Berwick: Building ACO Rule His 'Best Experience' at CMS

By Haydn Bush	December 07, 2011
Live coverage from the 2011 IHI National Forum.

ORLANDO ? During a freewheeling press briefing Tuesday at the Institute for Healthcare Improvement 2011 National Forum, outgoing Centers for Medicare & Medicaid Services Administrator Donald Berwick, M.D., characterized his time crafting the rule for Medicare's accountable care organization/shared savings initiative as one of the highlights of his year and a half in Washington. Berwick stepped down last week from CMS; it had been clear for several months that he would not receive Senate confirmation for a full term at the agency following his July 2010 recess appointment from President Obama.

"The best experience of my whole time there was working on the ACO rule," Berwick said. "That's the way democracy should work."

Given the heavy criticism of the initial version of the ACO rule back in April by hospitals and other providers, that statement came as bit of a surprise to many of us gathered in the pressroom, but Berwick insisted that he enjoyed the period of back-and-forth conversations before the final rule was released in October.

"I was the beneficiary of dialogue," Berwick said.

When asked about the political climate that ultimately led to the end of his tenure ? much of it stemming from a 2008 speech Berwick gave praising the British National Health Service on the eve of its 60th birthday ? Berwick argued that politicians, policymakers and providers all need to work harder to understand what each group is trying to accomplish.

"There is on both sides of [the political spectrum] a need of more understanding and connection with the world of delivery of care," Berwick said. "People who deliver care need to develop a capable understanding of what it's like to create policy."

Free, however, from the restraints of working for the Obama administration, Berwick did respond to some of the criticism he received.

"I think the sound bite world, 'Berwick likes the British,' give me a break," Berwick said. "Many of the Senators who criticized me heavily for my beliefs, to this day have never spoken a word to me."

Berwick also detailed his thoughts on curbing U.S. health care costs by as much as 20 to 30 percent overall by taking aim at six categories for improvement: reducing wasteful processes, addressing overtreatment, relaxing overly burdensome administrative requirements, reducing price variation for equipment and procedures, and fighting fraud and abuse.

In fact, when asked about his biggest regret at CMS, Berwick said he wished he'd focused more heavily on process improvement, arguing that the difficult economic climate has created a "horse race" between cutting health care services and working to reduce costs by improving quality.

"The horse I don't like is the cut-the care-horse, which is decreasing ambition and cutting back on supports to people," Berwick said. "That's the blunt, immediate way to save money if you're out of money. What you see here in this meeting is, don't change the care, but change the way care is given. If I could start again, I'd hit the ground faster on improvement."

Berwick, who headed IHI before accepting the CMS appointment, made a point of praising the process improvement work on display at this week's meeting, saying he remained optimistic that work to improve quality while reducing costs would gather steam.

"You need 20 to 30 percent of the industry to say we've got to change, and it's here in this room" at IHI, Berwick said.

The National Forum, of course, is dedicated to process improvement of that nature, and earlier Tuesday I had the chance to chat with Rick Foster, M.D., senior vice president of quality and patient safety for the South Carolina Hospital Association, about efforts by a group of hospitals in his state to build a robust reporting system to identify adverse events and communicate openly and fully with patients about potential harm. �Foster's thoughts are below:

Email your thoughts on Don Berwick's tenure at CMS to hbush@healthforum.com.

Haydn Bush is senior online editor for Hospitals & Health Networks magazine. Follow his tweets at www.twitter.com/haydnbush.

The opinions expressed by authors do not necessarily reflect the policy of Health Forum Inc. or the American Hospital Association.

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