2011 in Review: Berwick's CMS tenure

Berwick steps down as CMS chief amid political resistance

Topics: Accountable Care, Market Trends, Strategy, ACO, Health Policy, Shared Savings Model, Medicaid, Reimbursement, Finance, Medicare, Payer and Regulatory Policy

December 22, 2011

Cassandra Blohowiak, Editor

After a short reign as CMS chief, Donald Berwick left his post—but only after steering sweeping efforts intended to reform the U.S. health care system.

17 months at the top
Berwick, who served as president and CEO of the Institute for Health Care Improvement (IHI) and was a Harvard University professor, is best known for helping hospitals use standardized procedures to improve quality.

Berwick took the helm at CMS in July 2010, when President Obama sidestepped the traditional confirmation process by using "recess appointment" procedures. As a recess appointee, Berwick had all the powers of a permanent appointee, but had to be re-nominated and confirmed by the Senate to serve past 2011.

Although the Obama administration re-nominated Berwick in January, 42 GOP senators in March asked the White House to withdraw Berwick's nomination, arguing that his "lack of experience in the areas of health plan operations and insurance regulation raise[d] serious concerns about his qualifications for this position."

Because of the political impasse, Berwick stepped aside on Dec. 2. The Obama administration has nominated a replacement—Marilyn Tavenner—who industry wonks have called a pragmatist and a patient-centered manager.

A look at his tenure
As CMS administrator, Berwick mobilized thousands of hospitals, physicians, and other health providers behind the "Partnership for Patients," a nationwide initiative to reduce preventable injuries by 40% and cut hospital readmissions by 20% by 2013.

He also deployed about 180 health policy experts to explore ways for the federal government to improve care quality at the agency's new Innovation Center.

Berwick reflects on his time at CMS
Since stepping down as CMS administrator, Berwick in some ways has become an even more visible advocate for health care improvement and patient safety. During a handful of interviews and speeches—including with the New York Times and at IHI—he condemned ongoing waste in the nation's health care system and listed principles for improvement.

Commenting on his tenure at CMS in an interview with Kaiser Health News, Berwick said his short term did not affect his ability to accomplish goals but said he would have preferred a longer term. In addition, he said his most challenging tasks while at CMS were deciding whether to grant state requests to cut Medicaid benefits and writing regulations for ACOs.

Berwick's legacy
Even if Republicans take control of the White House in 2012—and many of Berwick's key initiatives are scaled back or eliminated—his legacy is likely to endure because he helped shift Medicare to a quality-oriented payment system and cultivated partnerships across the health care industry.

Daily Briefing reader Cynthia Jones notes that "Berwick is reforming health care everyday—through the seeds planted in not only IHI's Save 100K lives Campaign (2004) but that grew to Save 5M lives (2008)." She adds that, "[t]hese programs engaged hospitals, staff, and providers voluntarily—to do things just a little differently, to be the patient advocate first and intercept avoidable and preventable harm."

See what other readers think about Berwick's departure from CMS.

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