MEDICARE NEWS

"Smoking is the single most preventable cause of death and illness in the United States, especially among older Americans," said Nancy-Ann DeParle, HCFA administrator. "But it's never too late to stop."

Medicare, the federal health insurance program that covers Americans 65 and older, spent $14.2 billion in 1993 treating smoking-related illnesses, nearly 10 percent of the Medicare budget. Independent researchers have estimated that between 1995 and 2015, Medicare will spend $800 billion treating smoking-related illnesses.

"We know that if we can find ways to help Medicare beneficiaries stop smoking, it will enrich their lives and help them live longer," said Jeffrey Kang, MD, HCFA's chief clinical officer. "The health benefits are substantial, even for people who have smoked for a long time."

"By law, smoking cessation therapy as such is not a Medicare benefit," DeParle said. "If the demonstration proves successful in identifying the most effective ways to help seniors stop smoking, this could prompt Congress to consider a Medicare benefit to cover smoking cessation."

The demonstration cessation project will test specific strategies for helping older people quit smoking in states selected because of the prevalence of smokers age 65 in their populations. These states include Alabama, Florida, Missouri and Ohio, with additional states to be determined later.

Peer Review Organizations (PROs), Medicare's quality assurance contractors, will run the program in each selected state. The PROs will publicize the project through newspaper and broadcast advertisements, doctors' offices and community outreach programs. Eligible beneficiaries can use a toll-free telephone line to register to participate in the demonstration.

Counseling, either by health care providers or trained telephone counselors, and FDA-approved drugs, either nicotine replacement therapy or prescription drugs, will be used in a variety of combinations. These include counseling by health care providers only; provider counseling in conjunction with medication; and telephone counseling with drugs.

The demonstration will last approximately three years. Individual participants will be offered smoking cessation assistance for 12 months and health care professionals will follow their progress to evaluate success rates. Participants will be recruited on a rolling basis over the life of the program. HCFA will evaluate and publish the preliminary results in 2003.

The smoking cessation demonstration announced today was prompted by research sponsored jointly by HCFA and the U.S. Public Health Service, which produced scientific evidence that counseling and Food and Drug Administration-approved smoking cessation drugs are effective in encouraging older smokers to quit. The Public Health Service recently published a new guideline, "Treating Tobacco Use and Dependence: A Clinical Practice Guideline."

Smoking accounts for more than 430,000 deaths every year in the United States. More than 70 percent of these deaths occur in people age 65 and older, who suffer the most from smoking’s harmful effects. Smoking often leads to disability and poor quality of life. It either causes or contributes to a number of chronic illnesses, including cancer, heart and lung diseases, diabetes and osteoporosis.

Recent smoking cessation efforts have targeted younger populations, yet research shows that older smokers are more likely to be successful in quitting than younger adults and reap many benefits from quitting. These benefits include reducing the risk of heart attack, cancer and stroke, improving circulation and breathing, and better overall physical functioning.

"Health risks begin to decline within a few months of quitting," DeParle said. "Within five years, many ex-smokers have about the same risk for heart disease and stroke as persons who never smoked."

Smoking cessation is a special concern for Medicare because more smokers will be entering the program in coming years. The prevalence of smoking in the Medicare population is currently declining slowly, but the actual number of smokers will increase with the aging of baby boomers.

The smoking cessation demonstration is the latest part of HCFA's Healthy Aging Project, a new initiative aimed at identifying the best ways to keep seniors healthy. In developing the demonstration HCFA consulted with a number of other agencies and organizations including the National Institutes of Health, the Agency for Healthcare Research and Quality, and the Centers for Disease Control and Prevention.

"Medicare is about more than just paying bills after people get sick," DeParle said. "We want to help people stay healthy and enjoy a richer and smoke-free quality of life."