Don Berwick, a Harvard trained pediatrician who is founder and president of the Institute for Healthcare Improvement, may soon take the helm of the largest medical payer in the nation—the Centers for Medicare and Medicaid Services.
Administration officials reportedly have confirmed President Obama is expected to appoint Berwick, according to numerous reports. The CMS administrator position has been vacant since 2006.
James Conway, IHI senior vice president, said Sunday that he could not confirm whether Berwick has been asked or has accepted.
"We're well aware of the rumors, but at this point, they're only rumors," Conway says.
He says that just two months ago, similar rumors falsely claimed Obama planned to name Geisinger Health System President Glenn Steele, MD, to the post. "I can tell you this," Conway says. "It's been a long journey."
President Obama's pick must be confirmed by the Senate, a process that may reignite political concerns about the new health reform laws.
Many health policy officials last week said Berwick's track record makes him a perfect candidate for the job.
"A guy like Berwick could accomplish in two or three years what it would take others a decade," says Joseph Scherger, MD, medical director for quality and informatics at Lumetra Healthcare Solutions, a patient safety organization designated by the Agency for Healthcare Quality and Research.
But the task is not expected to be easy. The new director will pave the way for the $800 billion agency to implement dozens of demonstration projects and initiatives to improve the quality of healthcare at the same time as it enforces not paying for care associated with avoidable errors.
Those demonstration grants will be issued out of the agency's new Innovation Center.
The agency will also add millions of newly insured to the Medicaid rolls while cutting some $500 billion from Medicare. To do so, it will make what are sure to be unpopular decisions about what health procedures are worth paying for based on new definitions and evidence of efficacy.
But new CMS director will implement as federal policy what Berwick has been working on for years: Designing ways to reduce hospital readmissions, identifying adverse events—both those that are avoidable and those that are not—and structuring systems that incentivize providers by paying them for delivering higher quality care.
Conway says that more than ever before, the new director will need to balance improving the country's health with reducing the cost of care. That means cutting out waste, which includes the time and money now spent on treating conditions health providers could prevent.
Conway mentioned urinary tract infections and pressure ulcers, two common hospital occurrences that will be prevented with changes in reimbursement policies, he says.
The new CMS director will also be expected to drill down to the reasons why the cost of care across the country is so highly variable relative to morbidity and mortality, and thereby gain clues for what healthcare works, and what merely adds to the federal bill. And Berwick has been deeply engrossed in efforts to find the answers.
Conway says Berwick is now working with Elliott Fisher, director of the Center for Health Policy Research at Dartmouth; surgeon Atul Gawande, who wrote the widely read article in The New Yorker, "The Cost Conundrum" last year, and Mark McClellan, MD, CMS administrator from 2004 to 2006.
Whoever takes the job "will have to be visionary, an exquisite collaborator and someone who can show the way," says Conway.
"Berwick would be good if HHS and the President give him the authority and resources to do the job," says Steve Shortell, MD, dean of the School of Public Health at the University of California at Berkeley. "Otherwise, he will be very frustrated and quit within a year."