David B. Nash, MD, MBA

David B. Nash is founding dean, Jefferson School of Population Health, Thomas Jefferson University, Philadelphia, PA, and blogs at Nash on Health Policy and Focus on Health Policy.

A population health approach to wellness

Policy

May 28, 2012

FACT: Four determinants of health account for 40% of all deaths in the U.S. – smoking, unhealthy diet, physical inactivity, and alcohol use.

FACT: A mere 3% of Americans do all of the relatively “simple” things they should to stay healthy – i.e., exercise for 20 minutes 3 times a week, don’t smoke, eat fruits and vegetables regularly, wear seat belts regularly, and remain at their appropriate BMI.

FACT: According to the …

Improving patient safety in ambulatory care

David B. Nash, MD, MBA

Policy

April 3, 2012

Back in 2000, a group of experts convened by the Agency for Healthcare Research and Quality (AHRQ) reported that, although substantial medical error and injury was occurring in the ambulatory setting, very little research had been done to understand the reasons why.

To address what they recognized as a serious issue, this expert panel made 11 specific recommendations that were intended to stimulate research in this area.

Fast forward to the present …

4 possible scenarios for the future of primary care

David B. Nash, MD, MBA

Policy

March 4, 2012

For some 30 years now, I have been tracking the work of a gifted “futurist” — one Clement Bezold, PhD.

In this context, a futurist is a social scientist who specializes in making systematic predictions of the future of society, either in general or with respect to a particular segment.

Dr. Bezold has done considerable thinking about the future of healthcare, much of which he has captured in his books (“The Future …

Patient preferences may not be rational, but they are not irrelevant

David B. Nash, MD, MBA

Policy

February 4, 2012

Everyone in our industry — policymakers, clinicians, healthcare facility administrators, public and private payers, technicians, pharmacists — shares concerns about the state of healthcare in the U.S., each of us from a slightly different viewpoint.

The thread that joins us all is that one day each of us will be a patient.

As its title suggests, patients are central to almost every provision of the Patient Protection and Affordable Care Act (Act), …

An annual checkup on the Affordable Care Act

David B. Nash, MD, MBA

Policy

December 12, 2011

As we approach the end of what has been another roller-coaster year for our country, it seems an appropriate time for an “annual checkup” on healthcare reform in the U.S.

Like many of my colleagues, I have followed the implementation of the monumental Patient Protection and Affordable Care Act (ACA) with great interest, mild trepidation, and a small measure of optimism.

It’s hard to believe that almost two years have flown …

What patients actually say to their physicians is largely unknown

David B. Nash, MD, MBA

Patient

October 22, 2011

Every once in a while, I come across a new concept or technology application that really captures my imagination.

This was the case when I became aware of an enterprise whose core business is patient-physician communication.

What patients actually say to their physicians — and what physicians actually say to their patients — is largely unknown.

A company called Verilogue ventured into this previously uncharted territory and began to audio record patient-physician interactions.

To …

The ethics of being on a pharmaceutical advisory board

David B. Nash, MD, MBA

Meds

August 27, 2011

While diligently perusing a stack of unread journals, a piece in the July 25, 2011 issue of Modern Healthcare caught my attention.

Titled “What’s the Agenda?” this special report deftly navigated the murky waters of “physician participation on advisory boards” and managed to present an accurate appraisal of the issues.

Here is a brief recap.

Back in the days before “medical ethics” issues were commonplace, pharmaceutical and medical device manufacturers were accustomed …

Partnership for Patients to improve patient safety

David B. Nash, MD, MBA

Patient

August 3, 2011

When physician blogger Kevin Pho wrote about involving patients in healthcare reform in a recent article in USA Today, one thing he failed to mention is a novel government initiative that has been flying below most of our radar screens — the “Partnership for Patients: Better Care — Lower Costs.”

Why was it necessary to call out patient centeredness as a separate initiative?

Although no one disputes that those of us …

Will paying for outcomes improve healthcare quality and efficiency?

David B. Nash, MD, MBA

Policy

June 4, 2011

With the expected cutbacks in healthcare funding and the increasingly dismal outlook for “new” money in the healthcare pot, “value” has quickly become a key watchword.

In the past decade, we’ve seen many public and private payers implement value-based, pay-for-performance (P4P) programs as a means of spurring healthcare providers to improve the quality of services they provide and, tangentially, reduce the …

National Quality Strategy and Partnership for Patients to improve care

David B. Nash, MD, MBA

Policy

May 6, 2011

One year after passage of the Affordable Care Act, the Department of Health and Human Services (HHS) has unveiled two programs that will most certainly be transformative for U.S. healthcare, affecting both quality and safety.

With the announcement of the first-ever National Quality Strategy in March, HHS signaled a strong commitment to improving the quality of healthcare.

