Better Health, Better Healthcare and Lower Costs with Quality Improvement

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  • February 3, 2015
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By  Rhonda Buckholtz, CPC, CPMA, CPCI, CGSC, CPEDC, CENTC
Vice President, ICD-10 Training and Education
CMS has launched numerous programs and models to help health providers achieve large-scale transformation since the ACA was launched. Programs and models, such as the Hospital Value-Based Purchasing Program, Accountable Care Organizations, and the Partnership for Patients initiative with Hospital Engagement Networks, are striving to help clinicians and hospitals move from volume-based towards patient-centered quality health care services. The thought is to pay for quality, not quantity. CMS states this has resulted in fewer unnecessary hospital readmissions, reductions in healthcare-associated infections and hospital-acquired conditions, and improvements in quality outcomes and cost efficiency. Lower costs will be a goal but only with health improvement.
CMS estimates that only about 16 percent or 185,000 of the nation’s clinicians currently participate in existing programs, models, and initiatives that facilitate practice transformation.
The Transforming Clinical Practice Initiative is one of the largest federal investments uniquely designed to support clinician practices through nationwide, collaborative, and peer-based learning networks that facilitate large-scale practice transformation. Transformation will allow movement and adaptation.
CMS will award cooperative agreement funding for two network systems under this initiative: Practice Transformation Networks and the Support and Alignment Networks.
Practice Transformation Networks are designed to coach, mentor, and assist clinicians in developing core competencies to practice transformation. Clinical practices are allowed to become actively engaged. The most important is that health outcomes will improve.
Support and Alignment Networks provide the workforce development using national and regional professional associations and public-private partnerships that are currently working in practice transformation efforts. These will be made up of medical/specialties societies and those others helping provide evidence-based education and offerings.

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Rhonda Buckholtz, CPC, CPMA, CRC, CDEO, CMPE, CHC, COPC, AAPC Approved Instructor, is owner of Coding and Reimbursement Experts. She spends her time helping physician practices achieve operational excellence, compliance, education, and Lean Six Sigma through her consulting. Buckholtz has more than 30 years of experience in healthcare management, compliance, and reimbursement/coding sectors. She was responsible for all ICD-10 training and curriculum at AAPC during the transition from ICD-9. Buckholtz has authored numerous articles for healthcare publications and she has spoken at numerous national conferences for AAPC and others. She is past co-chair for the WEDI ICD-10 Implementation Workgroup, Advanced Payment Models Workgroup, and she provided testimony for ICD-10 and standardization of data for National Committee on Vital and Health Statistics. Buckholtz is on AAPC’s National Advisory Board.

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