Rocky Mountain Tobacco Treatment Specialist Certification RMTTSC Program
Rocky Mountain Tobacco Treatment Specialist Certification (RMTTS-C) Program
Module 9: Documentation, Evaluation & Professional Resources
Module 9: Documentation, Evaluation & Professional Resources Objectives Maintaining accurate records Implementing a protocol to track follow-up Standardized methods for measuring outcomes Accepted coding practices and reimbursement for treatments § Identify community resources for referral § Provide resources for individuals § Professional resources § § © 2016 BHWP
Maintaining Accurate Records
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) © 2016 BHWP
Documentation © 2016 BHWP
Integration into Standard Practice § Assess tobacco as part of normal assessment and screening § Add tobacco cessation to treatment plan © 2016 BHWP
Electronic Health Records Save time, space and money Identify high-risk individuals Improve the quality of care Strengthen the continuum of care Communicate information more efficiently § Reduce medical errors § Improve legal and regulatory compliance § § § © 2016 BHWP
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 © 2016 BHWP
Tobacco Use Screening: ID smoking status Treatment: Offer counseling Treatment: Offer medications © 2016 BHWP
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) § § © 2016 BHWP
Utilizing Standardized Outcome Measures
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? © 2016 BHWP
Common Measures: Long-Term Outcomes § Abstinence at 6 or 12 months after quit date § 7 - or 30 -day point prevalence abstinence § Continuous abstinence © 2016 BHWP
The Fagerström Test for Nicotine Dependence 1. How soon after you wake up do you smoke 4. How many cigarettes do you smoke each your first cigarette? day? Within 5 minutes (3 points) 10 or fewer (0 points) 11 to 20 (1 point) 5 to 30 minutes (2 points) 21 to 30 (2 points) 31 to 60 minutes (1 point) 31 or more (3 points) After 60 minutes (0 points) 5. Do you smoke more during the first few 2. Do you find it difficult not to smoke in hours after waking up than during the rest places where you shouldn't, such as in of the day? church or school, in a movie, at the library, Yes (1 point) / No (0 points) on a bus, in court or in a hospital? 6. Do you still smoke if you are so sick that Yes (1 point) / No (0 points) you are in bed most of the day, or if you 3. Which cigarette would you most hate to have a cold or the flu and have trouble give up; which cigarette do you treasure breathing? the most? Yes (1 point) / No (0 points) The first one in the morning (1 point) Any other one (0 points) © 2016 BHWP
Biologic Outcomes: Spirometry § Measures lung function ‒ Amount (volume) and/or speed (flow) of air that can be inhaled and exhaled § Assessing conditions such as asthma, pulmonary fibrosis, cystic fibrosis and COPD © 2016 BHWP
Biologic Outcomes: Carbon Monoxide Monitor § § § Non-invasive Visual motivational tool Reality check Severity of dependence Likelihood of cravings © 2016 BHWP
Biologic Outcomes: Cotinine § Primary metabolite of nicotine § Sample collected by blood, urine, saliva or hair § Longer half life than nicotine § NRT users will test positive © 2016 BHWP
Biologic Outcomes: Anabasine § An alkaloid found in tobacco plants that is similar in structure to nicotine § Not found in NRT medications § Positive tests = using tobacco products © 2016 BHWP
The Joint Commission § Optional indicator § Apply to all patients 18 years or older § Treatment defined as counseling and medication © 2016 BHWP
HITECH Act and Meaningful Use § Incentives for hospitals and providers to adopt certified EHR systems § Includes clinical quality measures that must be reported § Tobacco is one of 64 Core Quality Measures that can be reported on © 2016 BHWP
© 2016 BHWP
Healthcare Reform, Coding Services & Reimbursement
Individual Coverage Status Coverage Third Party Yes Insured Military Medicaid Medicare No Self-Paid © 2016 BHWP
What Do We Know About Coverage? Coverage of evidence-based treatment leads to: § Increases in quit attempts § Use of cessation treatments § Successful smoking cessation Coverage provisions that pose barriers: § Copayments § Prior authorization § Limitations on number/duration of treatments § Requiring counseling to obtain medications § Stepped or “fail-first” care © 2016 BHWP
Healthcare Reform: Some Basics (Affordable Care Act) § § Traditional Medicaid: Up to 100% FPL Medicaid Expansion: Up to 138% FPL Healthcare Exchange: 139%-400% FPL Key Questions: ‒ Is traditional Medicaid being rolled into expansion? ‒ Is tobacco use considered a substance abuse disorder? © 2016 BHWP
Essential Health Benefit Under the healthcare exchange, the Essential Benefit must include: § MH/SA treatment (including meds) § Preventive and wellness services for tobacco ‒ ‒ ‒ At least 2 attempts per year 4 counseling sessions (individual, group, or telephonic) 90 days of FDA medication No cost sharing This also applies to No prior authorization Medicaid expansion and third-party insurance © 2016 BHWP
Prior Authorization Form © 2016 BHWP
Medicare Providers § Medicare Part B covers tobacco use treatment multiple times each year ‒ 8 visits per year (4 sessions per attempt) ‒ At intermediate (3 to 10 min) or intensive (>10 min) levels § Medicare Part D covers cessation medications © 2016 BHWP
Billing Treatment Codes Disorders DSM-5 ICD-10 Tobacco Use Disorder Mild Moderate/Severe 305. 1 Tobacco Withdrawal 292. 0 F 17. 203 Unspecified Tobacco-Related Disorder 292. 2 F 17. 209 Other Tobacco-Induced Disorders No code Treatment Z 72. 0 F 17. 200 Duration CPT Code Symptomatic Tobacco Use Counseling 3 -10 min 99406 Symptomatic Tobacco Use Counseling >10 min 99407 Asymptomatic Tobacco Use Counseling 3 -10 min G 0436 Asymptomatic Tobacco Use Counseling >10 min G 0437 © 2016 BHWP
Military and Veterans § TRICARE benefit for military personnel, families and retirees ‒ No-cost cessation medications ‒ Counseling ‒ Access to a toll-free quitline that is available 24 hours a day, 7 days a week ‒ Access to print and web-based tobacco cessation materials § The Department of Veterans Affairs also offers cessation services © 2016 BHWP
Referrals & Resources
State and County Healthcare State tobacco programs County services State Medicaid office State and local behavioral health agencies § School-based programs § § © 2016 BHWP
State Quitlines © 2016 BHWP
Fax-to-Quit Referral Process © 2016 BHWP
The Health Consequences of Smoking: 50 Years of Progress A Report of the Surgeon General 1964 2014 © 2016 BHWP
Examples of resources available at the CDC website § Tips From Former Smokers Campaign § Best Practices for Comprehensive Tobacco Control Programs— 2014 § 2014 Surgeon General's Report § 2012 Tobacco Control State Highlights http: //www. cdc. gov/tobacco/index. htm © 2016 BHWP
Evidence-Based Tobacco Cessation Clinical Practice Guideline Guide to Community Preventive Services Contains 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. http: //www. ahrq. gov/path/tobacco. htm http: //www. thecommunityguide. org/to bacco/cessation/index. html © 2016 BHWP
§ Archived resources § Opportunities for continuing education § Large network of national partners http: //smokingcessationleadership. ucsf. edu/ © 2016 BHWP
§ 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 information http: //www. attud. org © 2016 BHWP
Promotes evidence-based approaches and best practices to prevent tobacco use and cancer among behavioral health populations http: //www. thenationalcouncil. org/consulting-bestpractices/national-behavioral-health-networktobacco-cancer-control/ © 2016 BHWP
Documentation, Evaluation and Resources Discussion
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