Ashish Jha, MD, MPH

Ashish Jha is an associate professor of health policy and management, Harvard School of Public Health, Boston, MA. He blogs at An Ounce of Evidence and can be found on Twitter @ashishkjha.

Ranking the world’s health systems: These results may surprise you

Ashish Jha, MD, MPH

Policy

September 24, 2017

I was recently by the New York Times’ the Upshot to rank eight health care systems they had chosen: Australia, Canada, France, Germany, Singapore, Switzerland, the United Kingdom, and the United States. This forced me to think about a pretty fundamental question: what do we want from a health care system?

What does an ideal health care system look like?

I would argue that most people want a health …

How much does it matter which hospital you go to?

Ashish Jha, MD, MPH

Policy

June 3, 2017

Of course, it matters a lot — hospitals vary enormously on quality of care, and choosing the right hospital can mean the difference between life and death. The problem is that it’s hard for most people to know how to choose. Useful data on patient outcomes remain hard to find, and even though Medicare provides data on patient mortality for select conditions on their Hospital Compare …

Men and women doctors versus correlation and causation

Ashish Jha, MD, MPH

Physician

January 27, 2017

Our recent paper on differences in outcomes for Medicare patients cared for by male and female physicians created a stir. While the paper received broad coverage and mostly positive responses, there have also been quite a few critiques. There is no doubt that the study raises questions that need to be aired and discussed openly and honestly. Its limitations — which the paper highlights — are important. Given the temptation …

The difference between male and female physicians. Here’s what it means.

Ashish Jha, MD, MPH

Physician

January 4, 2017

About a year ago, Yusuke Tsugawa — then a doctoral student in the Harvard health policy PhD program — and I were discussing the evidence around the quality of care delivered by female and male doctors. The data suggested that women practice medicine a little differently than men do. It appeared that practice patterns of female physicians were a little more evidence-based, sticking more closely to Read more…

The difference between male and female physicians. Here’s what it means.

Accountable care organizations: Who are the winners and losers?

Ashish Jha, MD, MPH

Policy

September 6, 2016

Recently, CMS sent out press releases touting over $1 billion in savings from Accountable Care Organizations. Here’s the tweet from Andy Slavitt, the acting Administrator of CMS:

NEW ACO RESULTS: physicians are changing care, w better results for patients & are saving money. Over $1B. https://t.co/FEfe3QErb5

— Andy Slavitt 🇺🇦 (@ASlavitt) August 25, 2016

The link in the tweet is to a press release. The link in the press release citing more details is to another press release. There’s little in the way of analysis or data about how ACOs did in …

Does publicly reporting hospital mortality rates improve outcomes?

Ashish Jha, MD, MPH

Policy

June 25, 2016

Get a group of health policy experts together and you’ll find one area of near universal agreement: We need more transparency in health care. The notion behind transparency is straightforward; greater availability of data on provider performance helps consumers make better choices and motivates providers to improve. And there is some evidence to suggest it works. In New York State, after cardiac surgery reporting went into effect, some …

Observation status and readmissions: The data may surprise you

Ashish Jha, MD, MPH

Policy

March 14, 2016

Because hospitals are expensive and often cause harm, there has been a big focus on reducing hospital use. This focus has been the underpinning for numerous policy interventions, most notable of which is the Affordable Care Act’s Hospital Readmissions Reduction Program (HRRP), which penalizes hospitals for higher than expected readmission rates. The motivation behind HRRP is simple: the readmission rate, the proportion of discharged patients who return to …

Bad data vs. no data: Defending ProPublica

Ashish Jha, MD, MPH

Policy

October 28, 2015

In July the investigative journalists at ProPublica released an analysis of 17,000 surgeons and their complication rates. Known as the Surgeon Scorecard, it set off a firestorm. In the months following, the primary objections to the scorecard have become clearer and were best distilled in a terrific piece by Lisa Rosenbaum. As anyone who follows me on Twitter knows, I am a big fan of Lisa — …

What is a 5-star hospital? The answer may surprise you.