In essence, …

Treating patients with pre-diabetes: Weight loss and carbohydrate restriction

David B. Nash, MD, MBA

Conditions

April 8, 2011

What physician has not stifled a groan when a patient presents with a chief complaint of “I just don’t feel right, Doc.”

About this time last year, I had that “not quite right” feeling and vague, seemingly unrelated symptoms … sweating, mid-morning headaches, and frequent feelings of hunger, which I was accustomed to satisfying with a muffin.

Like most people — patients and clinicians alike — I ignored these subtle signals.

One evening, …

High rate of surgical site infections (SSIs) in our nation’s hospitals

David B. Nash, MD, MBA

Physician

March 10, 2011

By now, most healthcare professionals — and many well-read consumers — are aware of the disturbingly high rate of surgical site infections (SSIs) in our nation’s hospitals.

Each year, approximately 500,000 surgical patients develop SSIs. In some types of operations, such as colorectal surgery, the rate is close to 10%.

Many hospitals submit information about SSIs in their institutions through the …

Patient safety lapses in the hospital

David B. Nash, MD, MBA

Physician

January 31, 2011

Earlier this month, at the third annual American Medical Student Association Patient Safety and Quality Leadership Institute, I listened with sympathy — and, frankly, a certain amount of discomfort — to a fourth-year medical student’s account of his grandmother’s recent hospitalization at a well regarded inpatient facility in New York City.

Admitted with an initial diagnosis of pneumonia, Cole Zanetti’s grandmother languished in the hospital for almost four weeks.

As the medically …

Read more…

Patient safety lapses in the hospital

Childhood obesity and chronic illnesses that result from being overweight

David B. Nash, MD, MBA

Patient

January 4, 2011

Our national health status is in imminent danger from the effects of a condition that most population health experts acknowledge is out of control.

I am speaking of obesity — and, in particular, its increasing prevalence in American adolescents and children.

Almost every study that has been done concerning obesity shows a correlation with soda consumption. As a result, some states and municipalities have tried to implement initiatives that make it more …

A National Quality Strategy can create improve patient safety

David B. Nash, MD, MBA

Policy

November 18, 2010

Among the many provisions in the Patient Protection and Affordable Care Act are elements intended to assure that every American has access to healthcare that is patient-centered, affordable, and of the highest clinical quality.

In my mind, one of the act’s most essential goals is to establish a National Health Care Quality Strategy — one that integrates disparate federal and private sector initiatives, building on and expanding current quality assessment and …

Unintended consequences from healthcare reform

David B. Nash, MD, MBA

Policy

October 27, 2010

In early October, the New York Times published two articles that addressed a pervasive problem from slightly different perspectives. Boiled down to its essence, the problem is the unintended consequences of some provisions of the new healthcare reform legislation.

In his well crafted article, entitled “Health Care’s Uneven Road to a New Era,” David Leonhardt explored the impact caused by the introduction of new regulations into a “status quo” system.

So-called “mini-med” …

Why doctors should care about Regional Extension Centers (RECs)

David B. Nash, MD, MBA

Policy

October 8, 2010

Over the past year, states across the country have begun to develop Regional Extension Centers (RECs) to help support the broad electronic health record (EHR) initiative passed as part of the economic stimulus package in 2009.

Why should physicians care? With benefit of a little background information, the answer is pretty clear.

The evidence suggests — and it is generally believed — that adoption of EHRs by physicians and other healthcare providers …

Explaining the critical gap of primary care physicians

David B. Nash, MD, MBA

Physician

September 29, 2010

There is a critical gap in the supply of primary care physicians in the U.S., and it should come as no surprise that our existing primary care delivery and payment models are at the heart of the issue.

The traditional primary care model — medical care provided by a physician and a small support staff, often without benefit of health information technology (HIT) — was developed at a time when the …

Today’s new physicians are unable to improve patient safety

David B. Nash, MD, MBA

Education

August 10, 2010

It has been 10 years since the landmark Institute of Medicine report “To Err is Human” uncovered disturbing deficiencies in the quality of our nation’s medical care.

Progress in correcting these deficiencies remains frustratingly slow, and it has become clear that achieving the quality and safety improvements we seek will require us to examine our approach to medical education.

Although today’s newly minted physicians are well prepared in the science of medicine …

Healthcare reform’s focus on outcome and how that affects doctors

David B. Nash, MD, MBA

Policy

June 25, 2010

With the signing of national healthcare reform into law, the U.S. healthcare system faces almost immediate — and substantial — transformation. I spent a recent Sunday reading all that I could find in order to get my arms around this massive piece of legislation and to understand its health policy implications.

Here is my view from 50,000 feet.

I needn’t list all of the aspects relating to expanded coverage and insurance reform …