• Derek J Baughman, Marcus Rauhut, and Edward Anselm.
• Departmet of Family Medicine, WellSpan Health, York, Pennsylvania; Departmet of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, Tennessee. Electronic address: derek.j.baughman@vanderbilt.edu.
• Am J Prev Med. 2024 Aug 22.

IntroductionTobacco cessation remains a critical challenge in healthcare, with evidence-based interventions often underutilized due to misaligned economic incentives and inadequate training. This study aims to quantify the economic impact of missed billing opportunities for tobacco cessation in a healthcare system, thereby assessing potential revenue loss and evaluating the effectiveness of systems-based approaches to enhancing tobacco cessation efforts.MethodsA retrospective cohort study utilized aggregated deidentified patient health data from an 8-hospital regional health system across Pennsylvania and Maryland, from 1/1/21 to 12/31/23. The analysis focused on primary care encounters eligible for tobacco cessation counseling (CPT codes 99406 or 99407), with potential revenue calculated based on the Medicare reimbursement rate.ResultsOver 3 years, and 507,656 office visits, only 1,557 (0.3%) of encounters with persons using tobacco were billed for cessation services. The estimated total potential revenue gained if each person who was identified as using tobacco was billed consistently for tobacco cessation counseling was $5,947,018.13, and $1,982,339.38 annually.ConclusionsThe study reveals a significant gap between the potential and actual billing for tobacco cessation services, highlighting not only the financial implications of missed opportunities but also a validation of a health system's public health impact. Underbilling contributes to considerable annual revenue loss and undermines primary prevention efforts against tobacco-related diseases. The findings illuminate the need for enhanced billing practices and systemic changes, including policy improvements that influence proper billing to promote public health benefits through improved tobacco cessation interventions.Published by Elsevier Inc.

5 keywords...

hide…