POLICY

Evaluation Support for Development and Refinement of Payment and Quality Measurement Concepts, Legislation, Regulations, Roll-Out, and Oversight
Next Wave is proud of its track record of implementation of our suggestions and recommendations for system refinements by national and state legislators, regulators, payors, and report card developers. 

• Evaluate Appropriateness of Hospital DRG Payment Category changes
  • MS-DRGs (Medicare Severity DRGs)
  • AP-DRGs (New York State All-Payor DRGs)
  • Evaluating and Predicting Coding and documentation behavioral offsets (“Creep”) at national and state levels – Input to CMS, Hospital Associations, Providers
• Refinements to ICD-9-CM Diagnosis and Procedure codes – Administrative Data
  • New codes implemented for Hip, Knee, and Spine Surgery, Major Osseous Defects
  • Formal requests for new codes under discussion for MRSA, Dural Tears
  • Identified availability of Chapter “00” for code expansion
  • Formal input on Present on Admission (POA) indicators and their use

• Evaluate Appropriateness of Medicare RUG III for Current Medicaid Population

• Served as Technical Consultant to refine New York’s Medicaid SNF payment system to incorporate Medicare RUG III categories.  Refinements made to:
  • Correct Medicare Weights to reflect a more chronic Medicaid population
  • Fit the current Medicaid beneficiary population (bariatric residents, residents with behavior and cognitive impairments, dementia, vents, etc.)
• Evaluate Impacts of proposed refinements, resolve with stakeholders
• Educate Provider SNFs on new payment rules and dynamics
• Evaluate Value-Based Purchasing (VBP) and Pay for Performance (P4P) Proposals
  • National Quality Forum (NQF) Panel on Unexpected Consequences of P4P
  • Active Participant in Medicare VBP Development – Verbal and Written Input
  • Validate Quality Indicators Used in Public Report Cards and VBP/P4P
  • Validation and Refinement of Payor Specific Report Cards and P4P
  • Methodology Validation of Commercial and State/Local Report Cards
• Prepare Formal Policy and Technical Evaluations to Support Client Issues
  • Individual Client Issue Papers
  • Association or Coalition Issue Papers
  • State Concerns on National Policy Issue Papers