Donald Berwick Resigns as Head of CMS

November 23, 2011

November 23, 2011 — Donald Berwick, MD, a long-time advocate of patient safety, is resigning as administrator of the Centers for Medicare and Medicaid Services (CMS), effective December 2, after a short tumultuous term as President Barack Obama's point person for healthcare reform.

Dr. Berwick will have served only 17 months in the post. He was denied Senate confirmation by Republicans, who branded the pediatrician an advocate of healthcare rationing. Dr. Berwick denied that charge, countering that the best way to cut costs is to improve the quality of care.

President Obama has nominated Marilyn Tavenner, RN, MHA, Dr. Berwick's principal deputy, to replace him. Ms. Tavenner, a former hospital executive, was secretary of the Virginia Department of Health and Human Resources under former Virginia Governor Tim Kaine.

The president nominated Dr. Berwick, who had headed the Institute for Healthcare Improvement, for the CMS post in April 2010 to the applause of such diverse groups such as the American College of Physicians, AARP, Walmart, and Consumers Union. However, in July 2010, when Obama found that GOP opponents were blocking the path to Senate confirmation, he installed Dr. Berwick as CMS administrator through a "pocket" appointment while the Senate was in recess. The special appointment is set to expire by law at the end of 2011. Dr. Berwick was renominated in January 2011, but he still faced granite opposition from Senate Republicans. His resignation, therefore, comes as no surprise.

As reported by Reuters, Dr. Berwick told the staff of the Department of Health and Human Services in an email — written with "bittersweet emotions" — that although their work was challenging and their journey incomplete, "we are now well on our way to achieving a whole new level of security and quality for healthcare in America."

"It's Been a Great Era"

During his tenure at CMS, Dr. Berwick helped implement a number of key provisions of the Affordable Care Act (ACA) pertaining to the Medicare and Medicaid programs. In October, for example, CMS issued final regulations for accountable care organizations (ACOs), which are provider consortiums designed to better coordinate the care received by Medicare patients and, in the process, improve medical outcomes and lower costs. ACOs will receive a share of any money they save for Medicare.

Dr. Berwick also oversaw the debut of ACA-spawned pilot projects to reward physicians for the quality as opposed to the quantity of their services. In the Comprehensive Primary Care Initiative, practices operating as "medical homes" will receive a monthly care-management fee on top of their usual fee-for-service reimbursement.

"We see that as a game changer," said Glen Stream, MD, president of the American Academy of Family Physicians (AAFP).

In an interview with Medscape Medical News, Dr. Stream praised Dr. Berwick as someone "with an impeccable background in quality improvement and a willingness to evaluate healthcare from top to bottom." However, "the jury is still out," he said, on whether the initiatives launched by Dr. Berwick will succeed in improving the quality of care while lowering its cost.

"We'll have to see how they play out," said Dr. Stream.

Other leaders in organized medicine today spoke highly of the departing CMS administrator.

Don Fisher, PhD, the president and chief executive officer of the American Medical Group Association, said Dr. Berwick "brought his deep expertise and vision for healthcare improvement to all he did at CMS."

"Dr. Berwick has been a friend to medical groups and the high standards of care which they practice and espouse," Dr. Fisher said in a press release.

Jack Lewin, MD, chief executive officer of the American College of Cardiology, credits Dr. Berwick with having listened to physicians in the process of reforming the healthcare system. When organized medicine panned the first version of the ACO rules, Dr. Berwick "went back and changed them significantly," said Dr. Lewin.

"CMS is trying to do its job as a regulatory agency, but facilitate innovation at the same time," Dr. Lewin told Medscape Medical News. "They're partnering with us. That's clearly part of Don's legacy."

"It's been a great era. It's too bad we don't have a few more years of it."

The Gauntlet of Criticism

Dr. Berwick steps down from his CMS position having run through a gauntlet of criticism in Congress as well as the conservative blogosphere, where he was dubbed "Dr. Death Panel." Opponents seized on his past statements praising the National Health Service in the United Kingdom — the epitome of socialized medicine — and acknowledging that rationing of healthcare is inevitable.

"The decision is not whether or not we will ration care — the decision is whether we will ration with our eyes open," Dr. Berwick told a magazine called Biotechnology Healthcare in 2009. "And right now, we are doing it blindly."

Despite the recent furor, the AAFP's Dr. Stream said that Dr. Berwick still enjoys "the highest degree of respect by physicians, particularly those who know the difficult role that leaders take in health system design."

Dr. Lewin chalks up the Berwick controversy to partisan politics.

"Unfortunately, he's been a scapegoat for Republicans who are mad about the ACA," he said.


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