Closing the Quality Gap: Tobacco Use – Screening and Cessation Intervention

Tobacco Cessation

Smoking remains one of the leading causes of preventable death in the United States, contributing to a range of serious health conditions such as cancer, heart disease, and respiratory illness. Smoking-related illnesses cost the nation more than $300 billion every year. As trusted healthcare professionals, doctors play a critical role in tobacco cessation.

Tobacco Cessation

Tobacco use cessation is one of the most important action patients can take to improve their health. Quitting tobacco improves health status, enhances quality of life, reduces the risk of premature death, lowers the risk for many adverse health effects, and reduces the financial burden that tobacco places on people who use it.

Tobacco dependence is a chronic disease that often requires repeat interventions. Tobacco users often cite a doctor’s advice to quit as an important motivator for attempting to stop smoking. Healthcare professionals can help patients quit by:

  • Advising them to quit tobacco use and discussing how that action helps improve overall health
  • Offering tobacco cessation counseling
  • Prescribing tobacco cessation medications
  • Connecting them to additional resources (Quitlines, community programs, online resources)
  • Continuing support after quitting tobacco to help prevent relapse
  • Continuing routine tobacco use screening even after cessation — consider it another vital sign

The U.S. Public Health Services (USPHS) published a Clinical Practice Guideline recommending that physicians implement a series of steps, known as the “5 A’s,” to treat tobacco use and dependence.

Ask About Tobacco UseIdentify and document tobacco use status of every patient at every visit.
Advise to QuitIn a clear, strong, and personalized manner, urge every tobacco user to quit.
Assess– For current tobacco user, is the tobacco user willing to currently make a quit attempt?
– For the former tobacco user, how recent did you quit and are there any challenges for remaining abstinent?
Assist– For the patient willing to make a tobacco quit attempt, offer medication and provide/refer for counseling or additional behavioral treatment to help the patient quit.
– For patients unwilling to quit tobacco at this time, provide provide motivational interventions designed to increase further quit attempts.
– For those who recently quit tobacco, and those with remaining challenges, provide relapse prevention.
ArrangeAll those receiving the previous A’s should receive follow-up.

Preventive Care and Screening: Tobacco Use – Screening and Cessation Intervention

The USPSTF recommends all clinicians ask adults about tobacco use, advise them to stop using tobacco, and provide tobacco cessation interventions to patients. The USPSTF recommendation references the U.S. Food and Drug Administration’s definition of tobacco which includes “any product made or derived from tobacco intended for human consumption, including, but not limited to, cigarettes, cigars, dissolvables, hookah tobacco, nicotine gels, pipe tobacco, roll-your own tobacco, smokeless tobacco products (including dip, snuff, snus, and chewing tobacco), vapes, electronic cigarettes, hookah pens, and other electronic nicotine delivery systems.”

The Centers for Medicare and Medicaid Services (CMS) determined the evidence is adequate to conclude that smoking and tobacco use cessation counseling is reasonable and necessary for patients. As such, CMS included Preventive Care and Screening: Tobacco Use – Screening and Cessation Intervention as a quality measure in Medicare Shared Savings Program (MSSP) and traditional Medicare programs.

Preventive Care and Screening: Tobacco Use – Screening and Cessation Intervention included in the CMS MSSP quality reporting program is defined as: Percentage of patients aged 12 years and older who were screened for tobacco use one or more times within the measurement period AND who received tobacco cessation intervention during the measurement period or in the six months prior to the measurement period if identified as a tobacco user.

This process-based measure contains three performance rates to help evaluate where certain gaps in care exist:

  1. Patients who were screened for tobacco use.
  2. Patients who were identified as tobacco users AND who received tobacco cessation intervention* (used for CMS MSSP reporting).
  3. Patients who were screened for tobacco use AND patients who received tobacco cessation intervention*.

* An intervention includes brief counseling (3 minutes or less) and/or pharmacotherapy.

Quality Measure Reporting Best Practices & Tips

  • Tobacco use screening must occur during the measurement period.
  • Screening can be completed during a telehealth encounter.
  • Use the most recent tobacco use screening for quality reporting purposes.
  • Tobacco screening and cessation intervention do not have to occur on the same encounter.
  • Tobacco cessation intervention can be preformed by another healthcare provider.
  • Document patient declination when cessation intervention is offered but deferred.
  • If the tobacco use status of a patient is unknown, the patient does not meet the required screening component.

Quitting tobacco is a challenging but achievable goal with the right support and resources. By integrating tobacco use interventions into routing care, doctors can make a significant impact on the health and well-being of their patients and communities.

RESOURCES: CDC Smoking Cessation Fast Facts, CDC How To Quit, AHRQ Tobacco Guidelines, AAFP Tobacco Preventing Treating,

About the Author

Tresa Shaw, MSN, RN

Tresa Shaw, MSN, RN

Director of Quality at CHESS