Obama To Name Medicare/ Medicaid Director
President Obama will soon name Dr. Donald M. Berwick, an iconoclastic scholar of health policy, to run Medicare and Medicaid, the programs that serve nearly one-third of all Americans, administration officials said Saturday.
Dr. Berwick, a Pediatrician, is president of the Institute for Health Care Improvement in Cambridge, Mass. He 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.
If confirmed by the Senate, Dr. Berwick would have a huge plate of responsibilities under the new health care law.
The law, signed Tuesday by Mr. Obama, will expand Medicaid to cover 16 million more people, squeeze nearly a half-trillion dollars out of Medicare in the next 10 years and establish many demonstration projects to test innovative ways of delivering health care.
Dr. Berwick’s nomination would be subject to Senate confirmation. Senators would almost surely use a confirmation hearing as a forum to debate the merits of the new health care law and to investigate how the administration plans to carry it out.
Steven D. Findlay, a health policy analyst at Consumers Union, said: “This would be a spectacular appointment. Don has been an intellectual force in health care for decades. He helped forge many ideas incorporated in the new health care law.”
As examples, Mr. Findlay cited provisions of the law intended to reduce readmissions to hospitals, prevent hospital-acquired infections and hold doctors and hospitals more accountable.
Dr. Elliott S. Fisher, director of the Center for Health Policy Research at Dartmouth Medical School, said Dr. Berwick was “a visionary leader who can motivate people to change.”
However, he does not appear to have experience managing a large bureaucracy.
The Medicare and Medicaid agency has about 4,400 employees and spends more than $800 billion a year, making it the largest purchaser of health care in the country. As administrator, Dr. Berwick would spend much of his time defending the health care overhaul, writing regulations to carry it out and fielding calls from members of Congress.
Dr. Berwick has denounced “the insanity of health care that costs too much and achieves too little.” But at the same time, he celebrates the work of hospitals that have reduced medical errors and deaths by the systematic application of proven techniques. And he wants to disseminate the secrets of communities that provide high-quality care at low cost.
Dr. Berwick could help shield the White House from Republican charges that Mr. Obama’s policies would lead to the rationing of care or even a government takeover.
At his institute’s annual conference in December, Dr. Berwick issued this challenge to health care providers: “Over the next three years, reduce the total resource consumption of your health care system, no matter where you start, by 10 percent. Do that without a single instance of harm, without rationing effective care, without excluding needed services for any population you serve.”
He said he had learned from his own medical problems, which include osteoarthritis in his right knee. “It comes from medical error, botched surgery when I was a medical student, aggravated by years of jogging,” he said.
Doctors urged him to have a knee replacement operation several years ago, but he decided instead to have just a “steroid injection,” and the outcome has been fine, he said.
In 1998, Dr. Berwick was a member of an advisory commission appointed by President Bill Clinton that recommended a patients’ bill of rights and steps to reduce medical mistakes.
He was also a member of a blue-ribbon panel that focused national attention on medical errors and patient safety in 1999. The panel, created by the Institute of Medicine, an arm of the National Academy of Sciences, said that medical errors caused tens of thousands of deaths in hospitals each year.
From 1996 to 1999, Dr. Berwick was the first independent member of the board of trustees of the American Hospital Association.
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Sources: NY Times, Harvard Medical School, Institute for Health Care Improvement, Boston.com, Youtube, Google Maps
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