If, as mainstream news media outlets had reported earlier this week, it turns out that President Obama does plan to nominate Donald M. Berwick, M.D., the president and CEO of the Cambridge, Mass.-based Institute for Healthcare Improvement (IHI), as administrator of the federal Centers for Medicare and Medicaid Services (CMS); and if President Obama does in fact nominate him for that post, it would represent a watershed moment for healthcare system quality nationwide, for obvious reasons. By making such a move before the ink had even dried on the sweeping healthcare reform legislation passed by Congress at the end of last month, the administration would confirm what supporters of healthcare reform legislation had long claimed: that the concept of healthcare reform was not just about health insurance reform, as important as that element had been to the passage of the final bill through Congress; but that internal healthcare reform was also a key component in the administration's and Congress's intent in passing such legislation. After all, Dr. Berwick is justifiably famous as one of the industry's standard-bearers for the critical cause of improving patient safety and care quality, and has been for years.
And while the range of quality of CMS administrators has oscillated rather considerably over the years, on the whole, most CMS administrators have fallen somewhere along the able-but-routine-bureaucrat spectrum, with a few worthy exceptions. Don Berwick stands outside that mold, in manifold positive ways. And who better to help Health and Human Services Secretary Kathleen Sebelius develop a national quality improvement strategy, as directed by healthcare reform? Or to help shape how such highly commendable concepts as accountable care organizations, bundled payments, and medical home models, come fully into being? Dr. Berwick would be the executive overseeing the creation of the Center for Medicare and Medicaid Innovation that the legislation calls for, which presumably would be the main engine for developing such reimbursement innovations.
At the same time, Berwick would be entrusted with creating a Medicare-wide value-based purchasing program, which would establish system-wide the kinds of innovations that have borne such terrific fruit under the current CMS/Premier pay-for-performance program developed by CMS and the Charlotte, N.C.-based Premier Inc. And he would obviously be the federal executive who would have to interface with the independent Payment Advisory Board created under the legislation. Given his fierce advocacy of a healthcare system that provides higher levels of patient safety, care quality, reliability, and efficacy, I can think of no one better-qualified than Don Berwick to oversee CMS. I have interviewed him myself, and have found him to be as genuinely passionate about the great work he's done at IHI as he appears in articles he's written or that have been written about him.
There's no question that whoever takes the helm at CMS will be faced with a cornucopia of policy, payment, quality, and other issues, many of them deeply pressing. But if the Obama administration had wanted to signal a commitment to truly improving the quality and patient safety of the healthcare system, and not merely addressing the insurance and cost issues bedeviling U.S. healthcare, it couldn't have issued a more meaningful symbolic gesture than to apparently choose Don Berwick to lead CMS at this pivotal time in the history of U.S. healthcare.
