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

Cheryl Clark, for HealthLeaders Media, December 6, 2012

HLM: Do you see more aggressive regulatory changes to value-based purchasing incentives and readmissions penalties, for example, more conditions added to the three that are now susceptible to readmissions penalties?

DB: I have a 3-year old grandson. I noticed at age 2, a child can stack blocks about four to six high. With my grandson last weekend, we stacked 24. Development is underway and the same is true with these metrics. We're just in the earliest episodes of learning how to measure at all.

The measures we really want to get to are global, around total system performance, "all or nothing" metrics, where you don't get partial credit if you leave something out, or measures that have to do with patient well-being and comprehensive care. That's where we need to go, but we're still on that journey.

HLM: What do you mean by "all or nothing"?

DB:
Let's say for a diabetes patient there are six things that should be done, check eyes, check feet, check A1c, and so forth. If you don't do one, you get zero, even if you did all the other five.

It's like buying a car and everything is fine except they left out the right front brake. That's a zero. That car is broken.  In healthcare, perfection is the goal, it's really key.

HLM: When will we start seeing "all or nothing" in regulations?

DB: They're already here on the private side. Lots of organizations are setting their own efficiencies very high, like Health Partners in Minneapolis, which has been using these for a decade. And the National Quality Forum has composite measures that are making progress. There's no question this is the way we should be going.

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