White Papers

Comments - Hospital Acquired Conditions (HAC)
and Public Reporting - Medicare FFY09 Rule

The Centers for Medicare and Medicaid Services (CMS) made several proposals for reduced payments for hospital acquired conditions and additions to the list of quality indicators that are publically reported.  Next Wave's comments urge caution in implementation of such measures unless they are risk adjusted, span all of the caregivers involved in care (including the patient themselves), and the need to expand the the number of diagnosis and procedure fields routinely captured by Medicare administrative data (MEDPAR.)

View May 14, 2008 Comments in Acrobat PDF

 Value Based Purchasing/Pay-for-Performance (VBP/P4P): 
Policy Questions/Practical Solutions
These White Papers were prepared in response to requests by the Centers for Medicare and Medicaid Services (CMS) for input into their Plan for Medicare Hospital Value Based Purchasing. 

Innovations suggested include specific recognition and reimbursement for:

  • "Pay for Reporting" Reimbursement for Data Infrastructure Costs (which allows small facilities to recover fixed reporting costs)
  • "Pay to Share" Best Practices (which continues to engage top performers AND disseminate their best practices sooner)
  • "Pay to Test" New Measures (which reimburses added costs for collecting and testing new measures prior to full implementation)

Portions of these papers were presented orally by John D. Shaw, Next Wave’s President at the Listening Sessions held on April 12, 2007 and January 17, 2007 at CMS offices in Baltimore, MD.
 

Malpractice Impacts:
Communication Between Physician and Patient

Lack of communication between a patient and their physician leads to many of the preventable adverse events plaguing health care today.  Of even greater importance for malpractice claims is the impact that communication has on the patient's likeliness to sue.  This white paper examines the magnitude of this impact, as well as some practical solutions to reduce both malpractice claims and adverse clinical events.

View Acrobat PDF

 Comments on CMS (HCFA) Proposals for Coding and Paying for New Technology
We support efforts to make the benefits of New Medical Technology available faster for Medicare Beneficiaries and others.  Our analysis indicates that the majority of the current time delay is in definition of appropriate ICD-9-CM codes and data collection.  Our comments relate primarily to innovative ways to find room for new codes in the outdated ICD-9-CM coding scheme, and implementing them sooner.
 
When a Quality Measure Doesn’t Measure Quality: A Case Study
The explosive growth of interest in Quality Measures/Indicators and Report Cards by the general public is a positive development in the long run, but raises serious concerns given the current state of the art. Do the current measures in use actually measure quality, and if not, why not? This case study examines a commonly utilized indicator - “Surgical Complications” (sometimes termed “Iatrogenic Complications” or “Major Complications”) for common procedures - Hip and Knee Joint Replacements.
Refinement of the Medicare Diagnosis-Related Groups (DRGs) to Incorporate a Measure of Severity
While strongly supporting the incorporation of a severity measure, Next Wave (NWI) advocates a number of specific modifications to make the measure more effective and avoid potential implementation concerns.
Task Force on Managed Care - What We Would Consider in Designing a Managed Care Model for the Capital Region
This paper was developed by the Task Force on Managed Care, which was sponsored by the Institute for the Advancement of Health Care Management of the State University of New York at Albany (SUNYA). The Task Force met during 1995 to identify issues and recommendations for a Managed Care Model for New York State’s Capital Region (comprising the towns and counties around Albany, New York). The Task Force was comprised of a cross section of the community, including physicians, health provider executives, consumers and advocates for the disabled, regulators, trade organizations, and consultants. Periodic meetings were held to define the scope of this concept paper, to obtain education on managed care issues, and to work through various drafts of materials.
Proposal for Significant Revisions In The Current Model for Long-Term Care Financing
In public testimony and correspondence, Next Wave (“NWI”) has long advocated leading-edge positions regarding healthcare and long-term care financing and payment reform. In its testimony to the New York State Task Force on Long Term Care Financing Public Hearing, NWI staff proposed...
 
Capitalizing on the External Forces Affecting Long Term Care
In 1998, John Shaw, President of Next Wave (“NWI”) presented before the New York Healthcare Information Management Association. NWI was able to make this presentation relevant to this group due to its background in: (a) performing significant data collection and analysis engagements for individual hospitals, nursing homes, and insurance companies; (b) its background in reviewing costs, payments, and case mix adjustments; (c) serving as trainers for the NYS Department of Health on several long-term care assessment forms, including the PRI, the Screen, and the MDS; and, (d) its understanding of patient classification systems and case mix payment system on nursing home management practices. NWI presented to this group in the hopes that its broad payor, provider, and research background might assist the NYHIMA members to better understand how their roles affect the delivery impacts of long-term care in NYS.

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