Congress and the White House can put away their boxing gloves for now, as President Obama used a surprising appointment to install Don Berwick as head of the Centers for Medicaid and Medicare Services (CMS). The White House said Wednesday the move was made to prevent Republicans from blocking Berwick’s appointment.
That Republican opposition stems partly from Berwick’s self-described “extremist” views, which lean heavily toward Britain’s socialized medicine model and emphasize patient-centered care. Those views shouldn’t necessarily be viewed as weaknesses, though, said Albert Wertheimer, professor and director for pharmaceutical health services research at Temple University. “Actually, it's nice to see a career professional, instead of a politician in that position.”
Berwick has a long list of healthcare credentials, including time spent as a pediatrician and a professor at Harvard’s School of Public Health. In 1991, he founded the Institute for Healthcare Improvement, whose mission statement includes the objective to “accelerate improvement by building the will for change, cultivating promising concepts for improving patient care, and helping healthcare systems put those ideas into action.” Berwick will need to keep those goals in mind as he deals with hospitals and providers, and attempts to navigate the bureaucratic maze of government agencies.
But while Berwick’s recess appointment has circumvented potential roadblocks, there is a caveat: He will only hold the position until the end of the next session of Congress, in 2011, when he will have to go through the confirmation process to be formally appointed. While this means he has time to prove his mettle, it also means “he has to get down to business immediately or sooner,” according to Wertheimer. “That's good for all stakeholders.”
Berwick’s biggest concern will be implementing comparative effectiveness research (CER)—not just with drugs, but with medical devices and surgical procedures as well. He’ll walk a fine line between appearing to use CER to ration care, and making CMS more financially efficient.
Wertheimer summed up: “I look for him to reduce waste and fraud, eliminate paying for obsolete or useless interventions, and probably—over time—reward quality improvements and meeting efficiency targets with monetary rewards.“