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Smoking Cessation Counseling Improves Quality of Care and Surgical Outcomes with Financial Gain for a Vascular Practice
Danielle Moses, James H. Mehaffey, Baldwin Mary, Margaret Clarke Tracci, John A. Kern, Gilbert R. Upchurch, Jr..
University of Virginia Health System, Charlottesville, VA, USA.

OBJECTIVES:To determine the association of smoking cessation counseling (SCC) with improved quality of care, surgical outcomes, and financial revenue.
METHODS: As a quality project using retrospective data, the study received IRB exemption status. A retrospective review of prospectively maintained database from April 2014 through March 2015 of encounters in a vascular surgery clinic was performed of current smokers. Providers were encouraged to counsel smokers to quit, document the discussion, and bill specific E/M codes (99406, 99407). The number of outpatients by smoking status, documentation and billing of SCC, demographics, and monetary collections were collected. Data was compared using a correlation coefficient calculated and tested for statistical significant using two-tailed T test.
RESULTS: A sample of 1077 visits by 612 currently smoking patients accounted for 24% of all visits. The average age was 61 years and 64% were male. Comorbidites included 77% with hypertension, 32% diabetes mellitus, and 14% chronic kidney disease. Medically, 72% were on aspirin, 71% statin, 48% beta blocker. A total of 208 (34%) never underwent a vascular intervention and 183 (30%) had an intervention during the study period (44% for PAD, 10% carotid stenosis, 14% amputations, 10% AAA). Documentation improved from 65% of encounters during the first month to 89% in the peak month and 79% of total encounters. All-cause mortality rate was 2% and this cohort demonstrated 75% SCC for 28 encounters. 55 patients (9%) quit smoking for more than 30 days at the end of the study period and this cohort had 69% of their 97 encounters with documented SCC.
Increased SCC was correlated with decreased 30-day readmissions during
the concurrent month (R = -0.711, p=0.009) and the following month (R = -0.719, p=0.008). There was a weak correlation with decreased amputations the following month (R = -0.5, p=0.08).
Financially, \ was collected for 33 pts with a potential for collections of \ predicted for minimum Medicare payment of one visit per patient.
CONCLUSIONS: Advising vascular patients in smoking cessation benefits both the patient and the health system. Proper documentation and billing decreases costs of early readmissions and increases departmental revenue.

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