John D. Shaw
     Master of Engineering, Health Systems       

     President                                     

     

 shawj@nextwave.info

Mr. Shaw is responsible for the overall management of Next Wave, as well as coordinating NWI's research efforts. Mr. Shaw's experience in health care consulting, research, and evaluation includes:

  • Served as Technical Consultant to the NYS Legislature (Council on Health Care Financing) for the Design of the DRG Payment System, Which is Also Known as the New York State Prospective Hospital Reimbursement Methodology (“NYPHRM”).
  • Served as Technical Consultant to redesign the NYS Nursing Home Payment System to utilize RUGS III.
  • Contracted by the New York State Department of Health (NYSDOH) as Sole Provider of Patient Review Instrument (PRI), SCREEN, Minimum Data Set Assessment (MDS+), and PASARR Training. These Are Long Term Care Assessment Tools For Both Patient Placement And Payment For Services.
  • Evaluated the Implementation of Case Mix Reimbursement (Resource Utilization Groups - RUGs) On Nursing Homes Over A Ten-Year Time Frame for the New York State Department Of Health. This Study Identified "Best Practice Success Strategies" For Facility Management.
  • Reviewer for the Agency for Healthcare Research and Quality (AHRQ) for Health Information Technology (HIT) Grants.
  • Served As Member Of The Technical Advisory Group For Development Of The Resource Utilization Groups (RUG II And RUG III) Used For Nursing Home Payment.
  • Developed The Cost Profile Exception Model To Identify Productivity Enhancements For All Nursing Homes In New York State For The New York Association Of Homes And Services For The Aging And The Hospital Association Of New York State.
  • Selected As Team Leader For The State University Of New York At Albany’s Task Force To Design The Ideal Managed Care System For The Capital Region.
  • Co-Founded The Center For Assisted Living Advancement (CALA), Dedicated To Research And Development Of Chronic Disease Prevention And Treatment Programs In Assisted Living Facilities.
  • Designed and Developed a RUGs Rate Model / Data Base For The New York Association Of Homes And Services For The Aging.
  • Completed Design And Evaluation Of the Statewide And Facility-Level Nurse Staffing And Patient Classification Tools To Predict And Evaluate Appropriate Staffing Levels And Skill Mix For Nursing Based Upon Patient Needs For Both Hospitals And Nursing Homes.
  • Conducted an Evaluation of the Effectiveness of the Nursing Home Case Mix Grouping Methodology (High, Medium, Low) in a Joint Project for the Three Statewide Nursing Home Associations.
  • Completed an Evaluation of the Impact of the Post-1987 Hospital Reimbursement System On All Health Maintenance Organization (HMO) Payors In New York for the NYS HMO Association.
  • Assisted the State Of Washington With the Implementation Of a Nursing Home Case Mix Pilot Project.
  • Completed a Study of the New York State Case Mix Study For Hospitals (Under a HCFA Grant, Serving As A Subcontract to the NYS Department Of Health). This Included an Analysis Of Fixed And Variable Cost Ratios And Development Of Costing Methodologies And Initial Design Of The SPARCS System.
  • Assisted With the Design And Development of the Costing Methodologies for the Rochester MAXICAP Reimbursement And Planning Experiment (Under a HCFA Grant to the Blue Cross Association).
  • Served as a Member Of The New York Quality Assurance System (NYQAS) Policy Advisory Group (Under a HCFA Grant) To Develop Quality Outcome Measures For Nursing Homes.
  • Completed a Conceptual Design of a Data Review System for the Island Peer Review Organization (IPRO) for Medicaid Utilization Review of Alternative Level of Care (“ALC”) Patients.
  • Retained to Evaluate the Health Care Report Card And Quality Measures Used To Rank Hospitals And Health Maintenance Organizations and to Develop Refined Measures.
  • Developed Compliance Plans and Assisted With Implementing Compliance Auditing.
  • Evaluated Payor Denial Patterns To Identify Administrative And Medical Documentation Solutions.
  • Reviewed the Orthopedic DRGs and Completed an Analysis Which Resulted In New DRGs (491 and 496 through 503).
  • Coordinated the National Medicare Lung Transplant Coverage Initiative, Designed to Facilitate a Consensus Among the Transplant Centers for Patient Selection Criteria and to Obtain Adequate Reimbursement from Medicare Through Definition of a New Diagnosis Related Group (DRG 495).
  • Studied the Fixed and Variable Hospital Cost Ratios for Blue Cross Of Northeastern New York for Use in Adjusting Hospital Prices for Patient Volume Changes.
  • Evaluated the Cost Effectiveness of a Left Ventricular Assist Device (LVAD - “Artificial Heart”) as an Interim “Bridge” for Heart Transplant Patients for the Medical Device Manufacturer.
  • Evaluated the Effectiveness of the Seed Cluster Grouping Methodology in Explaining Hospital Cost Differences for the Hospital Association Of New York State (“HANYS”).
  • Retained to Measure the Price Inflation ("Trend Factors") for Hospital Reimbursement In New York, New Jersey, Colorado, and Georgia.
  • Developed a Predictive Statistical Model of Hospital Energy Utilization for the Exxon Corporation for Use Nationally to Identify Those Facilities That Would Benefit Most from Energy Conservation Measures.
  • Evaluated A Financial Model Developed by Rensselaer Polytechnic Institute (“RPI”) for the Public Health Service to Predict Hospital Financial Health / Risk of Default for the Federal Loan Guarantee Programs. This Study Combined Quantitative Data Analysis With Qualitative Data Gathered Through On-Site Focused Interviews in Hospitals Throughout The United States.
  • Assisted the State of New Jersey's "Hospital Of The Future" Project, Which Sought to Consolidate Input from a National Panel on the Design of the Health Care System for the Year 2015. Mr. Shaw has provided expert testimony in legislative, regulatory and legal forums on:
    • Hospital and Long Term Care Financing Reform
    • Severity Measures for Hospital and Long Term Care Patients / Residents.
    • Payment, Quality Measurement, and Risk Adjustment Methodologies.
    • Productivity, Quality, and Economies of Scale Evidenced in Health Care Providers.
    • The Future of Rural Health Services.

