As part of its initial efforts to save money through prevention, Medicare says it will now pay all seniors for smoking cessation services, not just those who are sick.
According to the government blog, these services should be available "from a qualified physician or other Medicare-recognized practitioner" with medication covered by the Medicare Prescription Drug Program.
It's all part of "moving the overall health care system toward a prevention-based model," according to the post.
This last has been misunderstood throughout the health care debate, so the concept bears repeating.
The old model is you pay for services, so tobacco cessation is just a cost. The new model is you try to keep everyone well, thus paying to help end smoking pays for itself.
If you're in the insurance market, the concept is called capitation. The idea is you shift risk from the carrier to the caregiver. Carriers which offer it, like Kaiser, often run their own clinics in order to maintain control of their costs.
CMS director Donald Berwick believes in capitation, and related concepts like the medical home. Everyone in Medicare and Medicaid will need prevention and wellness services, he reasons. Paying those costs reduces the need for future services and thus pays for itself. What works for Kaiser can work for Uncle Sam.
Many physicians associate capitation with not getting paid enough, so Health Plan Insider notes it is not popular outside California and a few other states. The only way it can work, Les Masterson writes:
is having health insurers, physicians, pharmacists, nurses, and myriad other healthcare professionals sharing information and working collaboratively for the patient.
This describes how Medicare will work precisely, in a world where health IT systems are ubiquitous and up-to-date.
The post on smoking cessation notes that smoking kills 443,000 people very year. Reformers call cutting that toll a win. Cynics might argue that, if those 443,000 people are seniors, that's 443,000 fewer people sponging off the government. (Fine until it's someone you love.)
The new offering also got me thinking of one of our most "popular" posts here, my August 3 piece on e-cigarettes. Supporters of the devices said they kept people from smoking. I suggested, if that's the case, regulate them and have cartridges with smaller-and-smaller measured doses of nicotine, as is the case with gum and patches.
Now that Medicare is paying, will any of the e-cigarette makers take up my challenge? Stay tuned.