focused on the legal challenges tobacco companies pose whenever state or local governments try to enact tobacco control laws. “You have to expect legal challenges and have a good defense for those tobacco control laws that you pass and be prepared for litigation, both psychologically and financially,” McGoldrick advised. He noted that



The National Academies | 500 Fifth St. N.W. | Washington, D.C. 20001
Copyright © National Academy of Sciences. All rights reserved.
Terms of Use and Privacy Statement