For two decades, he and institute colleagues have worked with health-care institutions throughout the United States and internationally, coaching them on how to reduce medical mistakes and improve patients’ outcomes. He also helped write a pair of studies by the prestigious Institutes of Medicine that have had wide impact on thinking about health-care quality and patient safety.
At CMS, he has been trying to instill his views about systems, management and medical quality, holding seminars for staff members, urging them to collaborate with different parts of the agency and bringing in speakers. He is encouraging everyone there to spend a half-day at a hospital, doctor’s office or other medical site to ask the question, “What do we do that affects your work, and what can we do that will help?”
Although he had interacted with official Washington for years, Berwick acknowledged that, when he arrived, “I didn’t really know much about how government works. I had a citizen’s view.” Gail Wilensky, a friend and admirer who ran Medicare and Medicaid under President George H.W. Bush, said: “Don is not the most political of people” and has had “some amount of naivete as a result.”
The agency has been widely criticized, for instance, for rules it proposed this spring to create within Medicare “accountable care organizations” — a new form of managed care relying on teams of doctors and hospitals to improve the coordination of patients’ care and spend less money. Even health-care executives who agree with the basic idea have criticized many of the specifics. Berwick said the agency will alter the rules before they become final.
He has trained his focus most intensely on patient safety and better ways to organize health care. This spring, CMS announced a Partnership for Patients — an aspect of the law, but also vintage Berwick — that is giving out $1 billion to cut down on hospital infections and readmission of patients for whom things go wrong. So, far 1,800 hospitals have volunteered to take part.
Even some of his Democratic friends say that Obama placed him in an awkward spot. First, the president waited more than a year to name someone to the critical CMS administrator’s job, then he chose Berwick at a time of great political hostility, weeks after congressional Democrats pushed through the health-care law that Republicans already were vowing to dismantle.
Republicans focused, for instance, on academic writings in which Berwick had praised aspects of the British National Health Service; Republicans said his views were tantamount to support for rationing and socialized medicine.
The controversy, Berwick said, caught him by surprise. But in retrospect, he said, “I wouldn’t take a word back. . . .
My general reaction has been almost as if these people are talking about somebody else.”
Every nation, he said, must find a health-care system that fits it best. As for the rationing charge, he said: “Every bone in my body as a physician, even as a person, is to get everything they want and need to help them at every step. I have gone to the mat to get a last-ditch bone marrow transplant for a child with leukemia. . . . And they are telling me I’m a rationer? They haven’t met me.”
In January, Obama renominated Berwick, but the GOP criticism persists. “Unless his thoughts on health care have completely changed, I will once again oppose his nomination,” said one of his chief critics, Sen. Pat Roberts (R-Kan.), who reiterated his allegation that the administrator “has a record on rationing care.”
In March, 42 GOP senators — enough to block his confirmation — signed a letter, urging the president to withdraw Berwick’s name. Senate Finance Committee Chairman Max Baucus (D-Mont.), a key figure in his confirmation prospects, said publicly that the Republican opposition was too strong to move forward.
Berwick approaches the discord with a certain detachment. “This will sound a little weird,” he said, “but when you are a pediatrician or a father, you always are saying, what is this kid’s strength. . . . Even the people that disagree the most, they bring something to the table.”
Wilensky said, “I think basically he understands the handwriting on the wall. But, like many of us, he has a portion of him that hopes somehow it will come out differently.”
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