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Research, Consulting, and Evaluation Services
Select one of the following links to view typical Next Wave project examples and a partial list of clients for each
health care sector:
Associations/Groups
Health Services Research
Hospitals
Long Term Care: Nursing Homes, Assisted Living, HHC, etc.
Payors/Insurers/Attorneys
Regulatory Agency
Associations/Groups
Typical Next Wave Project Examples:
• Evaluate existing payment systems to identify discontinuities and inequities. Develop and facilitate implementation of solutions.
• Design and evaluate quality measures and internal/external oversight processes, including constraints (e.g. quality of source data.)
• Design Rate Models and Databases for a variety of Provider Associations.
• Serve on the Technical Advisory Groups for development and refinement of quality measurement and payment processes and regulations on behalf of provider, regulator, or payor groups.
• Facilitate the development of long term (3 - 30 years) visions and strategic plans for provider, regulator, or payor groups.
• Customized Training and Education in any of the above topics.
Partial List of Clients:
• Alberta Long Term Care Association (ALTCA)
• American Association of Procedural Coders (AAPC)
• American Lung Association of NYS (ALANYS)
• Columbia/HCA
• Empire State Association of Adult Homes and Assisted Living Facilities
• Healthcare Association of NYS (HANYS)
• Lung Transplant Centers across the US - Joint Project
• New York State Health Information Managers Association (NYHIMA)
• NYS Health Facilities Association (NYSHFA)
• NYS Association of Homes and Services for the Aging (NYSAHSA)
• NYS Health Maintenance Organization Conference (NYSHMOC)
• Park Associates
• Quorum Health Resources
• State of New Jersey Department of Health
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Health Services Research
Typical Next Wave Project Examples:
• Design and evaluate quality measures and processes, including constraints (e.g. quality of source data.)
• 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.
• Evaluate inconsistencies in published "Report Cards" and other benchmarks, and facilitate their correction.
• Served on the Technical Advisory Groups 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.
• 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.
• 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.
• Assisted with development of both the ICD-9-CM 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.
• Customized Training and Education in any of the above topics.
Partial List of Clients:
• American Lung Association of NYS
• Center for Assisted Living Advancement
• Healthy Schools Network
• Institute for the Advancement of Health Care Management
• NYS Department of Health Commissioner's Priority Research Pool
• Rensselaer Polytechnic Institute
• Individual hospitals
• Medical Device Manufacturers
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Hospitals
Typical Next Wave Project Examples:
• Assist with development and facilitate implementation of both ICD-9-CM codes and Diagnosis Related Group (DRG) categories to assist hospitals to obtain equitable reimbursement (11 NYS and federal DRGs are the result of our work.)
• Develop and implement both Medicare and Medicaid Compliance Plans for several Health Information Management (Medical Records) departments.
• Conduct Reimbursement, Case Mix, and Rate Analysis audits.
• Conduct 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.
• Evaluate potential case mix systems for Rehabilitation (MDS-PAC, CMGs / RIC / FIM).
• Evaluate potential case mix systems for Home Care (OASIS, HHRGs).
• Use case mix and clinical data to support Managed Care / Provider contracting and Medical Necessity determination at both the plan and provider level.
• Prepare both hospitals and physicians for Medicare Ambulatory Patient Categories (APCs), and demonstrate how they can properly document their services for Medicare / Medicaid Compliance.
• Design, implement, and evaluate quality measures and processes, including audit of quality and documentation of source data.
• Evaluate published "Quality Rankings" and other benchmark indicators and determine appropriateness. Facilitate operational and clinical solutions for confirmed quality concerns and/or facilitate correction of methodological or data inconsistencies.
• Perform Longitudinal Quality Assessment and Documentation Reviews for individual providers to assess whether appropriate care was being delivered and to identify any potential payment problems.
• Assist 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.
• Negotiated Rate Support Which Includes Risk Assessment, Sensitivity Analysis and Billing Systems Review.
• Perform Focused Medical Records Coding Reviews for Both Compliance and Payment Review.
• Customized Training and Education in any of the above topics.
