Donald Berwick

Donald Berwick
Donald Berwick
Administrator of the Centers for Medicare and Medicaid Services
Incumbent
Assumed office
July 7, 2010
President Barack Obama
Preceded by Marilyn Tavenner (Acting)
Personal details
Born 1946 (age 64–65)
New York City, New York, U.S.
Alma mater Harvard University

Donald Mark Berwick (born 1946) is the Administrator of the Centers for Medicare & Medicaid Services (CMS), and was formerly President and Chief Executive Officer of the Institute for Healthcare Improvement (IHI)[1] a not-for-profit organization helping to lead the improvement of health care throughout the world. On July 7, 2010, Barack Obama appointed Dr. Berwick to serve as the Administrator of CMS through a recess appointment.[2][dead link]

Berwick has studied the management of health care systems, with emphasis on using scientific methods and evidence-based medicine and comparative effectiveness research to improve the tradeoff among quality, safety and costs.[3][4][5] Among IHI's projects are online courses for health care professionals for reducing Clostridium difficile infections, lowering the number of heart failure readmissions or managing advanced disease and palliative care.[6]

Berwick's critics have cited his statements about the need for health care to redistribute resources from the rich to the poor, and his favorable statements about the British health care system. They quote Berwick as saying, “The decision is not whether or not we will ration care - the decision is whether we will ration with our eyes open.”[7][dubious – discuss] They point to statements such as, “Any health care funding plan that is just, equitable, civilized and humane must, must redistribute wealth from the richer among us to the poorer and the less fortunate. Excellent health care is by definition redistributional.”[8][9]

Supporters contend rationing already is done by insurance companies and Berwick simply wants transparency and accountability in medical decisions.[10][dead link]

Berwick is Clinical Professor of Pediatrics and Health Care Policy in the Department of Pediatrics at the Harvard Medical School and Professor of Health Policy and Management at the Harvard School of Public Health.[11] He is also a pediatrician, Adjunct Staff in the Department of Medicine at Children's Hospital Boston, and a Consultant in Pediatrics at Massachusetts General Hospital.

Contents

Biography

Berwick graduated from Nathan Hale-Ray High School in Moodus, Connecticut. Berwick graduated with a B.A. from Harvard College, and received an M.P.P. from John F. Kennedy School of Government at Harvard University and an M.D. from Harvard Medical School. He completed his medical residency in pediatrics at Children's Hospital Boston.

Berwick began his career as a pediatrician at Harvard Community Health Plan; in 1983 he became the plan's first Vice President of Quality-of-Care Measurement.[12] In that position, Berwick investigated quality control measures in other industries such as aeronautics and manufacturing and considered their application in health care settings.[citation needed] From 1987-1991, Berwick was co-founder and Co-Principal Investigator for the National Demonstration Project on Quality Improvement in Health Care, designed to explore opportunities for quality improvement in health care. Based on this work, Berwick left Harvard Community Health Plan in 1989 and co-founded the IHI.

Based in Cambridge, Massachusetts, IHI works to accelerate improvement by building the will for change, cultivating promising concepts for improving patient care, and helping health care systems put those ideas into action. Employing a staff of approximately 100 people and maintaining partnerships with hundreds of faculty members, IHI offers programs that aim to improve the lives of patients, the health of communities, and the satisfaction of the health care workforce. IHI’s work is funded primarily through fee-based programs and services, and also through the support of foundations, companies, and individuals. IHI provides program scholarships, research and development, professional education, and initiatives in developing countries.

IHI's vision for health care is an adaptation from the Institute of Medicine's six improvement aims for the health care system – care that is safe, effective, patient-centered, timely, efficient, and equitable:[13]

  • No Needless Deaths
  • No Needless Pain or Suffering
  • No Helplessness in Those Served or Serving
  • No Unwanted Waiting
  • No Waste
  • No One Left Out

Berwick has published over 129 articles in professional journals on health care policy, decision analysis, technology assessment, and health care quality management. He is the co-author of several books, including Cholesterol, Children, and Heart Disease: an Analysis of Alternatives (1980), Curing Health Care (1990), and New Rules: Regulation, Markets and the Quality of American Health Care (1996).

