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Donald Berwick Nominated by White House to Head CMS

By Jane Norman, CQ HealthBeat Associate Editor

April 19, 2010 -- The White House on Monday announced that Donald Berwick has been nominated as administrator of the Centers for Medicare and Medicaid Services, filling the administration's last major health care position 15 months after President Obama took office.

The nomination was delayed while Congress and the White House were preoccupied with the year-long battle to enact the health care law, but Berwick's selection came as no surprise since White House officials said in late March that Berwick would be the nominee. It puts Obama's selection at the helm of an agency that will be central to the work of implementation of the new law (PL 111-148) as Medicare cuts are put in place and Medicaid undergoes a massive expansion. CMS is a major purchaser of health care in the United States and influential in its cost.

Yet it's also a tough and sensitive post in its need for a chief who can keep at bay the many members of Congress with strong opinions about federal health programs that exercise a direct impact on many constituents' lives.

Obama in this pick has selected a pediatrician by training who's focused on quality improvement in health care in his career and is already well-known throughout the health care policy world.

Berwick currently is president and CEO of the Institute for Healthcare Improvement, and is a professor at Harvard Medical School and the Harvard School of Public Health. He's also a pediatrician, adjunct staff in the Department of Medicine at Boston's Children's Hospital and a consultant in pediatrics at Massachusetts General Hospital.

"Dr. Berwick has dedicated his career to improving outcomes for patients and providing better care at lower cost," Obama said in a statement. "That's one of the core missions facing our next CMS administrator, and I'm confident that Don will be an outstanding leader for the agency and the millions of Americans it serves."

Congressional aides said Berwick's hearing will be the jurisdiction of the Senate Finance Committee, which oversees Medicare and Medicaid. The Senate Health, Education, Labor and Pensions Committee will not be involved. A Finance hearing date has not been announced. The nomination was sent to the Senate by the White House shortly after it was announced.

Finance Committee Chairman Max Baucus, D-Mont., said the hearing process will be "expeditious" and praised the CMS choice. "Dr. Berwick is an experienced health policy expert and researcher whose career has focused on innovative and effective ways to improve health care quality," Baucus said in a statement.

"Implementing innovative ideas that work and boosting health care quality will be critical goals for the next administrator of CMS, particularly in our fight to deliver better health care outcomes and lower costs for patients across the country. Improving health care quality was a major part of the landmark health reform bill passed this year and the CMS administrator will play a crucial role implementing that law."

Republicans have promised scrutiny. Sen. Charles E. Grassley of Iowa, the top Republican on Finance, said at the time Berwick's probable nomination was reported in March that the committee "will need to explore the nominee's preparedness for the enormous challenges that face the agency."

House Ways and Means Committee Chairman Sander M. Levin, D-Mich., said Berwick has been a "visionary leader" in the field of health care, working to make the system more efficient and patient-centered. "I appreciated his insight in developing legislation to accelerate the translation of cutting-edge medical research and health care delivery best practices into bedside care, a form of which was included in the new health care reform law," said Levin.

Rep. Pete Stark, D-Calif., chairman of the health subcommittee, said he wants to see the Senate act quickly on the Berwick nomination. "His leadership and expertise are needed now as the agency implements critical Medicare reforms and other health reform initiatives at CMS," said Stark.

In a 2005 interview with the magazine Health Affairs, Berwick discussed the role of government in influencing the health agenda, and specifically about CMS.

"Government remains a major purchaser," he said. "It's much bigger than GE. So as CMS goes and as Medicaid goes, so goes the system. CMS needs to continue to develop to be the best and possible purchaser of care, on behalf of its beneficiaries. To do that through giving more choice to individuals. . . is a very weak lead. To do it as an aggregate purchaser, demanding performance, is a very strong lead."

In another interview, this one with the publication Biotechnology Healthcare in 2009, Berwick was asked about the value of comparative effectiveness research and whether it will rein in costs, and specifically about critics who say it will lead to rationing.

"We can make a sensible social decision and say, 'Well, at this point, to have access to a particular additional benefit [new drug or medical intervention] is so expensive that our taxpayers have better use for those funds.' We make those decisions all the time," he said. "The decision is not whether or not we will ration care — the decision is whether we will ration with our eyes open. And right now, we are doing it blindly."

Berwick's nomination was met with praise from sectors of the health care industry, who said he's a proven leader.

"Dr. Berwick is a true leader of the national movement to improve the quality of care in the United States," said Chip Kahn, president and CEO of the Federation of American Hospitals, which represents for-profit institutions, in a statement. "His efforts have made a material difference in the quality and safety of hospital care in this country."

The American Hospital Association, which represents non-profit hospitals, applauded as well. "Don is a true leader in health care quality improvement and brings a wealth of knowledge and experience to CMS," said Rich Umbdenstock, president and CEO. "Through his work at the Institute for Healthcare Improvement, Don has led a movement to engage hospitals, doctors, nurses and other health care providers in the continuous quest to provide better, safer care,"

The American Medical Association also cited his work on patient care. "He is widely known and well-respected for his visionary leadership efforts that focus on optimizing the quality and safety of patient care in hospitals and across health-care settings," said Nancy H. Nielsen, AMA immediate past president.

Susan DeVore, president and CEO of Premier healthcare alliance, which includes 2,300 hospitals, said the nomination by the White House sent a strong signal. "While with the Institute for Healthcare Improvement, Dr. Berwick earned respect and admiration from all sectors of health care for his ability to understand what drives errors and inefficiencies, challenge the status quo and overcome barriers to achieve continuous quality improvements," she said in a statement.

The American College of Cardiologists said: "As CEO of the Institute for Healthcare Improvement, Don worked alongside the ACC on our Hospital to Home campaign, an initiative that is reducing unnecessary and costly hospital readmissions and improving care transitions for cardiovascular patients. With Don's help, we're on our way to meeting our goal of reducing all-cause readmission rates among patients discharged with heart failure or acute myocardial infarction by 20 percent by December 2012."

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