Will Congress Do an End Run Around Berwick? Don’t Bet Against It

Hospitals, through the American Hospital Association, did all they could to derail the 2.9% Final Inpatient Rule cuts from CMS—even enlisting the aid of a majority of senators and House members via letters protesting the cut to CMS Administrator Don Berwick. He ignored them. But they haven’t yet failed because in Washington, calling something final doesn’t mean it’s over.

Look for the AHA to try an end-run around Berwick to rescind the cuts through Congress. If they’re smart, they’ll ask the same representatives that signed their letters to come through for them again via legislation. And they are smart, if a little heavy-handed.

I’m not going to try to get into the merits of the cuts here, which go into effect for discharges occurring after Oct. 1. The two sides have agreed to disagree. Whether the cuts will harm patient care is debatable, and so is CMS’ decision to ignore the increasing severity of illness of hospital patients.

This whole disagreement might fade with time, but don’t bet on it. What we might be witnessing is the first challenge to Berwick’s authority as the healthcare cost-cutter-in-chief. Implied in the letters was a threat from representatives who, despite their protestations to the contrary, and the voting populace’s purported disgust with wasteful government spending, can’t help themselves from trying to bring home the bacon at every

opportunity. I’m no oddsmaker, but in an election year, I wouldn’t be surprised if some of those who signed the letter don’t try to override Berwick and CMS in such a way.

Berwick was brought on as a person who has intimate knowledge of how healthcare works—and doesn’t work. Through his previous longtime stint as the head of the Institute for Healthcare Improvement, he’s spent a career pointing out the myriad ways healthcare could be made better and less costly. Some of it has to do with simple blocking and tackling. By that, I mean treating the patient as a customer who needs to get well and whose care needs to be coordinated. Too often, enough healthcare providers—certainly not most—appear to treat patients as money-printing machines who belch cash—by virtue of being covered by a number of government and nongovernment

payers—whenever something is “done” to them. That may sound like a cynical statement, but cost to the patient and to the taxpayer has been absent from the treatment decision-making process for too long. In the past, Berwick and IHI have suggested ways healthcare can operate more efficiently, and now he’s in a position to actually do something about it.

I’m sympathetic to the AHA’s position. If my boss sat me down and told me I was going to take a 2.9% pay cut, I could either accept it or leave. Hospitals don’t have that option, for various reasons, but they also have a powerful ally in their corner that I don’t have—and neither does any individual patient. They can pressure Congress to make this problem go away.