About Us

Staff Profile

Project Expertise

Description And Experience
NWI’s Founder and President
Case Mix Consulting Projects
Quality Measures
Reimbursement / Management Consulting
Training And Professional Development

Description And Experience

Next Wave (“NWI”) is a health services research, management consulting, and evaluation firm. We are dedicated to helping all sectors of the healthcare industry and regulators provide access to the highest quality care within their given fiscal constraints. We help our clients balance the competing demands created by existing or proposed Federal and State budgets, patient expectations, health plan resources, and provider needs - all within the context of the rapidly-changing healthcare marketplace.

Next Wave was founded in 1984 by John D. Shaw and a team of experienced professionals with backgrounds in management and reimbursement consulting, staff training, management engineering and clinical systems design. Our areas of primary focus include measuring:

  • Patient, resident or client needs (using assessment and classification systems)

  • Quality of care and quality of life (applying outcome and satisfaction measures), and,

  • Resource consumption (developing or evaluating costing and payment systems).

NWI’s Founder and President

John D. Shaw, the founder and president of Next Wave, has been extensively involved in health care costing, reimbursement, and patient classification since 1972. He has been directly involved in the development and implementation of hospital and long term care reimbursement systems in a number of states based on case mix methodologies (DRGs and RUGs). John has also served on a variety of Technical Review Panels established to review the original RUG II classification system and the federal RUG III system, including the case mix index development.

Case Mix Consulting Projects

NWI has completed numerous projects which involve developing, implementing and evaluating case mix measurement tools for inpatient, outpatient and long-term care. A selection of these engagements include:

  • Designing the New York State Diagnosis Related Group (DRG) Hospital Payment System

  • Refining the existing systems (11 NYS and federal DRGs are the result of our work)

  • Implementing the nursing home PPS (RUG II for Medicaid in several states and RUGS III for Medicare) and evaluating that implementation at both the organization and regulatory levels

  • Evaluating potential case mix systems for Rehabilitation (MDS-PAC, CMGs / RIC / FIM), and Home Care (OASIS, HHRGs)

  • Using case mix and clinical data to support Managed Care / Provider contracting and Medical Necessity determination at both the plan and provider level

  • Preparing both hospitals and physicians for Medicare Ambulatory Patient Categories (APCs), and demonstrating how they can properly document their services for Medicare / Medicaid Compliance.

Quality Measures

NWI’s work on quality measures includes designing, evaluating, and implementing quality measures and processes at the regulatory and organization levels, assisting in the revision of several national report cards. Costing systems developed by NWI staff have been implemented at the micro (facility, plan, or county) and macro (association, state, or national) level. We believe that it is through the effective use of both case mix tools and outcomes data that we can assist our clients achieve an appropriate balance between the access, quality, and cost of care. We also believe that patient classification, quality, and costing systems, when properly used, can be a sound predictor of healthcare needs and cost effectiveness.

Reimbursement / Management Consulting

Next Wave’s consulting projects range from designing state or national payment systems to evaluating an individual facility’s procedures and training their staff on coding, billing, and compliance issues. Our clients include individual providers, groups of providers, legislative and regulatory agencies, individual insurance and managed care companies, groups or associations of insurers, etc. This broad range of experience and diverse clientele allows us to offer our clients an unparalleled understanding of the health care industry. In addition, this in-depth knowledge enables us to accurately forecast future fiscal impacts for both providers and payors of health care, on a pro-active rather than a reactive basis. The following is a sampling of some NWI client engagements:

  • Selected by the New York State Department of Health (NYSDOH) as the sole provider of Patient Review Instrument (PRI), SCREEN / PASARR, and Minimum Data Set (MDS) training.

  • Evaluated the implementation of case mix reimbursement on nursing homes over a ten-year time period for the New York State Department of Health. This study identified "Best Practice Success Strategies" for facility management.

  • Served on the Technical Advisory Group which developed the Resource Utilization Groups (RUG II and RUG III) for nursing home reimbursement and quality assurance in New York State and provided RUG III advice to several other states.

  • Facilitated the development of "A Vision for Assisted Living in the Overall Health Care Delivery System" for the Empire Adult Home Association's Future Society, and implementing this vision through the Center for Assisted Living Advancement (CALA).

  • Functioned as Technical Consultant to the New York State Legislature’s Council on Health Care Financing to design the post-1987 hospital reimbursement system for New York State (NYPHRM) based on Case Payment by Diagnosis Related Group (DRG).

  • Served as team leader and spokesperson for the Task Force that identified the “Ideal Managed Care” system for the Institute for the Advancement of Health Care Management of the State University of New York at Albany (SUNY).

  • Assessed the impact of the New York State Case Payment System on the New York State health maintenance organizations (HMOs) for the New York State HMO Conference (NYSHMOC), on both a global and individual rate component basis.

