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Healthy Aging Initiative

Demonstration Projects
Medicare Stop Smoking Program

(For more information, contact Jim Coan or Jackie Harley)

Background: Smoking is the single most preventable cause of disease and death in the United States, and is a major risk factor for a number of chronic illnesses, including cardiovascular disease, chronic obstructive lung disease, hypertension, cancer, diabetic complications, and osteoporosis. There is evidence demonstrating significant benefits to smoking cessation, even after thirty or more years of regular smoking.¹ Although smokers who are 65 + years old are less likely to perceive the health consequences of smoking, they are more likely to achieve success in their cessation attempts than younger smokers.²

The Centers for Medicare & Medicaid Services (CMS) is conducting a demonstration to test smoking cessation as a Medicare benefit, based on RAND's Healthy Aging Project Evidence Report on smoking cessation and the Public Health Service clinical guideline on treating tobacco use and dependence. The demonstration will compare the impact of offering three different types of benefits for smoking cessation services on quit rates. The three benefit options are:

• Reimbursement for provider counseling only
• Reimbursement for provider counseling + FDA-approved prescription or nicotine replacement pharmacotherapy
• A telephone counseling quitline + reimbursement for nicotine replacement therapy
• Usual care (smoking cessation information)

The demonstration went live in October 2002. Over the twelve month enrollment period 7,350 Medicare beneficiaries voluntarily participated in the demonstration from seven states--Alabama, Florida, Missouri, Ohio, Oklahoma, Nebraska, and Wyoming. Although enrollment fell far below anticipated levels there should be sufficient participation to analyze the results.

Currently the demonstration is in the follow-up data collection phase. The response rate for 6-month follow-up is at 64% with many more surveys still to come. Early estimates of self-reported quit rates indicate that those assigned to the quitline intervention fared better, overall, than others with a quit rate at 32.5%. The usual care intervention (information only) has the lowest reported quit rate, so far, at 13%. Provider counseling, alone is at 19% and provider counseling, plus pharmacotherapy is being reported at 23.6%. It must be understood that these rates are only reflective of the earliest follow-up surveys and should not be used as an indicator of program success or failure. Furthermore, these estimates should not be referenced in presentation or publication unless specifically authorized. More meaningful analysis will be made when results are received from all 6-month and 12-month follow-up surveys, sometime in mid 2005.

Current Status: The Medicare Stop Smoking Program will complete the follow-up data collection phase in December 2004. Final analysis is expected around June 2005.

Morgan GD, Noll EL, OrleansCT, Rimer BK, Amfoh K, Phil M, Bonney G: reaching Midlife and Older Smokers: Tailored Interventions for Routine Medicare care. Preventive Medicine 1996; 26:346-354.

² Clark, MA, Rakowski W, Kviz FJ, Hogan JW: Age and stage of readiness for smoking cessation. Journal of Gerontology: Social Sciences 1997; 52B, No. 4, s212-s221 and Hatziandreau RJ, Pierce JP, Lefkopoulou M, et al. Quitting smoking in the U.S. in 1986. J Natl Cancer Inst 1990; 82:1402-6.