Ambulatory Surgery Centers  ·  Perioperative Tobacco Cessation

Reduce preventable surgical risk.
Support added surgeon revenue.

QPM helps ASCs identify tobacco-using surgical patients at scheduling, route them to treatment, document counseling and prescription recommendations, support surgeon sign-off, and capture information relevant to revenue and MIPS Measure #226 documentation.

Clinical

Reduce surgical complications

Preoperative tobacco cessation cuts wound complications by 33%, pulmonary complications by 29–37%, and all post-op complications by up to 41%. Every tobacco-using patient is a preventable risk.

Revenue

Generate net-new revenue

Surgeons bill payers under their own NPI for tobacco treatment services performed under their general supervision by qualified tobacco treatment specialists.

Compliance

Support MIPS Measure #226

QPM automates tobacco screening documentation and cessation intervention records for every patient — supporting MIPS quality reporting documentation for surgeons without adding paperwork.

Clinical Risk

Your tobacco-using patients are carrying preventable surgical risk into your OR

The evidence linking tobacco to surgical complications is among the most consistent in all of medicine — and the preoperative window is the most powerful moment to intervene.

What tobacco does to every stage of the surgical encounter

Tobacco use affects the patient before, during, and after surgery — and in an ASC setting, each of these translates directly to operational risk: unplanned hospital transfers, returns to the OR, and surgical site infections that damage outcomes data and payer relationships.

+65%
higher risk of wound disruption post-operatively
+31%
higher risk of surgical site infection
+47%
higher risk of reintubation
  • Higher rates of laryngospasm and difficult airway for anesthesia
  • Higher rates of implant failure and bone nonunion (orthopedics, spine)
  • Higher anastomotic leak risk in GI and colorectal procedures

QPM starts working the moment a patient is scheduled

Unlike hospital or primary care deployments triggered at discharge, QPM for ASCs is designed to run in the preoperative window — maximizing cessation time before the OR date.

"When trying to stop smoking in the preoperative period, surgical patients experience much higher than average cessation rates compared with the general population, indicating that the time around surgery is ripe for motivating and sustaining behavior change."

Published research
Revenue & Billing

Your surgeons encounter patients who are using tobacco. QPM turns referrals of these patients into revenue.

The same CMS general supervision billing mechanism available to physician groups applies to surgeons at ASCs — and the revenue flows to the referring surgeon, not the facility.

The CMS regulatory foundation

Tobacco Use Disorder is classified as a substance use disorder under ICD-10-CM. The CY 2023 Physician Fee Schedule Final Rule changed the supervision requirement for behavioral health services from direct to general supervision — meaning cessation counseling can be performed by a contracted TTS and billed under the supervising physician's NPI without the physician being physically present.

Important billing note

CPT 99406/99407 cannot be billed on the same day as a surgical procedure — they are denied as incidental to the primary procedure. Tobacco treatment specialist sessions occur in the weeks before and after surgery, not on the procedure date. The pre-op consultation or a scheduling encounter is the appropriate trigger for the referral.

How the billing flows — three steps

Step 1 — Referral of the tobacco user

A surgeon who sees a tobacco user at a pre-surgical consultation invokes a standing order in the EHR. That single action triggers QPM enrollment and establishes the general supervision relationship required for billing.

Step 2 — QPM's contracted TTS delivers the sessions

Contracted Tobacco Treatment Specialists deliver up to 8 covered counseling sessions per patient per year. Each session is documented in QPM with billing codes (CPT 99406 or 99407) transmitted back to the EHR — ready for the surgeon's billing team.

Step 3 — Surgeon bills, revenue is split

The surgeon bills CMS under their own NPI. QPM charges $6 per enrolled patient for its software platform. The balance of each reimbursement is shared between the referring surgeon and the tobacco treatment specialist — creating a net-new revenue stream.

Revenue Calculator

Model your ASC's Revenue Potential

Select your state to auto-populate adult current cigarette smoking prevalence, then adjust the sliders. The model updates in real time for surgeons referring tobacco-using surgical patients.

Number of surgeons affiliated with your ASC5
Average surgical patients per surgeon1,500
Estimated tobacco users in surgical panel-
Auto-calculated from state prevalence x surgical panel size
Counseling sessions per patient per year5
Average revenue per session$35

Your revenue projection

Tobacco users in surgical panel
Select state above
Total counseling sessions per year
-
Gross annual revenue
-
Less QPM platform cost ($6 x tobacco users)
-
Net program revenue before CTTS split
shared 50/50 with CTTS contractor
-
Surgeon share (50%)
-
Select your state above to auto-populate adult current cigarette smoking prevalence and activate the calculator.

Illustrative model. Actual results depend on payer mix, local CMS rates, surgical volume, and patient engagement. Net surgeon revenues are shared 50/50 with the CTTS. Book a call for an ASC-specific analysis. Source: CDC BRFSS 2024 crude prevalence of current cigarette smoking among adults; Tennessee uses 2023 because it was not included in the 2024 public dataset.

