Physicians know the dangers of smoking, but they don’t have time to counsel patients. Toll free tobacco quit lines are a proven, cost-effective alternative, but physicians rarely refer patients to such services.
A study published in this week’s Archives of Internal Medicine has shown that paying physicians to refer cigarette-smoking patients to quit lines increases their referral rates by 250%.
The study was a randomized trial of a program offering physicians $5,000 for 50 referrals to a quit line vs. usual care (no pay for performance). Only patients who intended to quit within 30 days were eligible for referral. Physicians in the incentive program referred 11.4% of eligible smokers while those in the usual care cohort referred 4.2%.
The marginal cost per quit line enrollee was $300, a pittance given that in the US, tobacco use causes 440,000 premature deaths and $75 billion in extra medical costs per year.
The study’s authors commented that health plan collaboration was essential to program success. It streamlined referrals and allowed physicians to refer patients regardless of their insurer. Thus physicians could target all smokers rather than just those from certain health plans.
BC/BS of Minnesota funded the study with money from a tobacco settlement. When the results of the study became known, they and other health plans in the state continued the program with reduced financial incentives.