Ashish Jha, MD, MPH

Policy

August 24, 2015

Now we’re giving star ratings to hospitals? Does anyone think this is a good idea? Actually, I do. Hospital rating schemes have cropped up all over the place, and sorting out what’s important and what isn’t is difficult and time consuming. The Centers for Medicare & Medicaid Services (CMS) runs the best known and most comprehensive hospital rating website, Hospital Compare. But, unlike most “rating” systems, Hospital Compare …

Why ProPublica’s Surgeon Scorecard is worth celebrating

Ashish Jha, MD, MPH

Physician

July 26, 2015

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Recently, Marshall Allan and Olga Pierce, two journalists at ProPublica, published a surgeon report card detailing complication rates of 17,000 individual surgeons from across the nation. A product of many years of work, it benefitted from the input of a large number of experts (as well as folks like me). The report card has received a lot of attention … and a …

Patient outcomes: It’s time to account for socioeconomic factors

Ashish Jha, MD, MPH

Policy

October 7, 2014

We recently had a readmission — a straightforward case, really. Mr. Jones, a 64-year-old homeless veteran, intermittently took his diabetes medications and would often run out. He had recently been discharged from our hospital (a VA hospital) after admission for hyperglycemia. The discharging team had been meticulous in their care. At the time of discharge, they had simplified his medication regimen, called him at his shelter to check in a few …

The difficulty of moving the needle on patient safety

Ashish Jha, MD, MPH

Policy

July 21, 2014

Adverse events — when bad things happen to patients because of what we as medical professionals do — are a leading cause of suffering and death in the U.S. and globally. Indeed, as I have written before, patient safety is a major issue in American health care, and one that has gotten far too little attention. Tens of thousands of Americans die needlessly because of preventable infections, medication errors, surgical …

Can we measure what it takes to be a good doctor?

Ashish Jha, MD, MPH

Physician

March 28, 2014

I recently spoke to a quality measures development organization and it got me thinking — what makes a good doctor, and how do we measure it?

In thinking about this, I reflected on how far we have come on quality measurement. A decade or so ago, many physicians didn’t think the quality of their care could be measured and any attempt to do so was “bean counting” folly at best or …

Patient safety and the human toll of inaction

Ashish Jha, MD, MPH

Policy

March 12, 2014

March 2nd through the 8th was National Patient Safety Awareness Week — I don’t really know what that means either. We seem to have a lot of these kinds of days and weeks — my daughters pointed out that March 4 was National Pancake Day — with resultant implications for our family meals.

But back to patient safety and National Patient Safety Awareness Week. In recognition, I thought it would be useful to …

What can we learn from health policy in China?

Ashish Jha, MD, MPH

Policy

January 16, 2014

I was just recently in Guiyang, the capital of the Guizhou province in China and had a chance to visit the Huaxi District People’s Hospital (HDPH), one of the largest “secondary” hospitals in the province. Like the rest of China, it has been gripped by the construction boom, recently opening a new surgery center and revamped medical facilities. They had a terrific EHR from a local vendor — probably more …

Do safety net hospitals get penalized under new payment models?

Ashish Jha, MD, MPH

Policy

December 2, 2013

The most commonly heard comment in healthcare these days is that we have to move from paying for volume to paying for value. While it may sound trite, it also turns out to be pretty true. Right now, most healthcare services are paid for on a fee-for-service basis — with little regard for the quality of that service. We clearly need to move towards value-based payments (sometimes referred to as …

Why quality doesn’t affect hospital CEO pay

Ashish Jha, MD, MPH

Policy

November 18, 2013

In my previous blog, I made the argument that whatever strategy we use to improve care in hospitals will not be implemented and executed well without proper focus by hospital leadership. So, it is in this context, that we recently published some pretty disappointing findings that are worth reflecting on.

We examined the pay of CEOs across U.S. hospitals and found that some CEOs got paid a lot more than others. This …

How do hospitals build a culture of quality?

Ashish Jha, MD, MPH

Policy

November 7, 2013

I was recently chastised by a colleague for being too negative in one of my pieces on hospital care. His is a remarkable story of what happens when things go well, and it has made me think a lot about why, in some places, things seem to work while in others, not so much.

He told me how a few months ago, soon after returning to Boston from a trip to China, he …

My patient experience wasn’t an outlier

Ashish Jha, MD, MPH

Physician

September 20, 2013

On a warm and sunny August Sunday, I was rollerblading with my kids on the Shining Sea Bikeway. On mile nine on the trip, I hit a tree root, went flying, and landed on my shoulder. I could tell immediately that something was wrong — I couldn’t move my arm and was in the worst pain of my life. Feeling for my left shoulder, it was obvious that I had …

Read more…

My patient experience wasn’t an outlier

The challenge of using health IT more effectively

Ashish Jha, MD, MPH

Tech

August 21, 2013

Just a little over four years ago, President Obama, in his inaugural address, challenged us a nation to “wield technology’s wonders to raise health care’s quality and lower its costs.” This was an awe-inspiring, “we will go to the moon” moment for the healthcare delivery system. But the next thought that ran through the minds of so many of us who work on health IT issues was this: how were we …

Ashish Jha, MD, MPH

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