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Q&A: Don Berwick Reflects on Healthcare Reform, Part I

Cheryl Clark, for HealthLeaders Media, December 6, 2012

HLM: We hear rumors you might return to CMS to spearhead the transition to health insurance exchanges in 2014.

DB:  I am happy being home with my family. And have no plans beyond that.

HLM: There is criticism that the pointy-headed healthcare policies wonks in Washington and Boston are out of touch with the front lines of the healthcare delivery system and don't have a sense of the real world. When you visit communities, do you hear people talking about problems you didn't anticipate?

DB: Let's start with your premise. We've been very much in the real world. IHI, the organization I used to lead, has relationships with thousands of hospitals and clinical groups around the country, and at the [IHI] national forum coming up next week, there will be 6,000 people from hundreds of hospitals and healthcare organizations and probably 49 countries.

To regard the improvement movement as being out of touch with the front lines is wrong.

And at CMS, there [are] 5,500 people who work there, and I was at first just astonished and then delighted with the level of competence and dedication of the workforce. There's so much unknown about the agency. And I visited all the regional offices, who know their doctor groups and clinical settings very well

The other thing I did was [reduce] administrative waste, which adds complexity where it's not needed... and the amount of administrative waste within CMS was quite high. I challenged the agency to identify outmoded regulations and rules and procedures that didn't make much sense.

An early request of the staff was, let's have a target of 50 rules and regulations that could be removed without harming patients, and would simplify life and make things better.

When we published the regulation, which was at the request of the White House, which was advocating for decreased complexity, we had about 100 rules that were removed with one stroke.

And we had enormous numbers of public meetings getting feedback on every regulation that we proposed, with comments and I read a lot of those comments.

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