Prior to founding NWI in 1984, Mr. Shaw was with the Hospital Association of New York State (HANYS). As Vice President of Management and Planning Services (MAPS), he oversaw information system support to both the trade organization and its consulting organization, as well as conducting research and developing quality, financial, and productivity monitoring tools and consulting services. He served in a number of positions in his 12 years at the Association and was the founder of the Financial Consulting and Research and Development Divisions. Much of his effort was focused on the integration of planning, financial and clinical issues and the integration of long term and acute care issues. Mr. Shaw is the author of "Who Pays and How? - Hospital Reimbursement in New York State" which served as the textbook for a series of statewide seminars held throughout New York. He is also co-author of "QA Outcome Measures in Long-Term Care" published by the Journal of Nursing Quality Assurance and numerous journal articles. Over the years, he has designed and presented seminars for researchers, administrators, financial directors and clinical staff throughout New York and the United States. Topics of these seminars have included:

  • Managed care, hospital, and long term care reimbursement, case mix, compliance, and risk issues.
  • Empowering the health care consumer under managed care.
  • Utilizing long term care assessment data as a management tool under prospective payment.
  • Implementing Formal Quality Improvement and Quality Assurance Systems.
  • Using patient classification tools to predict and evaluate appropriate cost and staffing levels.
  • Patient Documentation and Care Planning across the health care continuum.
  • Using hospital cost profiles and productivity monitoring tools to enhance efficiency.

He has also served on the faculties of Rensselaer Polytechnic Institute (RPI) and Russell Sage College. Mr. Shaw serves on the Board of the Healthy Schools Network, has served on the Board of the American Lung Association of New York State and is a member of the Healthcare Financial Management Association (HFMA), the New York Association of Homes and Services for the Aging (NYAHSA) and the New York State Health Facilities Association (NYSHFA). He received his Masters in Health Systems Management Engineering and a B.S. in Management Engineering from Rensselaer Polytechnic Institute in Troy, New York.