Nominee for Medicare-Medicaid agency has reputation for being ‘visionary'

Donald Berwick
Donald Berwick (Richard Chase - Via Bloomberg)
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By N.C. Aizenman
Washington Post Staff Writer
Wednesday, April 21, 2010

For two decades, Donald Berwick has made a career of finding innovative ways to improve health care and then persuading hospital administrators and doctors to adopt his recommendations.

That experience could prove useful if the 63-year-old Harvard University professor is confirmed as administrator of the federal Centers for Medicare and Medicaid Services.

The job, which has been filled through temporary appointments since 2006, is central to the success of the new law overhauling health insurance, the largest rollout of a social program since the 1960s. President Obama announced Berwick's nomination Monday.

Over the next decade, CMS, which is under the U.S. Department of Health and Human Services, will be charged with slashing hundreds of millions of dollars in spending by Medicare, the federal insurance program for the elderly. The agency will also need to cover an estimated 16 million more people through Medicaid, the federal-state insurance program for the poor.

Then there is the day-to-day task of managing a bureaucracy of 4,500 that serves nearly one in three Americans and has an annual budget of about $780 billion.

The largest organization that Berwick, a pediatrician, has led is the Institute for Healthcare Improvement. He co-founded the nonprofit Boston area consulting and research group, which has a staff of about 110, in 1991.

But Berwick's admirers in public health describe him as a "visionary" whose work at the institute has given him a direct role in transforming the way some of the largest health-care systems in the country do business.

Among the initiatives the institute has launched was a national campaign that helped thousands of hospitals implement measures proven to avert patient deaths.

Some of the reforms Berwick has championed are as simple as keeping patients propped up to prevent pneumonia or extending visiting hours so patients' loved ones can help monitor them.

Other measures have been more complex: developing checklists to cut back on bloodstream infections and creating rapid-response teams to swoop in at the first sign that a patient is deteriorating.

But the common theme in Berwick's work is "his ability to inspire doctors and hospital administrators to work together," said Nancy Nielsen, the immediate past president of the American Medical Association. "Don is so widely respected because he has worked in such a collaborative way."

Although Berwick's focus has been on improving care, several health policy experts said his methods often result in lower costs as well. They expressed confidence that Berwick would approach the task of cutting Medicare spending in that spirit.

"I would imagine there are going to be some hard trade-offs, so I'm delighted that Don will be at the helm to ensure that quality doesn't suffer," said Peter Pronovost, medical director of the Center for Innovation in Quality Patient Care at Johns Hopkins Medicine.

Democrats in the Senate said that, given Berwick's national stature and broad-based support, he would be easily confirmed under ordinary circumstances. But lingering partisan rancor over the health-care overhaul is almost certain to slow his confirmation, Senate sources in both parties said.

Berwick must first clear the Senate Finance Committee, where ranking Republican Charles E. Grassley (Iowa) said that he plans to vigorously "explore the nominee's preparedness for the enormous challenges that face the agency."

Staff writer Lori Montgomery contributed to this report.

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