  • Performed Longitudinal Quality Assessment and Documentation Reviews for individual providers to assess whether appropriate care was being delivered and to identify any potential payment problems.

  • Prepared nursing homes clients for the Long Term Care Survey by identifying potential problems and suggested improvements in both the internal quality monitoring process and the actual quality of care provided to the facility residents.

  • Prepared and implemented Survey Plans of Correction for nursing home clients focused on staff education, systems improvement, and follow-up to prevent recurrence.

  • Assisted with development of both the procedure codes and Diagnosis Related Group (DRG) categories to assist hospitals and medical device manufacturers to obtain proper reimbursement. This work resulted in the development by HCFA of Medicare DRGs 491 and 495 through 503.

  • Evaluated numerous Quality and Report Card Measurement systems to determine their effect on both Hospital and HMO “rankings”.

  • Developed and implemented both Medicare and Medicaid Compliance Plans for several Health Information Management (Medical Records) departments.

  • Conducted Patient Care Time Studies for several clients to analyze staff productivity and the potential for work force redeployment. These studies focused on determining patients’ needs using several patient classification tools to help our clients evaluate their populations’ case mix and appropriate staffing levels.

  • Prepared a Nurse Staffing and Affordability Analysis to evaluate planned, provided and paid staffing, which included the use of external patient classification standards.

  • Additional consulting engagements have been completed on the following topics:

    • Designing Rate Models and Databases for a variety of Provider Associations and Individual Providers

    • Negotiated Rate Support Which Included Risk Assessment, Sensitivity Analysis and Billing Systems Review

    • Conducting Reimbursement, Case Mix, and Rate Analysis for both Acute and Long Term Care Facilities

    • Performing Focused Medical Records Coding Reviews for Both Compliance and Payment Review

    • Performing a Variety of Studies for Many Different Clients Which Focused On the Following:

      • Length of Stay Reduction

      • Fiscal Budgeting and Feasibility

      • Subacute Care Program Feasibility and Implementation

      • Strategic Planning and Certificate-of-Need (CON)

      • Regulatory Rate and CREEP / Recalibration Appeals

      • Customized Seminars on Current Health Care Issues.

Training And Professional Development

Our expertise has enabled us to provide both training and educational seminars across New York and throughout the United States to over 63,000 participants on topics such as:

  • “Compliance Plans - Reducing Your Risk”

  • “Building and Implementing a Compliance Plan for Your Facility - The Model, The Process, The Effort, The Risks”.

  • “New York State Patient Review Instrument (PRI) and Screen.” NWI served as the sole contractor to the New York State Department of Health (including MI and MR supplemental PASARR training) to train and certify qualified individuals.

  • “Effects of Case Mix Reimbursement: Best Management Practices” - For the National Subacute Care Association.

  • “Minimum Data Set (MDS)” These training sessions include both Executive Summary and Transition Courses for Administrators and Technical Courses for Clinical Staff.

  • “DRG Development Initiatives - Previous Successes / Future Opportunities.” Presented at the Annual Transplant Administrators Forum to National Centers of Excellence.

  • Served as Education Contractor to the New York State Health Facilities Association. Administered All NYSHFA Training Programs and Taught Courses in Various Areas of NWI Expertise.

  • “Using the Minimum Data Set (MDS) and Resident Assessment Protocols (RAPS) for Care Planning - How to Incorporate Both MDS and RAPS Into The Care Planning Process”.

  • “Implementing a Formal Quality Assurance System for Long Term Care Facilities: The Process, Costs, and Benefits - Detailed Quality Assurance Team Instruction”.

  • “Care Planning for the 90's, Meeting Resident Needs in a Time of Nursing Shortage - How to Incorporate Standards of Care into the Care Planning Process”.

  • “Nurse Staffing Productivity - How to Measure.” Presented to combined groups of Nurses and Finance Directors to show them how to balance clinical needs with budgetary constraints.

  • Conducted the “Train-the-Trainer” Course for 300 In-Service Directors for New York State's 100-Hour Nurses Aide Training for Residential Health Care Facilities.

  • “Using the Patient Review Instrument (PRI) as a Management Tool.” This course trained Administrators, Nurses, and Finance Directors on how to use Long Term Care Assessment Data for Reimbursement, Staffing, and Quality Assurance.

  • “The Federal Prospective Payment System.” Presented for the Hospital Association of New York State (HANYS) training for all New York Hospitals and other interested parties.

  • Developed Customized Seminars and Training for Individual Facilities, Hospital and Nursing Home Associations, and Professional Societies for finance, administration, nursing, physicians, medical records professionals, etc.

  • New Jersey "Hospital of the Future" Planning Project. Participated in project team that developed a conceptual design for the New Jersey Health Care System for the year 2015.