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A report in the Daily Beast (June 12, 2018) talks about an 18-year-old woman in Pennsylvania who developed wet lung after using e-cigarettes for just three weeks
Withdrawal from smokeless tobacco is as difficult as smoking and may cause intense cravings, depressed mood, and irritability
This is a fundamentally different game than a urine test
(c) * * * (3) * * * (iv) For performance year 2025 and subsequent performance years, if the ACO reports the APP Plus quality measure set and meets the data completeness requirement at 414.1340 of this subchapter and receives a MIPS Quality performance category score under 414.1380(b)(1) of this subchapter, CMS will use the higher of the ACO's health equity adjusted quality performance score or the equivalent of the 40th percentile MIPS Quality performance category score across all MIPS Quality performance category scores, excluding entities/providers eligible for facility-based scoring, for the relevant performance year
So reducing the number of cigarettes you smoke a day is a good first step
