Wednesday, April 23, 2014
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David Nash

POSTED: Monday, March 3, 2014, 6:00 AM
Filed Under: David Nash

Health reform means, in part, practicing a different kind of medical care. This new care will focus on the care of entire populations that we serve, not just on individual patients. While every individual is, of course, important, the healthcare system will soon be held accountable for outcomes of care across larger groups. These populations may be defined by persons with the same insurance coverage, folks in the same zip code, or even everyone who has diabetes in a clinical practice. We know that the health of populations is largely determined by so-called “social determinants of health” – factors like socioeconomic status, crime, and pollution.   Yet, we are just beginning to understand their full impact.

The United States, despite its outsize spending on health care services, ranks only 17th in the world with regard to our national health status. It seems clear to many experts that we are not getting the best return for the money we are spending!!  Shifting the focus to population health may change that.

If you are interested in these kinds of critical issues, I urge you to attend the 14th Annual Population Health Colloquium to be held in Philadelphia on March 17 through the 19th at the Loews Philadelphia Hotel. Among the major national figures who will be speaking are Dr. Jeffrey Brenner of the Camden Coalition (recent MacArthur Genius Award Winner and fellow Field Clinic blogger), the CEO of Humana, the Commissioner of Health for the State of New York, and the President and CEO of Thomas Jefferson University and its health system. Since health care is one of the largest and most important “businesses ” in our region, we all have a stake in the transition to a population health focus. You can learn more about this important conference by visiting, or by calling 215-955-6969.

POSTED: Monday, February 10, 2014, 6:00 AM
Filed Under: David Nash

After four years of medical school, physicians enter that “twilight zone” known as residency training.  This intensive, hazing-like program of on-the-job training is characterized by very long hours and increasing levels of responsibility.  I’m sure many readers have been in the great teaching hospitals that are bursting at the seams with residents.  However, even the most educated people oftentimes have no idea that they are not only paying for this training, but they’re sometimes getting a raw deal to boot!

Post-medical school training, called Graduate Medical Education, or GME, is primarily funded with public money, to the tune of $10 billion dollars a year, paid by Medicare.  Your tax dollars, in part, go to pay the salaries of physicians in training.  Currently, the average resident makes $112,642 per year, but on an hourly basis, that’s about on par with an unskilled laborer without a high school diploma.

GME is divided into two components.  Direct GME takes up about one-third of the dedicated Medicare funding; that pays for the trainees and the supervising faculty who watch over their work in the hospital.  The other two-thirds is called Indirect GME.  This compensates teaching hospitals for the higher costs associated with training new physicians and for the “lower clinical efficiency” - these new doctors tend to order more tests and are not as efficient as their older, more experienced colleagues. 

POSTED: Monday, November 18, 2013, 6:00 AM
Filed Under: David Nash

A delivery truck carrying your company’s goods is detoured more than 100 miles around a closed bridge, causing it to be late in getting key parts to a supplier, not to mention wasting gasoline and incurring extra labor costs.  The decaying bridge could not be repaired because the annual budget for the Commonwealth is out of control due to the ballooning cost of healthcare. 

This scenario clearly got the attention of an assembled group of leading corporate CEOs during a recent closed-door meeting. Business needs health reform because healthcare costs are accelerating like a runaway train, and a good portion of those costs make no sense and do not contribute to improving the health and well-being of employees.  Let me deconstruct this challenge by first asking several basic questions: What do we spend for care and why?, and What do we get for the money we spend?  Then I’ll propose a plan for engagement.

Healthcare costs are the key driver of the federal deficit, especially costs associated with entitlement programs like Medicare and Medicaid.  In fact, the percentage of the GDP dedicated to healthcare, perilously close to 18%, is nearly 4 times what the United States spends for our military worldwide.  If the entire healthcare industry were to somehow secede from the Union, it would represent the sixth largest GDP in the world!  The magnitude of this spending prevents investments in public education, communication, transportation, and places our entire infrastructure at risk. 

POSTED: Wednesday, May 8, 2013, 6:00 AM
Filed Under: David Nash

In recent months, I have been witness to a genuine groundswell of interest in improving the methods in which patient safety measures are taught, across the board, in medical education.

In January, there was the release by the Association of American Medical Colleges (AAMC) of “Teaching for Quality,” a report on integrating quality improvement and patient safety across the continuum of medical education.  The report articulates a broad vision for health care delivery, offers a strategy to increase faculty capacity, and makes three core recommendations focused on quality improvement and patient safety. I have been on the steering committee at the AAMC since the inception of this program, therefore I can vouch that the report addresses the need to increase the capacity of the academic medical centers, teaching hospitals, and medical schools of the U.S. to meet the challenges of health care in the 21st century. These challenges are numerous and include healthcare redesign, accountable care, cost containment, and the quality of care gap.

On top of “Teaching for Quality,” there was the announcement that the American Medical Association (AMA) will award $10 million in grants over five years to a group of medical schools to engage in a broad range of teaching innovations, including new ways of teaching and assessing core competencies, individualized learning plans, and a greater focus on patient safety, quality improvement and health care financing.

POSTED: Friday, March 1, 2013, 6:00 AM
Filed Under: David Nash

The Field Clinic is pleased to present the inaugural guest blog by Dr. David Nash, the Founding Dean of the Jefferson School of Population Health where he is the Dr. Raymond C. and Doris N. Grandon Professor of Health Policy.

My mother prefers restaurants that offer a complete meal for a set price, say, $20. This way, should she choose that option, she knows she’ll have a great experience that includes an appetizer, entrée and dessert, and she’ll know what it’s going to cost before the bill even hits the table.

You could say that when it comes to dining out, my mother prefers the bundled payment system. Smart lady, my mom.

About this blog

The Field Clinic reports and analyzes health care laws, government policies, and political trends that are transforming the care we receive and the way we pay for it. Read more about our panel of bloggers here.

This blog is produced in partnership with Kaiser Health News, an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health-policy research and communication organization not affiliated with Kaiser Permanente. Portions of this blog may also be found on and in the Inquirer's Sunday Health Section.

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Robert I. Field, Ph.D., J.D., M.P.H. Professor, School of Law & Drexel School of Public Health
Jeffrey Brenner, MD Founder of the Camden Coalition of Healthcare Providers, Medical Director of the Urban Health Institute at Cooper University Healthcare
Andy Carter President & CEO, The Hospital & Healthsystem Assoc. of Pa.
Robert B. Doherty Senior Vice President of Governmental Affairs & Public Policy American College of Physicians
Neil I. Goldfarb President & CEO of the Greater Philadelphia Business Coalition on Health
David Grande, MD, MPA Assistant Professor of Medicine at the University of Pennsylvania
Tine Hansen-Turton Chief Strategy Officer of Public Health Management Corporation
Drew A. Harris, DPM, MPH Director of Health Policy Program at the Jefferson School of Population Health
Antoinette Kraus Director of the Pennsylvania Health Access Network
Laval Miller-Wilson Executive Director of the Pennsylvania Health Law Project
David B. Nash, MD, MBA Founding Dean of the Jefferson School of Population Health
Howard J. Peterson, MHA Managing Partner of TRG Healthcare, a national healthcare consulting firm
Donald Schwarz, MD, MPH Deputy Mayor for Health & Opportunity and Health Commissioner for the City of Philadelphia
Paula L. Stillman, MD, MBA Healthcare consultant with special expertise in population health and disease management
Elizabeth A. W. Williams Senior Vice President & Chief Communications Officer for Independence Blue Cross
Krystyna Dereszowska A third-year law student concentrating in health at Drexel
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