Nomination and controversy

On April 19, 2010, Dr. Berwick was nominated to be Administrator of the Centers for Medicare and Medicaid, which oversees the two federal programs.[14]

Some felt his policy ideas could cut health care costs.[15] Conservatives criticized Berwick, based on comments he made about health care being, by definition, redistribution of wealth, rationing care with "our eyes open" and complete lives system.[16]

Berwick advocates cutting health costs by adopting some of the approaches of Great Britain’s National Health Services (NHS) and its National Institute for Health and Clinical Excellence (NICE). NICE evaluates the costs and effectiveness of medical therapy that is covered by the NHS, as guidance for local authorities to decide what to cover. Mark McClellan, who served in the Bush administration, also advocated adopting some of NICE's methods.[17]

Conservative critics claim, "NICE decides which healthcare people will get and which they won’t."[18] Philip Klein in The American Spectator dubbed him “Obama’s Rationing Man.”[19] The chairman of NICE called these statements "outrageous lies."[20]

Senator John F. Kerry defended Dr. Berwick against “phony assertions” and accused Republicans of using an “attack machine [to] make his nomination a distorted referendum on reform.”[21]

Dr. Berwick was installed by recess appointment on July 7, 2010 before confirmation hearings were scheduled by the Democratic-controlled Senate committee.[22] Dr. Berwick could thus serve until the summer of 2011 without a Senate approval. The White House had talked up the possibility of a re-nomination through the fall of 2010; on January 26, 2011, the President re-nominated Dr. Berwick. On March 4, 2011, 42 U.S. Senators wrote the White House and asked for the nomination to be withdrawn. The signers of the letter broke along partisan lines as all were Republicans.

Awards and honors

  • Ernest A. Codman Award, 1999
  • Alfred I. DuPont Award for excellence in children’s healthcare, 2001
  • American Hospital Association, "Award of Honor", 2002
  • Fellow of the Royal College of Physicians in London, 2004
  • Honorary Knight Commander of the Most Excellent Order of the British Empire, 2005
  • Purpose Prize for "enlisting wide-scale cooperation and scientifically-proven protocols to help hospitals improve care and save more than 100,000 lives," 2007[23]
  • The 13th Annual Heinz Award for Public Policy, 2007[24]

Quotations

  • "Some is not a number. Soon is not a time." (slogan for IHI's completed 100K Lives Campaign, now slogan for IHI's 5 Million Lives Campaign in progress)[25][26]
  • "We are guests in our patients’ lives; and we are their hosts when they come to us. Why should they, or we, expect anything less than the graciousness expected by guests and from hosts at their very best. Service is quality."[27]
  • "We are not hosts in our organizations so much as we are guests in our patients’ lives."[28]
  • "Some say that doctors and patients should now be partners in care. Not so, I think. In my view, we doctors are not our patients' partners; we are guests in our patients' lives. We are not hosts. We are not priests in a cathedral of technology."[29][30]
  • "You could have protected the wealthy and the well, instead of recognizing that sick people tend to be poorer and that poor people tend to be sicker and that any health care funding plan that is just, equitable, civilized and humane must, MUST redistribute wealth from the richer among us to the poorer and the less fortunate. Excellent health care is, by definition, redistributional."[31]

The quote "What can you do by next Tuesday?" is frequently credited to Berwick but seems to have been coined by the authors of Improving Care for the End of Life: A Sourcebook for Health Care Managers and Clinicians, which they wrote under the IHI aegis.[32]

