Possible Medicare/Medicaid Chief Brings New Ideas to Medicine

Dr. Donald Berwick, nominated to head Medicare and Medicaid, wants to reward physicians for better outcomes.  Dr. Donald Berwick, a Harvard-educated pediatrician and Harvard Medical School professor, is President Barack Obama’s choice to head the Centers for Medicare and Medicaid Services (CMS), the parent agency of Medicare and Medicaid.  A sharp critic of the way healthcare is delivered in the United States, Berwick believes the system is inefficient and lacks an efficient information-sharing apparatus.  In addition to his practice and academic work, Berwick is the founder of the Institute for Health Care Improvement, a think tank that focuses on “cultivating promising concepts for improving patient care and turning those ideas into action.”

Berwick believes in improving the quality of healthcare so physicians are rewarded for better outcomes rather than on a per-procedure basis.  Although it’s unlikely that this idea could be applied to the medical profession, Medicare and Medicaid are large enough that changing the traditional way healthcare is delivered would echo throughout medicine.  Together, Medicare and Medicaid cover 100 million Americans – approximately one-third – and accounted for $750 billion of federal spending in 2009.  According to the Congressional Budget Office, that totals 20 percent of the federal budget.

Berwick’s nomination, which requires Senate confirmation, has some opposition, primarily from Senator Tom Coburn (R-OK) who is a practicing obstetrician.  “One concern I have is that he’s an advocate of comparative effectiveness,” Coburn said.  “There may be one or two or three ways of doing something.  I want to do what’s best for the patient, not necessarily what’s cheapest.”

David Helms, CEO of AcademyHealth, is a Berwick supporter.  According to Helms, “I think Don Berwick as a practicing physician will be able to communicate with other practicing physicians in a way that’s persuasive.”

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