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Will Dr. Berwick's Vision Survive?

December 8, 2011
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Healthcare reform in an age of political rancor

Last week Donald M. Berwick, M.D. formally stepped down as administrator of the federal Centers for Medicare and Medicaid Services, a leadership position he held as a recess appointment in July 2010. I think it’s significant that Dr. Berwick’s brief tenure both began and ended amid political intransigence, and that it is remarkable that during his brief tenure he was able to establish a vision to use Medicare as a force for change.

In an article on Dec. 5, New York Times columnist Joe Nocera called Dr. Berwick “the most qualified person in the country to run Medicare at this critical juncture and the fact that he is no longer in the job is the country’s loss.” As Nocera notes, Dr. Berwick is enamored by management experts such as W. Edwards Deming and pioneering companies such as Toyota, and he is convinced that their ideas of continuous improvement and cost reduction is possible in healthcare.

Nocera also makes the point that Dr. Berwick is a firm believer in universal healthcare, and regards President Obama’s health care reform efforts as a first step in achieving it. This, in Nocera’s view, made him a political casualty. Berwick noted in an interview that he tried to re-conceptualize Medicare as an improvement organization with a triple aim: better healthcare, better health for the overall population, and lower costs.

Unfortunately, Dr. Berwick’s 17 months as CMS head was far too short a time to accomplish that undertaking. The question is, will his successor be able to carry out his vision? Last month President Obama announced that he nominate Marilyn Tavenner, the agency’s principal deputy administrator to take on the top CMS post.

Tavenner does share Dr. Berwick’s vision. As noted by Healthcare Informatics Editor-in-Chief Mark Hagland in an article on Dr. Berwick’s resignation last month, she reportedly told a gathering of the National Association of Medicaid Directors that “the only way to stabilize costs is to improve the care of those with the highest healthcare costs.”

Dr. Berwick’s vision remains intact. Unfortunately, so does the political climate that existed during his too-brief time as CMS Administrator.