Medicare Boosts Pay 19% for Doctors Who Help Smokers Quit

Starting soon, doctors who help patients quit smoking will see their pay jump by 19%, a change that public health experts say is decades overdue.

The proposed Medicare policy tucked into a 1,592-page document this week would increase reimbursement for tobacco cessation counseling during doctor visits. The same boost applies to alcohol and substance misuse screenings and interventions.

"The prioritization of cessation as a service is long overdue, and we're very excited about it," said Anne DiGiulio, senior director of tobacco cessation policy at the American Lung Association. Smoking remains the leading cause of preventable death in America.

Until now, doctors earned around $10 for tobacco cessation counseling. That pittance meant detailed conversations about quitting often fell to the bottom of already packed appointment agendas.

The gap in care shows in the numbers. Less than 10% of people who try quitting on their own succeed long term. Success rates climb significantly when smokers get both counseling and medication like nicotine patches or varenicline.

Yet only 5% of recent quitters received both, according to 2022 CDC data. A survey of Medicaid claims found just 2.7% of smokers who tried quitting got counseling from their doctors.

"Most clinicians recognize tobacco use as an important health issue, but what patients receive often amounts to a brief statement such as, 'You should quit,'" said Dr. Adam Goldstein, director of tobacco intervention programs at UNC School of Medicine. Research shows even a few minutes of proper advice during doctor visits improves quitting rates.

Dr. Ned Sharpless, former National Cancer Institute director who advocated for this change for years, was in a celebratory mood. "We have something to offer these patients, and we need to incentivize doctors to do this," he said.

The change affects far more than just Medicare patients. Private insurers typically follow Medicare's lead, and the program covers about 2 in 5 Americans.

The Ripple Effect

This policy shift could transform how America tackles its smoking crisis. When doctors have real incentive to spend time on evidence-based quitting plans, more patients get connected to treatments that work.

The increase extends beyond tobacco to alcohol screening too. Currently, only 12% of patients with alcohol use disorder who discuss drinking with clinicians receive brief interventions, and just 5% get referrals or information about treatment options.

Public comments on the proposal are due September 14. If finalized, the change takes effect in the next physician fee schedule.

Experts acknowledge the raise alone won't solve everything. Comprehensive support requires trained staff, electronic health record prompts, standing medication protocols, and follow-up systems. But it's a significant start toward treating addiction like the chronic disease it is.

Thousands of Americans could live longer, healthier lives simply because their doctor now has time and reason to ask the right questions.