Selected publications

References

  1. ^ Galewitz P. Local hospitals and doctors join forces to improve health care, restrain costs. Kaiser Health News. 2009 Jul 22. Accessed 2009 Jul 25.
  2. ^ [1] Obama nominates Berwick for top CMS job. Modern Healthcare. 2010 Apr 19. Accessed 2010 Apr 19.
  3. ^ Rethinking Comparative Effectiveness Research.
  4. ^ Interview with Donald Berwick. Katherine T. Adams, Biotechnol Healthc. 2009 June; 6(2): 35-36, 38.
  5. ^ Carmichael, Mary (March 29, 2010). "Five Things You Should Know About Donald Berwick, the New Medicare/Medicaid Chief". Newsweek. http://www.newsweek.com/blogs/the-human-condition/2010/03/29/five-things-you-should-know-about-donald-berwick-the-new-medicare-medicaid-chief.html. 
  6. ^ Who Is Don Berwick and What Will He Mean for Reform? By MAGGIE MAHAR March 30, 2010.
  7. ^ Rethinking Comparative Effectiveness Research. Interview with Donald Berwick. Biotechnology Healthcare Magazine June, 2009
  8. ^ Obama Nominee Donald Berwick’s Radical Agenda by Ben Domenech, May 12, 2010
  9. ^ ‘Death panels’ were an overblown claim – until now By Michael Tanner | Published: 05/27/10 at 12:00 AM | Updated: 05/27/10 at 2:06 PM
  10. ^ Obama Bypasses Senate for New Medicare Chief
  11. ^ Report: hospital medication errors commonplace. Talk of the Nation, National Public Radio. 2006 Jul 28. Accessed 2009 Jul 25.
  12. ^ Feder BJ. Thomas Pyle, 67, innovator in 1980s health care plans. New York Times. 2007 Jul 21
  13. ^ Institute of Medicine Vision and Values [2]
  14. ^ White House. President Obama Nominates Dr. Donald Berwick for Administrator of the Centers for Medicare and Medicaid Services. 10 April 19.
  15. ^ Editorial, "Donald Berwick, a nominee well-suited to trim the fat on health care", The Washington Post, June 29, 2010
  16. ^ Obama's cynical recess appointment of Donald Berwick, By Ruth Marcus, The Washington Post, July 8, 2010; 2:50 PM ET,
  17. ^ The Evidence Gap: British Balance Benefit vs. Cost of Latest Drugs, By GARDINER HARRIS, New York Times, December 2, 2008
  18. ^ Anderson, Jeffrey H (2010-04-29). "Not NICE". The Weekly Standard. http://www.weeklystandard.com/blogs/not-nice. Retrieved 2010-06-04. 
  19. ^ Klein P. “http://spectator.org/archives/2010/05/13/obamas-rationing-man” American Spectator. 2010 May 13.
  20. ^ Official Defends British Health Service Against ‘Outrageous Lies’, By GARDINER HARRIS, New York Times, August 21, 2009
  21. ^ Milligan S. Kerry comes to defense of nominee to run Medicare, Medicaid programs. Boston Globe. 2010 May 14.
  22. ^ Pear, Robert (July 6, 2010). "Obama to Bypass Senate to Name Health Official". New York Times. http://www.nytimes.com/2010/07/07/health/policy/07recess.html. Retrieved August 19, 2010. 
  23. ^ Civic Ventures. Five social innovators over age 60 receive $100,000 Purpose Prize (news release). 2007 Sep 4. Accessed 2009 Jul 25.
  24. ^ The Heinz Awards, Donald Berwick profile
  25. ^ Institute for Healthcare Improvement. "Campaign". Institute for Healthcare Improvement. http://www.ihi.org/IHI/Programs/Campaign/. Retrieved 2010-05-13. 
  26. ^ Institute for Healthcare Improvement. "Overview of the 100,000 Lives Campaign". Institute for Healthcare Improvement. http://www.ihi.org/IHI/Programs/Campaign/100kCampaignOverviewArchive.htm. Retrieved 2010-05-13. 
  27. ^ Kaiser Permanente (Winter 1999). "The Permanente Journal, Volume 3 No. 1" (PDF). Kaiser Permanente. p. 9. http://xnet.kp.org/permanentejournal/winter99pj/insides.pdf. Retrieved 2010-05-12. 
  28. ^ Berwick, Donald M., MD, MPP (2002). "Escape Fire: Lessons for the Future of Health Care" (PDF). Commonwealth Fund. p. 54. http://www.commonwealthfund.org/usr_doc/berwick_escapefire_563.pdf. Retrieved 2010-05-12. 
  29. ^ Berwick, Donald M., KBE, MD, MPP, FRCP (London), FRCGP, FRCPS (Glasgow) (November 25, 2008). The epitaph of profession. British Journal of General Practice. doi:10.3399/bjgp08X376438. PMC 2629825. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2629825. 
  30. ^ Berwick, Donald M., KBE, MD, MPP, FRCP (London), FRCGP, FRCPS (Glasgow) (2008). "The epitaph of profession" (PDF). British Journal of General Practice. p. e4. http://www.aha.org/aha/content/2009/pdf/bjgp_08_JohnHuntLecture_Berwick_AOP1.pdf. Retrieved 2010-05-12. 
  31. ^ Berwick, Donald M., MD (8). "Transcript: Dr. Donald Berwick's Speech to the British National Health Service". Kaiser Health News. http://www.kaiserhealthnews.org/Stories/2010/July/07/berwick-british-NHS-speech-transcript.aspx. Retrieved 2011-09-20. 
  32. ^ Beresford, Larry (April 30, 2010). "Don Berwick and End-of-Life Care". The Growth House Blogging Portal: Larry Beresford. TypePad. http://growthhouse.typepad.com/larry_beresford/2010/04/don-berwick-and-endoflife-care.html. Retrieved 2010-05-13. 


External links

Blog posts
Political offices
Preceded by
Marilyn Tavenner
Acting		 Administrator of the Centers for Medicare and Medicaid Services
2010–present		 Incumbent

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