Don Berwick and whether he can change Medicare and Medicaid

by Marianne Mattera

President Obama is planning to appoint Don Berwick — the Harvard pediatrician, recognized health policy expert, and head of the Institute for Healthcare Improvement (IHI) — as the new head of CMS.

Berwick’s nomination has been heralded by many as a terrific choice.

Our own health policy columnist, David Nash, said that “Berwick’s global following is a powerful political force that could be harnessed for real reform, and initiate the creation of real value through a fundamental change in the reimbursement structure. Imagine if aspects of his prior writings and research come true — CMS becomes a savvy shopper with global payment, pay for performance, and comparative effectiveness research with teeth.”

I first became aware of Berwick and his efforts a little more than a decade ago when a magazine that I would soon serve as editor-in-chief ran a series on re-engineering medical practice. The series was based largely on the IHI’s already-in-progress program aimed at upgrading the quality of outpatient care. Central to the program were improving patient access (by, among other things, revamping the way office visits are scheduled), reducing waste and inefficiency, improving doctor-patient and provider-community communications, and fostering access to clinical information at the point of care (read health information technology, EHRs).

So, Berwick has long championed the quality improvement movement and lord knows Medicare and Medicaid have quality issues — though it’s not the quality of the medical care delivered under those programs that I’m questioning right now.

And Berwick doesn’t advocate improvement in quality of care at the expense of physician income — but I suspect that, given the two federal agencies in question, physician reimbursement would be the first thing attacked so that we could “afford” better quality care.

I know that Berwick has previously served on national panels, including the U.S. Preventive Services Task Force, the National Advisory Council of the Agency for Healthcare Research and Quality, and several Institute of Medicine boards. But such service is far different from managing a vast government bureaucracy. And that’s what CMS is.

I find it very hard to believe that Berwick will be able to bring his passion and his insight — and yes, his independence — to bear in a position that is, essentially a cog in the Administration’s wheel.

I find it very hard to believe that he will be allowed to speak his mind freely or make the hard decisions that may be necessary but politically incorrect.

David Nash worries about it too. Nash asks: “Can he tame the beast? Can he manage the internecine politics?”

My assessment is: Probably not.  And if he does, I suspect he’ll be asked to resign.

And so, sadly, I’m almost hoping that Obama doesn’t appoint Berwick to the post.

I’d hate to lose Berwick’s fine mind and strong voice in the morass of government.

Marianne Mattera is Managing Editor at MedPage Today and blogs at In Other Words, the MedPage Today staff blog.

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