President Barack Obama found a point man for critical healthcare reform initiatives including comparative effectiveness research and cost-control, nominating Dr. Donald Berwick to be administrator of the Centers for Medicare and Medicaid Services.
Several reports, linked to White House officials, point to Berwick, a Harvard medical school professor, pediatrician, and president and CEO of the Cambridge, Mass.-based Institute for Healthcare Improvement, as the man for the top job at CMS, a role that hasn’t had a permanent inhabitant for four years.
In Berwick, 64, Obama has tapped a public health hawk minted in the same mold as Food & Drug Administration chief Margaret Hamburg. Berwick is an outspoken advocate on issues such as stopping preventable deaths and accidents in hospitals, improving reporting and analytical tools used by healthcare providers and instituting tighter controls on the costs of healthcare.
In the IHI’s 2009 annual report, Berwick wrote that we are entering a period in which wasteful healthcare practices “will become even less tolerable.”
“Eventually, we’ll have to face the music because waste in healthcare is integrally related to soaring and unsustainable costs,” he wrote. “We can’t whistle in the dark about this anymore. That’s not going to work. We have to bring total spending on health care down … way down.”
Today’s independent healthcare model needs to be replaced with silos in which healthcare officials share information on best practices and create better analytical tools to track things like preventable deaths, hospital accidents and the best ways to treat major health problems.
IHI already has a blueprint in place for Berwick’s vision, the “IMI improvement map,” an online tool that distills the best knowledge available on the key process improvements in patient care. The open resource is a web-based platform designed to allow hospitals to implement the patient care process improvements, broken down by such categories as quality, cost to implement, time to implement, difficulty in implementing and level of evidence on effectiveness, using a numeric scale from one to three.
In IHI’s annual report, Berwick wrote that he envisions patients and families having a larger role in aspects of healthcare improvements, including processes to reduce costs.
“Health care will not be something given,” he said. “But managed by patients themselves, in evermore collaborative agreements with providers.”
In addition, he has been a vocal advocate for more “democratization” in the healthcare process, citing the Internet as a model for the future of healthcare.
“It’s only a matter of time before this same democratization spreads to the structure and organization of the healthcare delivery system itself,” he wrote.
Berwick was more direct about inefficiencies in healthcare delivery during a
2007 interview with Katie Couric.
Donald Berwick
“When I order pizza it’s done on a computer,” he said. “Hospitals still run on paper. … They rely on heroism. The system needs to get more modernized. … You need to build a hospital like you build an airplane, where everything works together.”
If his appointment is confirmed by the U.S. Senate, Berwick’s vision could make a profound impact on healthcare delivery as he takes the reins of the country’s national insurance payer. CMS dictates decisions ranging from how much physicians are paid for certain procedures to which medical devices are covered. While it does not make the decisions for private insurers, the marketplace tends to follow its cues in establishing reimbursement.
MassDevice blogger Ed Berger, in a May 2009 post, called the position “directly critical to the eventual success of the health reform initiative.”
Speculation inside the Beltway at the time was that Berwick had been offered the job before but turned it down. CMS has not had a permanent administrator since 2006, when Mark McClellan stepped down.
According to his biography, Berwick has received numerous citations for his work, including being appointed “Honorary Knight Commander of the British Empire” by the Queen of England.
