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Wednesday, March 23, 2011

Smoking cessation good, but not if you don't smoke

At my hospital smoking cessation education is something we take very seriously. In fact, the order to do smoking cessation comes up on any patient admitted with CHF, COPD, MI, pneumonia, asthma and just about any other diagnosis under the sun.

This might sound like overkill, and it is. Yet our medical director wants us to do smoking cessation even if a person doesn't smoke. Thus, if they don't smoke, we're supposed to encourage them not to start, and we're supposed to inform them of the danger of not smoking.

I don't think this is a bad thing, yet where is the time do do all of this? If we're going to do smoking cessation on every patient, it's going to get to the point where the therapist dumbs down his presentation just to get it done and over with. In the end, a poor job will be the result.

Likewise, even while smoking cessation is deemed so important, we RTs have received no formal training to make sure we are providing the best education. Most RTs in my department that I talk to don't even know why we are doing it. I know because I ask around.

In fact, while smoking cessation is deemed so important, the hospital won't even splurge on a good smoking cessation packet. All they give us to give to the patient is a single sheet of paper with some basics about quitting smoking.

It's frustrating to me. It's frustrating because most of the patients who are ordered to get smoking cessation education have never smoked, or quit smoking years ago. So it seems quite frivolous and a waste of our time to HAVE to educate these people.

One man said to me, "I quit 75 years ago."

One patient has been admitted 4 times in the past month, and every time the order comes up automatically. I finally got irritated and started charting, "Smoking cessation done last visit." Yet I still, by hospital policy, have to bill the patient.

Of course the real reason we are doing all this education is not to help the patient. That's what we say, and that's what's said to us. But I know for a fact the real reason is because CMS reimburses for it, and when a patient is given smoking cessation, that helps to qualify the patient for reimbursement.

You see, everything in the new healthcare system comes down to money. No, it's not about saving the hospital money, because they (CMS) already only pay one lump sum regardless of how many things are done to the patient. In fact, it actually costs the hospital more money.

Yet our hospital wants to make sure the patient meets criteria and that the hospital is reimbursed for the patient's visit, and by charting smoking cessation for every patient admitted this is a step in assuring reimbursement criteria is met for that patient.

This is another perfect example of stupidity that results when we put the government in charge of anything.

Look, smoking cessations are good. Yet doing smoking cessations on people who never smoked or have already quit more than 6 months ago is a waste of time. IMO! Smoking cessation is good, but not if you don't smoke.

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