Donald Berwick, MD, Prospects for Success as Head of CMS

CMS, the Centers for Medicare and Medicaid, has a new director – Donald Berwick, MD, MPP, FRCP. Dr. Berwick is Clinical Professor of Pediatrics and Health Care Policy in the Department of Pediatrics at the Harvard Medical School and Professor of Health Policy and Management at the Harvard School of Public Health. He is also a pediatrician, Adjunct Staff in the Department of Medicine at Children's Hospital Boston, and a Consultant in Pediatrics at Massachusetts General Hospital.

As if that were not enough, he is Founder, President, and CEO of the Health Improvement Institute in Cambridge where he has focused on issues such as pay-for-performance, continuous quality improvement, the success of Medicare demonstration projects, hospital safety, and the role of electronic personal health records in improving the system. He has been extremely active in helping the Institute of Medicine write its groundbreaking reports, e.g, Crossing The Quality Chasm and To Err is Human. Furthermore he is an inspiring motivational speaker, and author of many books on how to make the system better.

He is a charter member of the Boston Medical Academic Complex. He is a graduate of Harvard College, the John Kennedy School of Government, the Harvard Medical School, a pediatrician at the Harvard –affiliated Children’s Hospital in Boston, a Harvard associate professor of Pediatrics, a big academic dog at the Harvard School of Public Health. He has, in short, an impeccable Harvard pedigree.
His philosophy of medicine and its management can be summed up in his six “No Needless List:

--No needless deaths

--No needless pain or suffering

--No helplessness in those served or serving

--No unwanted waiting

--No waste

--No one left out

Furthermore, he is close to and familiar with the work of other Obama advisors and admirers, including David Blumenthal, MD, Obama’s, National Coordinator for Health Information Technology David Cutler, PhD, chief medical advisor and professor of applied economics at Harvard, and Elliot Fisher, MD, Professor at Dartmouth Institute for Health Policy and Clinical Practice and Professor Of Medicine and Community and Family Medicine at Dartmouth Medical School.

Berwick is a world-class policy wonk. I would classify him as a pragmatic idealist and a genuine humanist. His academic peers respect him and honor him, and under his leadership, the Institute of Health Care Improvement has carried out a number of successful projects on the ground in a number of settings.

He has earned the admiration of many in the academic and government sector, and he is being widely praised by prominent liberals such as Maggie Mahar, a former Yale English professor who wrote Money-Driven Medicine: The Real Reason Money Costs So Much, and Bull! A History of the Boom 1982-1999, which denigrates market-driven capitalism. In The Health Care Blog, March 30, “Who is Don Berwick and What Will He Mean for Health Reform?” she waxes enthusiastically about the prospects of Obama transforming and reforming the U.S. health system.

Among other things, Berwick is said to have the experience and savvy to:

1. Reduce medical errors
2. Make your hospital stay more pleasant.
3. Make preventive care more effective
4. Help hospitals provide high-quality care without high costs.=
5. Has a realistic attitude, He knows talk is cheap:, but changing cultures is hard.

Berwick would appear to be the ideal candidate as head of CMS. Certainly his admirers in the academic and government establishment think so.

I am not so sure. The job of simultaneously transforming and reforming U.S. health care, altering the complex U.S culture, and managing a huge bureaucracy covering100 million Americans may be beyond the reach and talents of any single individual. Berwick has not practiced medicine “in the trenches” for 15 years, and many physicians are skeptical that he appreciates the difficulties of sustaining a viable practice given government regulations, extensive health reforms, the influx of 32 million more patients, and the expense and disruptions imposed by electronic medical records. Lastly, his Boston health policy perspective and the Massachusetts experience with universal coverage may not apply to the rest of the U.S. which may be more conservative and resistant to Obamacare than the rest of the U.S.