Workflow

Surgical workflow: clinical risk reduction, surgeon revenue, and MIPS documentation in one path

This is the single ASC workflow: the surgeon identifies the tobacco-using surgical patient and signs the standing order; QPM handles opt-out enrollment, preoperative outreach, specialist counseling, session documentation, EHR return, and MIPS Measure #226 documentation support.

1
Surgeon

Identify & refer at scheduling

Surgeon identifies a tobacco-using patient at the pre-surgical consultation or scheduling encounter and signs a standing order within the EHR.

2
Automated

Automatic enrollment

QPM receives patient data from the EHR and enrolls the patient under the presumed consent (opt-out) model. Less than 1% of patients decline. Outreach begins within 24 hours.

3
Automated

Preoperative outreach & TTS scheduling

Personalized texts, calls, and emails engage the patient in the weeks before surgery. When ready, QPM connects them to a contracted Tobacco Treatment Specialist for evidence-based cessation counseling.

4
Automated

Session documentation for billing purposes

QPM records counseling sessions and transmits summaries of same to the EHR along with any prescription recommendations and appropriate billing codes.

5
Surgeon

Surgeon signs-off

The surgeon reviews the summary and prescription recommendation and signs-off within their normal EHR workflow - a 30-second task.

6
Automated

Outcomes loop & MIPS reporting

Cessation status, medication use, and session outcomes flow back to the patient's chart in the EHR automatically. MIPS Measure #226 documentation is captured as a by-product — with minimal additional reporting work.

Quality Reporting

QPM supports MIPS Measure #226 documentation as a by-product of doing the work

MIPS-eligible surgeons operating at ASCs are evaluated on tobacco screening and cessation intervention. QPM looks after the intervention and the documentation.

MIPS Measure #226

Preventive Care & Screening — Tobacco Use Screening & Cessation Intervention

Measure type
Process
Eligible specialties
Orthopedics, general surgery, plastics, spine, podiatry, and more
Submission criteria 1
Tobacco screening documented at point of scheduling
Submission criteria 2
Cessation intervention records generated for every enrolled patient
QPM coverage
Both criteria documented through the workflow

How QPM supports the measure

  • Tobacco screening is documented at the point of scheduling — satisfying Submission Criteria 1
  • Cessation intervention records are generated for every enrolled patient — satisfying Submission Criteria 2
  • All data returned to the EHR — supports MIPS claims submission with no manual data entry
  • Monthly reporting dashboard provides the quality improvement data accreditation bodies (AAAHC, Joint Commission) expect
  • Applicable across all MIPS-eligible specialties: orthopedics, general surgery, plastics, spine, podiatry, and more
FAQ

What ASC leaders ask us

The most common questions we hear from ASC Medical Directors and Administrators — answered directly.

"We already ask patients if they smoke."
Screening is step one. QPM handles the other nine: automated outreach, TTS scheduling, counseling documentation, billing code generation, prescription initiation, post-discharge follow-up, outcomes capture, EHR return, and MIPS reporting. Without structured follow-up, screening alone produces no behavior change.
"Our patients are only with us for one day."
QPM starts working weeks before the procedure — triggered at scheduling, not at the surgical encounter. Post-discharge follow-up continues for 6 months. The ASC is the referral origin, not the treatment venue.
"Can surgeons really bill for this from an ASC setting?"
Yes. The CMS general supervision billing pathway follows the physician, not the facility. A surgeon at an ASC who refers a patient to QPM's supervised TTS can bill under their own NPI for those sessions — which occur outside the ASC, in the weeks before and after surgery. The key is that the sessions are not billed on the same date as the surgical procedure itself.
"We don't have staff to run a cessation program."
QPM requires no ongoing staff involvement after the initial EHR integration. The standing order takes one click. Everything else — outreach, scheduling, counseling, documentation, billing codes, outcomes reporting — is automated or handled by QPM's contracted TTS network.
"What's the ROI for a small ASC?"
Even one prevented surgical site infection or unplanned hospital transfer typically costs far more than QPM's annual fee. Add the recurring CMS revenue from TTS sessions and MIPS performance improvement, and the economics are clear at any ASC size.
"We're not on Epic."
QPM integrates with multiple EHR platforms. While Epic Connection Hub provides the most streamlined pathway for Epic-using ASCs, we have established integration pathways for other major platforms. Contact us to discuss your specific EHR environment.
Evidence & Partners

What the evidence and our partners say

The Quit Plan Manager platform has been supporting our 'No Smoker Left Behind' program for several years. Tobacco users are automatically enrolled and outcomes flow back to their charts. This saves a tremendous amount of work for staff and helps us reduce health disparities for our underserved patients.
University of Chicago
Clinical Partner
When trying to stop smoking in the preoperative period, surgical patients experience much higher than average cessation rates compared with the general population, indicating that the time around surgery is ripe for motivating and sustaining behavior change.
Published Research
Perioperative Cessation Evidence
Get Started

Model surgeon revenue and MIPS documentation for your ASC

We'll model your specific ASC — procedure mix, surgeon count, tobacco prevalence — and show you the projected revenue and complication reduction impact. No commitment required.

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