In his first appearance before Congress this week, Centers for Medicare & Medicaid Services Administrator Donald Berwick answered some predictably tough questions from Senate Finance Committee members—about potential conflicts of interest from previous affiliations and how the department intended to pay for many programs outlined by ACA.
The opposition also made known their displeasure that Berwick had received charge of a government office with a larger budget than the Pentagon by recessed appointment, instead of a Congressional vote. Ranking committee member Sen. Chuck Grassley, R-Iowa, expressed his frustration that in spite of repeated requests from Republicans, "there was never a nomination hearing."
Yet he was advised by Republican members that questioning today was only a warm-up for the grilling he would receive in subsequent committee hearings, particularly when he makes an initial appearance before a GOP-controlled House committee.
Some of the strongest criticism came from Sen. Orrin Hatch, R-Iowa, who said that normally, he would be a strong ally of Berwick, but "since the passage of this new health law, the reality has failed to meet the rhetoric on everything from the promised cost reductions to Americans keeping the coverage of their choice. I fear this is only the beginning of these impacts and that it's essential that we fully understand the consequences of this new law."
The hearing was almost exclusively dedicated to healthcare reform issues, including proposed Medicare spending cuts and the expansion of the Medicaid program. When questioned about a report's findings that indicated Medicare cuts under the new healthcare law would jeopardize access for beneficiaries, Berwick assured the committee that CMS was dedicated to increasing access to Medicare.
"Beneficiaries will find themselves in better shape after implementation of the act," he said. "The new law strengthens our ability to measure quality and use good market forces on behalf of beneficiaries to find them the best possible deals on health plans, supplies, and medicines."
When asked about his priorities, Berwick responded that the overall priority is to protect the public trust and trust fund that pays for Medicare and Medicaid, and ensure the longevity and viability of this system. And when pressed about specific activities, he articulated four goals for CMS: to work better with other agencies and the private sector; reduce waste within the agency; improve patient care—specifically patient safety; and move toward a more integrated care environment.
This gave him a platform to explain many of the coordinated care efforts—such as the health home and accountable care organizations—CMS was pursuing, guided by the healthcare reform law. "Better care for chronically ill means coordinated care," he said. "The ACA offers us a tremendous range of opportunities for making it possible for clinicians to get together."
He also explained the ACO concept at the request of committee chair Max Baucus, D- Mont. "It's a really exciting part of the new law, the chance to encourage that type of coordinated care, especially for chronically ill people," Berwick said. "The ACO would take responsibility for the care of a group of patients with a primary care base. And it operates on the fee-for-service side of Medicare."
In spite of the somewhat hostile environment, Berwick managed express his gratefulness in being selected to run the nearly $800 billion federal healthcare program serving nearly 100 million Americans.
"I feel incredibly lucky to join CMS at such an historic time, a time of promise for our nation's healthcare," he said. "How can we make sure the best treatment is within the reach of every single American? We need to address the rising costs of healthcare, costs that are stretching public and private capacities."