CMS Director Don Berwick’s gone. Now what?

Now that Don Berwick has returned home from Washington, what’s to become of Medicare?
The former head of the Centers for Medicare and Medicaid, widely acknowledged as one of the brightest and most effective health care executives in the nation, was only there for 17 months, a victim of politics. That’s sad, disheartening, and deeply concerning.
Here was a guy whose life’s passion is to improve the delivery of health care; one who founded and turned the Institute for Healthcare Improvement into one of the most effective agents for change in the nation; who, by all reports was doing a masterful job at CMS changing the culture to one of continuous improvement in the quality of care delivered while reducing the cost of that care.
Yet Dr Berwick couldn’t get approved by the Senate. He was rejected by Republican Senators who vilified him for such blatant transgressions as:
– complimenting one aspect of the British National Health Service (while ignoring Berwick’s pointed criticisms of NHS),
– explicitly acknowledging the US health care system rations care, and calling on politicians to acknowledge that fact as well (a quote remarkably similar to one from GOP Rep Paul Ryan)
These attacks were misguided, politically motivated, and in most instances relied on taking highly selective, out-of-context quotes to misrepresent what Berwick was actually saying.
For those unfamiliar with IHI, the basic premise was to take improvement techniques learned in industry and seek ways to apply them to health care. IHI has had a major impact on all areas of health care; their Improvement Map is widely used and demonstrates the Institute’s focus on bringing quality improvement – carefully thought out and rigorously evaluated – to health care.
What bothers me – a lot – about this is politicians decided that demagoguing and scoring political points was more important that reforming Medicare.
What Don Berwick was trying to do was exactly what needs doing – reform CMS to improve quality and strip out unnecessary cost. If we are ever to get health care costs under control, we have to do so by rationalizing what services get delivered, in what setting, by which providers, to which patients. CMS can be, and under Berwick has been, an enormous force for positive change.
The good news – to the extent there is any – is Berwick’s replacement is an accomplished, effective health care exec with a long history of achievement. Marilyn Tavenner.
Here’s a quote that bodes well for her tenure:
“The only way to stabilize costs without cutting benefits or provider fees is to improve care to those with the highest health care costs.”
Here’s hoping Ms Tavenner is actually allowed to do just that.