As CMS nominee, Berwick would face changes and challenges

President Barack Obama will soon nominate Dr. Donald M. Berwick to "run Medicare and Medicaid, the programs that serve nearly one-third of all Americans, administration officials said Saturday," The New York Times reports.

"Dr. Berwick … has repeatedly challenged doctors and hospitals to provide better care at a lower cost. He says the government and insurers can increase the quality and efficiency of care by basing payments on the value of services, not the volume. Mr. Obama plans to nominate Dr. Berwick to be administrator of the Centers for Medicare and Medicaid Services, a unit of the Department of Health and Human Services that has been without a permanent chief since October 2006, when Dr. Mark B. McClellan stepped down" (Pear, 3/27).

The Wall Street Journal: "The post—among the most-critical to implementing the president's health overhaul—has been vacant for more than three years. Dr. Berwick runs the Boston-based Institute for Healthcare Improvement and is a pediatrics and health policy professor at Harvard University. His focus has been to improve patient safety by applying more systemized procedures to the medical field. … If confirmed by the Senate, Dr. Berwick, who has Washington experience but hasn't held a top agency job, would face an enormous task. The agency must prepare for a major expansion of the Medicaid federal-state insurance program for the poor starting in 2014, as required by the health-overhaul legislation. The program is expected to add some 16 million Americans by the end of the decade as part of the new law's expansion of insurance coverage." For Medicare, the major challenge "will be phasing in more than $400 billion in cuts over the next decade to health-care providers who participate in insurance program for the elderly without weakening it" (Adamy and Meckler, 3/29). 

CQ: "Berwick preaches that imbuing health care organizations with a culture of thinking through how to deliver care more safely and efficiently not only saves lives but reduces wasteful spending. Berwick predicts in [the Institute for Health Improvement's] annual report that wasteful practices in health care 'will become even less tolerable' and says 'we can't whistle in the dark about this any more. That's not going to work. We have to bring total spending on health care down . . . way down.' Berwick is perhaps best known for his '100,000 Lives' campaign built around the idea that certain specific practices can eliminate that number of deaths — which is the estimated number of deaths from medical errors that occur in the hospital each year" (Reichard, 3/28).

Bloomberg/BusinessWeek: Berwick "will be thrust into the political fight over the overhaul law." Berwick "has said patient records should be more easily shared, care should be better coordinated, and provider compensation should be based on results rather than the number of procedures. Republicans, who have promised to make repealing the law a central campaign issue in November, may focus more on that battle at Berwick's confirmation hearings than on his views, said Robert J. Blendon, a Harvard colleague" (Armstrong and Lauerman, 3/29).

Financial Times: "Republicans have been able to block 217 nominees under Senate rules that allow any single lawmaker to put an indefinite 'hold' on the individuals. Mr. Obama said the US Senate had a responsibility at least to allow his nominees to be voted on and approved or disapproved. 'But if, in the interest of political points, Republicans in the Senate refuse to exercise that responsibility, I must act in the interest of the American people and exercise my authority to fill these positions on an interim basis,' he said" (Kirchgaessner, 3/29).