Sunday, July 11, 2010

The Value of Don Berwick at CMS


Today I am offering a little more opinion than usual; this just as a disclaimer upfront. I want to talk about the recess appointment of Don Berwick as administrator of the Centers for Medicare & Medicaid Services (CMS) and the potential value for patients attached to this appointment.

The Appointment
As you've probably heard, President Obama appointed him during a recess of congress, which means that we will not have to be confirmed. There has been a lot of outrage about this in the media and the blogosphere since it would be more democratic if congress has a say in who runs a Federal agency that spends hundreds of billions of dollars each year. However, there were concerns that the Republicans in congress would have blocked Berwick or significantly delayed his appointment (of note, CMS has been without a real leader since 2006). Interestingly, there were a few hundred recess appointments in the Bush years.

The Potential Value
CMS is in the midsts of changing standard to hold health care providers more accountable. For example, preventable conditions acquired such as falls, certain infections, pressure ulcers and "never-events" such as objects left in the body during surgery, air embolisms, and transfusion reactions due to blood incompatibilities. In 2012, a national program will be started to create "accountable care organizations" to ensure costs and quality, and it will be adminstered by - you guessed it - CMS (see Health Affairs article by Elliot Fischer and others with a proposal on the details).
However, it's not just Medicare and Medicaid which will finally (or I should say, hopefully) focus not just on quality but also on value; it will also benefit other health insurances purchasers including single individuals. The health care reform bill will lead to the creation of health insurance exchanges and "smart buys" by small businesses and individuals. As in coding/billing and coverage decision-making, CMS is expected to set standards for the whole industry.

The Candidate
Don Berwick has been called "healthcare’s most innovative and influential leader" (link). He has created and lead the Institute for Health Care Improvement which is empowering health care providers to improve their quality. Examples include national campaigns to drastically reduce if not completely eliminate ventilator-associated pneumonias and other hospital-acquired infections. As CMS (and other payors) are not paying for these now preventable infections, on top of the health benefits "bundles" like these are now also saving money for the providers. He is also known for his self-proclaimed extreme patient-centeredness; just read his recent address to the Yale Med School class of 2010. There are resources on Berwick and his accomplishments on the Kaiser Health News website.

My Conclusion
The White House said congress "[was] going to stall the nomination as long as they could, solely to score political points." Health care needs CMS with its purchasing power to implement promising solutions to not just increase the quality but ensure the value of health care that not just Mediare and Medicaid but all patients will receive from their providers. This will be hard without someone like Berwick at one of the central controls. I think the value of this recent appointment for patients will be enormous.

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