The resignation of Don Berwick last week after 18 months as administrator of the Centers for Medicare & Medicaid Services (CMS) should be a cause of concern in the healthcare industry, as well as the health IT sector. Berwick was the Obama Administration's point man on healthcare reform, and his departure due to Republican opposition in the Senate likely will slow the industry's inevitable transition to accountable care.
When President Obama appointed Berwick during a Congressional recess in April 2010, industry groups widely supported the move--despite the fact that the pediatrician and Harvard professor was a leading proponent of change. In his role as founder and CEO of the Institute for Healthcare Improvement (IHI), Berwick had built a stellar reputation as an advocate of quality and safety improvement. IHI's safety campaigns, in particular, had enlisted thousands of hospitals; later, when Berwick became CMS administrator, many of those hospitals joined CMS' Partnership for Patients safety program partly out of respect for Berwick.
But moral authority took a back seat to politics. Earlier this year, 42 Republican senators signaled they would vote against confirming Berwick at the end of this year, effectively ending his chances of remaining in the post. Some senators seized on his earlier statements about his admiration for the National Health Service in the U.K. as evidence that he endorsed healthcare rationing--which Berwick denied. But it seems clear that their real reason for opposing him is that he was pushing forward the Obama reform agenda in a competent and intelligent way.
Here are some of the areas affecting health IT where Berwick made a mark during his brief tenure at CMS:
- Creating the infrastructure for the state health insurance exchanges;
- Implementing the Meaningful Use regulations for the government's electronic health records incentive program;
- Writing the regulations for Medicare's shared-savings program for accountable care organizations (ACOs);
- Introducing pilot programs to test payment bundling;
- Launching the Partnership for Patients, which rewards hospital participants for working with community organizations to improve transitions of care;
- Preparing programs that incentivize hospitals to lower readmission rates and provide higher value to Medicare for its expenditures.
Berwick left no doubt that he viewed health IT as instrumental to the success of reform. In discussing the original version of the proposed ACO regulations--later revised after industry groups protested some onerous provisions--Berwick said that "information management--making sure patients and all healthcare providers have the right information at the point of care--will be a core competency of ACOs."
Health IT also will be essential to measuring performance and improving coordination of care in the other areas of reform that Berwick promoted at CMS. As a recent CSC white paper notes, "Data and the EHR are critical infrastructure for not just measurement, but also patient tracking and point-of-care clinical management enabled by the EHR. While rolling out the EHR for the HITECH incentive program, hospitals have the opportunity to build in the necessary data capture, point-of-care support and data analytics that are the foundation for the future."
Marilyn Tavenner, Berwick's principal assistant, will succeed him at CMS. It remains unclear, however, whether she will be confirmed as CMS administrator. Tavenner has an outstanding record in healthcare, including a stint as Virginia's top health official and 25 years with HCA.
Meanwhile, the future of the Affordable Care Act itself is in doubt, with the U.S. Supreme Court set to rule on key provisions and Republicans aiming to retake the White House in 2012. While some of the programs championed by Berwick--including the Meaningful Use incentive program--were authorized by other pieces of legislation, the Affordable Care Act initiated the key healthcare delivery reforms that will be required to raise quality and reduce costs significantly.
Berwick's work at CMS will have an impact for years to come. His moral example will inspire the industry to continue down the difficult and costly path that leads to an affordable, high-quality healthcare system. Nevertheless, his resignation comes as a blow to these efforts and creates an additional barrier to badly needed reforms. - Ken