Partial List of Clients:
• Amsterdam Memorial Hospital
• Columbia Presbyterian Hospital
• Community General Hospital of Greater Syracuse
• Corning Hospital
• Ellis Hospital
• Hospital for Special Surgery
• Mary Imogene Bassett Hospital
• Mt. Sinai Hospital
• New York-Presbyterian Hospitals
• Park Ridge Hospital
• St. Mary's Hospital
• Lung Transplant Centers across the US
• Healthcare Association of NYS (HANYS)
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Long Term Care: Nursing Homes, Assisted Living, HHC, etc.
Typical Next Wave Project Examples:
• Evaluate Home and Community Alternatives to Long Term Institutional Care
from a
program
and fiscal perspective.
• Design, implement, and evaluate quality measures and processes, including audit of quality and documentation of source data.
• Perform Longitudinal Quality Assessment and Documentation Reviews for individual long term care providers to assess whether appropriate care was being delivered and to identify any potential payment or compliance problems.
• Conduct Reimbursement, Case Mix, and Rate Analysis audits.
• Prepare and implement Survey Plans of Correction for nursing home clients focused on staff education, systems improvement, and follow-up to prevent recurrence.
• Conduct Patient Care Time Studies to analyze staff productivity and the potential for work force redeployment. These studies focus on determining patients' needs using several patient classification tools to help our clients evaluate their populations' case mix and appropriate staffing levels.
• Customized Training and Education in any of the above topics.
Partial List of Clients:
• Albany County Nursing Home/Ann Lee Home
• Community General Hospital Nursing Home
• Daughters of Sarah Nursing Home
• Eden Park Nursing Home Cobleskill
• Hebrew Home for the Aged at Riverdale
• Ideal Senior Living Center
• Home for the Aged Blind
• James Square Health and Rehabilitation Center
• Jewish Home and Hospital
• Jewish Home and Infirmary of Rochester
• New York City Health and Hospitals Corporation (NYC-HHC)
• NYS Veterans Home
• Ruth Taylor Geriatric Rehabilitation Institute/Westchester Co. M.C.
• Samuel and Bertha Schulman Institute for Nursing and Rehabilitation
• Wartburg Nursing Home
• NYS Health Facilities Association (NYSHFA)
• NYS Association of Homes and Services for the Aging (NYSAHSA)
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Payors/Insurers/Attorneys
Typical Next Wave Project Examples:
• Implement of the nursing home PPS (RUG II for Medicaid in several states and RUGS III) and evaluating that implementation at both the organization and regulatory levels
• Evaluated numerous Quality and Report Card Measurement systems to determine their effect on HMO "rankings".
• Use case mix and clinical data to support Managed Care / Provider contracting and Medical Necessity determination at the plan level.
• Negotiated Rate support which includes risk assessment, sensitivity analysis and billing systems review.
• Assess 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.
• Evaluate 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.
• Case Documentation Due Diligence
• Customized Training and Education in any of the above topics.
Partial List of Clients:
• Blue Cross/Blue Shield of Rochester
• Brindisi, Murad, Brindisi-Pearlman, LLP
• HIMCO
• New York State Department of Health - Medicaid
• NYS Health Maintenance Organization Conference (NYSHMOC)
• Preferred Care
• State of North Dakota Department of Health - Medicaid
• State of Washington -Aging and Adult Services - Medicaid
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Regulatory Agency
Typical Next Wave Project Examples:
• 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).
• Design and evaluate quality measures and processes, including constraints (e.g. quality of source data.)
• Develop and test computer supported audit protocols.
• Selected by the New York State Department of Health (NYSDOH) as the sole provider for 13 years of Patient Review Instrument (PRI), SCREEN / PASARR, and Minimum Data Set (MDS) training. Clarification of MDS Long Term Care assessment items and educational effectiveness with HCFA and several states.
• Serve on Technical Advisory Groups 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.
• Customized Training and Education in any of the above topics.
Partial List of Clients:
• Health Care Financing Administration (HCFA)
• Island Peer Review Organization (IPRO)
• New York State Legislature - Council on Health Care Financing
• New York State Department of Health
• State of North Dakota Department of Health
• State of Washington -Aging and Adult Services
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