Berwick Resignation Is a Loss for Responsible Health Care

Patients’ rights advocates lost a valuable team member this month.

Dr. Donald Berwick resigned as administrator of the Centers for Medicare and Medicaid Services (CMS) for reasons wholly political. The respected, forward-thinking medical professional opted to leave rather than continue in the role for which President Obama sought Congressional approval, but resorted to a so-called “pocket” appointment when Senate Republicans blocked his nomination last year.

The appointment, which Obama made when the Senate was in recess, was in effect until the end of this year. Berwick, a pediatrician, has served 17 months and is leaving, as opposition among Republicans remains strong. They claim Berwick is a fellow traveler with Obama’s health-care reform movement-the Affordable Care Act, or ACA-and all too willing to ration health care.

They’re not completely wrong, but they’re not right.

As recounted on Medscape.com, when Obama nominated Berwick in April last year, he had headed the Institute for Healthcare Improvement, and various organizations supported the move, including the American College of Physicians, AARP, Walmart and Consumers Union.

In his temporary tenure at CMS, Berwick helped implement several elements of the ACA pertaining to the Medicare and Medicaid programs. Among them were regulations for accountable care organizations (ACOs). Those groups of health-care providers improve outcomes and reduce costs by coordinating the care of Medicare patients and, as a reward, get a cut of the money saved.

Berwick also shepherded a pilot program to effect essentially the same change-and benefits-for physicians, rewarding them for providing better quality versus higher quantity of care for the quality as opposed to the quantity of their services. Known as the Comprehensive Primary Care Initiative, the program assists primary care doctors in:

  • helping patients with serious or chronic diseases follow personalized care plans;
  • giving patients 24-hour access to care and health information;
  • delivering preventive care;
  • engaging patients and their families in their own care; and
  • working together with other doctors, including specialists, to provide better coordinated care.

Dr. Glen Stream, president of the American Academy of Family Physicians, described Berwick for Medscape as someone “with an impeccable background in quality improvement and a willingness to evaluate healthcare from top to bottom.” Stream doesn’t know if the initiatives Berwick supports will succeed in improving the quality of and lowering its cost, but like many of his professional colleagues, he give him props for addressing thorny medical-industrial issues others won’t.

Among them are the president and chief executive officer of the American Medical Group Association and the chief executive officer of the American College of Cardiology. The latter, Dr. Jack Lewin, applauds Dr. Berwick for listening to physicians while trying to reform the health-care system. As Medscape notes, when organized medicine initially gave a thumbs-down to the ACO rules, Berwick “went back and changed them significantly,” Lewin said.

“CMS is trying to do its job as a regulatory agency, but facilitate innovation at the same time,” Lewin said. “They’re partnering with us. That’s clearly part of Don’s legacy.”

“It’s been a great era. It’s too bad we don’t have a few more years of it.”

Because of his willingness to accept the limitations of modern health-care delivery, Berwick was scorned in Congress and all over the conservative blogosphere as “Dr. Death Panel,” referring to his past statements supporting Britain’s National Health Service and accepting that rationing of healthcare is inevitable.

“The decision is not whether or not we will ration care – the decision is whether we will ration with our eyes open,” Berwick is quoted as saying in Biotechnology Healthcare magazine in 2009. “And right now, we are doing it blindly.”

For people more concerned about the quality, accessibility and cost of health care more than who wins political points making it happen, Lewin summarized Berwick’s situation for Medscape: “Unfortunately, he’s been a scapegoat for Republicans who are mad about the ACA.”

Here’s an interesting interview with Dr. Berwick in the New York Times, where he gets off some parting shots about what’s wrong with the politics of our health care system.

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