Letters to the Editor  |   July 2009
Stop Smoking, Save Money, Get Free OMM
Author Affiliations
  • Thomas R. Byrnes, Jr, DO
    Southern Light Osteopathic Wellness & Healthcare Associates, Inc—REDICARE, Richmond Hill, Ga
Article Information
Addiction Medicine
Letters to the Editor   |   July 2009
Stop Smoking, Save Money, Get Free OMM
The Journal of the American Osteopathic Association, July 2009, Vol. 109, 382-383. doi:10.7556/jaoa.2009.109.7.382
The Journal of the American Osteopathic Association, July 2009, Vol. 109, 382-383. doi:10.7556/jaoa.2009.109.7.382
To the Editor:  
I write this letter to share some recent experiences of success in encouraging patients to quit smoking. 
I am an osteopathic physician who practices at a walk-in urgent-care/wellness osteopathic manipulative medicine (OMM) facility. Patients visiting this facility may pay by cash, credit card, or personal check. On payment, they are given a CMS (Centers for Medicare & Medicaid Services) 1500 claim form generated by our electronic medical record (EMR) system in addition to a receipt, which they can submit to their insurance company—if they have one and choose to do so. This arrangement allows us to offer significant discounts in charges for our services. It also allows patients to actively participate in many of the decisions involving their healthcare and their “healthcare dollars.” 
By necessity, the services at our facility are limited to what is affordable for patients. We practice a great deal of empiric diagnoses and treatments with follow-up via telephone to ensure adequate patient response. If we do not deliver quality care for a reasonable price, patients will go elsewhere. 
We have about 100 patients with chronic health problems and no insurance who depend on our facility as their main source of healthcare. Many of these patients with chronic problems are smokers. Between November 2008 and May 2009, seven of these patients had quit smoking and maintained that abstinence for at least 3 months. In addition, about a dozen more smokers have cut their cigarette consumption in half. These success stories are the result of anti-smoking measures that we instituted last fall. 
At that time, we began to make sure that every smoker carries the diagnosis of tobacco dependency (ie, nicotine addiction) and that this diagnosis is printed on his or her EMR-generated patient notes at checkout. Because we do not bill the patient's insurance company, we are able to include all relevant diagnoses related to each particular care visit on the patient's paperwork—even if there are more than the arbitrary limit of four diagnoses per claim form imposed by the current system of US healthcare “financiers” and “profiteers.” Thus, every patient with a chronic smoking condition gets the written “smoking-is-bad-for-you” message, in addition to the diagnosis of tobacco dependency, clearly printed on his or her take-home papers at every visit. 
I was pleasantly surprised when patients spontaneously began reporting their efforts to quit smoking. My favorite story involves a woman who taught herself sign language as a way to quit! She learned to spell a new word or phrase in sign language each time she felt a nicotine craving—thereby occupying her hands and mind, as well as learning a marketable new skill. It was a win-win-win trifecta for her! I was glad to share her success story (but not her patient health information, of course) with the other smokers at our facility. 
Several smokers at our facility have been able to quit “cold turkey.” Others have availed themselves of the bupropion hydrochloride 17-pill starter pack offered by the pharmacy at the local “big box” store. This antidepressant medication seems to be effective in helping some smokers quit, though we are still tracking patient outcomes to evaluate sustained results of using this drug as an antismoking aid. One patient who quit smoking reported that he has $300 more in his pocket each month, and his savings increase each time the state raises the “sin tax” on a pack of cigarettes. 
Another aspect of our program is our offer of two free OMM treatments to any patient who quits smoking for at least 2 months. These patients still must pay the evaluation-and-management charge for their visits but not the charge for their next two OMM treatments. 
I hope that these encouraging experiences will provoke useful dialogue regarding experiences that other osteopathic physicians might have with efforts to get patients to quit smoking.