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Donald Berwick: The Good Doctor at CMS

 |  By Jim Molpus  
   December 02, 2010

In our annual HealthLeaders 20, we profile individuals who are changing healthcare for the better. Some are longtime industry fixtures; others would clearly be considered outsiders. Some are revered; others would not win many popularity contests. All of them are playing a crucial role in making the healthcare industry better. This is Donald Berwick's story.

So much about leadership is timing. Donald Berwick's timing for leading the Centers for Medicare & Medicaid Services may be the perfect man for his times, or just the opposite, depending on who you ask.

Medicare alone now covers 47 million Americans and accounts for 12% of all federal spending. Some 48 million Americans are signed up for Medicaid, a number that will grow by an estimated 15 million under the provisions of the Patient Protection and Affordable Care Act. The CMS that Berwick inherited was already a massive, influential, but largely stagnant bureaucracy. Berwick's goal is to transform CMS from a bureaucracy into something more like a revolutionary force. He intends on using the reach and power of the federal government to herd elements of a fractured industry  in hopes of closing gaps in waste that costs taxpayers dollars and threaten patient care, all while overseeing the most massive expansion of government coverage since the Johnson administration.

Berwick's record as a healthcare shepherd is unassailable. Through the Institute for Healthcare Improvement he founded, Berwick and his team cleverly hooked into the healthcare industry's untapped desire to improve with catchy, actionable programs like the 100,000 Lives Campaign. His critics worry that at CMS, what Berwick envisions would be less like feel-good voluntary programs and more toward British-style universal care of which he has spoken fondly. It was that part of his background that conservatives rang loudly as his nomination was announced. His confirmation never came, and Berwick was installed through the political backdoor of a recess appointment that expires next year.

Even in the space of a few months, Berwick has launched the Center for Medicare and Medicaid Innovation, and has pushed the first steps for the creation of accountable care organizations. During that same time Berwick has been largely withdrawn from the public spotlight, declining interview requests and letting speeches at carefully chosen industry events reveal his plans one layer at a time. Still, many in the industry's leadership hold out hope that Berwick can use his strengths to shape CMS in ways that his predecessors have not even attempted.

"Dr. Berwick's biggest strength is that he understands the current delivery system is broken and, therefore, we need to reform the delivery system as well as access to insurance in order to improve the quality, patient safety, and inefficiencies," says Dan Wolterman, CEO of Houston-based Memorial Hermann.

Berwick's background as a family physician and history of pushing patient-centered leadership will serve him well. "He has a history of caring for the well-being of patients, families, and caregivers, coupled with the vision to see a better way of doing things and the courage to make that happen," says Jeff Thompson, MD, CEO of Gundersen Lutheran Health Systems in La Crosse, WI. Chris Van Gorder, CEO of San Diego-based Scripps Health says Berwick is not only familiar with the industry and its key players, but is proven at "healthcare change concepts" that will be necessary at CMS.

But even with his strengths, the political landmines are being set. Unraveling or even repealing the Act was a recurring theme in the midterm elections. "Change is harder in an atmosphere of polarized distrust," Thompson says. "Too many in politics, medicine, and insurance have power and money as the lead priorities, not the well being of the citizens."

And even with the debate over the cost of healthcare being in the national focus for two years, Berwick still may have the convince the public, Wolterman says. "Dr. Berwick's biggest hurdle is to educate the citizens of this country that our current healthcare system is unsustainable and inefficient," Wolterman says. "We all need to be open to a new way of delivering high quality healthcare in value-driven manner that improves the health of the individuals in our community and that the health reform law, as it is currently written, will not get us to this desired outcome." It does not help that Berwick does not have the political mandate behind him. "He lacks experience as a government administrator and he does not have the full support, or for that matter, the approval of Congress for his position," Van Gorder says. "That means he will not have bipartisan support for changes he suggests to Congress."

Hopes are still high that with his background and unique relationships with the industry that Berwick will, as Thompson hopes, "change CMS from a payer of bills to an organization that helps guide us to better value in healthcare."

Berwick's to-do list is daunting. Says Wolterman: "I hope Dr. Berwick pushes CMS to write clear implementing regulations in a timely fashion that take into account the provider perspectives. I hope he promptly removes regulatory barriers that currently exist which prevent hospitals, physicians, and other providers from coming together to be an ACO. And I hope he convinces congress and the administration to pass a new bill that includes specific healthcare delivery system reforms and individual accountability for health which are missing in the newly passed health reform bill."

In patient safety, much is made of the "rights" in care: the right drug given to the right patient at the right time. In the case of Berwick's tenure at CMS, he may have the right training, background, and industry respect to drive CMS to something new. The key questions remain whether his particular fix is the right dose, and whether the politics, the industry, and the economy are converging at the right time for him. 

Jim Molpus is the director of the HealthLeaders Exchange.

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