Berwick's Big Vision Will Make Him a Target If Obama Names Him Medicare Chief

Last Updated Mar 30, 2010 9:00 AM EDT

Donald M. Berwick, the Harvard professor, quality expert, and healthcare visionary whom President Obama is expected to nominate as administrator of the Centers for Medicare and Medicaid Services (CMS), is an inspired choice for that post. But his identification with the most progressive ideas in the health reform legislation could prove an impediment to his confirmation by the Senate.

It is, after all, no accident that Berwick, if confirmed, would be the first CMS Administrator since 2006, when Mark McClellan, MD, resigned from that position. In the interim, there have been three acting CMS administrators. That's an indication of how hard it is to get bipartisan agreement on the official who oversees $750 billion in outlays for Medicare and Medicaid, or about one fourth of the federal budget. And the Republican opposition to cooperating with Obama on anything related to health care has stiffened even further since the passage of the reform bill.

But if Republicans were able to look beyond the ends of their noses, they would see in Berwick a giant intellect, universally respected in the healthcare field, who is as nonpartisan as they come. To my knowledge, Berwick has never taken political sides. Rather, he has been single-mindedly committed to improving the quality and safety of healthcare. Through his work with the Institute For Healthcare Improvement, which he founded in 1991, this pediatrician-turned-crusader has saved countless lives through his organization's work with hospitals to improve their processes in very specific ways, such as reducing central-line infections and ensuring that prophylactic antibiotics are administered before surgery.

That's only part of Berwick's contribution. He was the guiding force behind two of the most important reports assembled by the Institute of Medicine: the 1999 tome To Err Is Human, which put hospital safety on the policy agenda, and Crossing The Quality Chasm (2001), which laid out the blueprint for improving preventive and chronic disease care by restructuring our system of healthcare delivery. More recently, he has strongly supported the formation of accountable care organizations, the planned hospital-and-doctor entities that are a key part of the reform agenda.

If Berwick is confirmed, he'll have to shoulder the burden of implementing reform over the next few years. He'll have to cut payments to Medicare Advantage plans, vastly expand the reach of Medicaid, set up CMS' new Innovation Center (which will revise Medicare payment methodology), and carry out several important demonstration projects authorized by the reform legislation. Although he's never run a large organization, he has formidable organizing and people skills, and I have no doubt that he'll be up to the job.

While Berwick will be constrained by congressional directives and institutional rules, his large vision focuses on nothing less than revamping the delivery system from top to bottom. For example, when I interviewed him for my book Rx For Healthcare Reform, here's how Berwick explained why he thought we could cut 30 to 40 percent out of healthcare spending without affecting quality:

The work of John Wennberg and Elliott Fisher at Dartmouth shows that the more intensive services are available in a community, the more that they're used without effect on the quality of care. So supply drives demand. It's a monster cost driver without value added.

This isn't what most of the healthcare community (aside from primary care doctors) wants to hear. It isn't what drug or device makers want to hear. And it's a major reason why Republicans will oppose Berwick. But it is the message that all stakeholders need to absorb and take to heart if we really want to control costs and make good healthcare available to everyone.

Image supplied courtesy of Christian Gidlif at Wikimedia Commons.

  • Ken Terry

    Ken Terry, a former senior editor at Medical Economics Magazine, is the author of the book Rx For Health Care Reform.