Senate confirmation only first hurdle for CMS nominee Dr. Berwick
■ The quality improvement expert faces the prospect of tough questions from Senate Republicans. If confirmed, he would be expected to help implement major health reforms.
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Washington -- After a long leadership drought at the agency overseeing Medicare and Medicaid, the Obama administration has placed its faith in a pediatrician widely renowned for his contributions to health care quality research and improvement to help lead the agency through the start of a critical system overhaul.
Although the nomination was not yet official at this article's deadline, a White House official confirmed March 29 that President Obama will nominate Donald M. Berwick, MD, as the next administrator of the Centers for Medicare & Medicaid Services. CMS has been relying on a string of interim administrators since Mark B. McClellan, MD, PhD, stepped down in October 2006.
Dr. Berwick, a Harvard professor, would have a massive undertaking ahead of him if his nomination is confirmed by the Senate. He would be charged with overseeing an agency that will play an integral part in implementing the health system reform package signed into law by the president in late March, a statute that will significantly expand the role of public health programs in covering the uninsured.
Some health care experts said that despite the challenging nature of the job opportunity, Dr. Berwick's nomination should go through the Senate without too much trouble. Many agreed that the putative nominee is a good fit for the position.
"I've known him for 20 years, and I think this is a very positive development," said Kenneth E. Thorpe, PhD, professor of health policy at Emory University in Atlanta and executive director of the Partnership to Fight Chronic Disease. "It's a signal that the administration wants to do something major with quality systems, delivery system reform and financial payment reform. It shows they want to focus on quality and getting at the root of what is driving up costs."
Dr. Berwick is president and CEO of the Institute for Healthcare Improvement, a Cambridge, Mass., nonprofit organization that promotes concepts to improve the quality of patient care. IHI has done impressive work in helping health care systems develop innovative quality care programs, particularly by working with hospitals, said Thorpe, who has testified before Congress about the need to improve care coordination in Medicare. Because of this vital area of expertise, Thorpe said he hopes Dr. Berwick is installed in the top position at CMS soon. "The time is now to get someone in there and move as fast as possible."
A drawn-out nomination process?
But even before the nomination was official, Senate Republicans said the upper chamber would take its time and exercise due diligence during the nomination process.
Sen. Charles Grassley (R, Iowa), the ranking GOP member on the Senate Finance Committee, which will consider the nomination ahead of a full Senate vote, noted that the programs Dr. Berwick would oversee serve nearly a third of all Americans. He also indicated that the nominee would face tough questions related to the administration's enactment of the health reform package, which was universally opposed by Republican lawmakers.
"This is always a big job, but the administration of health care reform, which includes implementing the hundreds of billions of dollars in Medicare cuts and the biggest expansion of Medicaid in its history, will make it more challenging than ever," Grassley said. "The Finance Committee vetting will need to explore the nominee's preparedness for the enormous challenges that face the agency."
Former CMS Administrator Thomas A. Scully predicted that Dr. Berwick will get through the process with the job in hand. "He's about as noncontroversial and well-liked as you can get. You're not going to do any better," said Scully, who served as administrator from 2001 to 2004 and is now senior counsel at the law firm Alston & Bird.
But Scully also said political obstacles stemming from the reform debate will be unavoidable. Dr. Berwick's backers in the health care community should steel themselves for a drawn-out nomination process in light of the raw emotions that have deluged Capitol Hill in the wake of the passage of health system reform, Scully said. "Tensions are running high, and I'm sure people are going to be excited, so I don't think it's going to be easy."
Prior to the official nomination, no Republican senator had said that he or she would place a hold on the nominee, a move that can grind a confirmation process to a halt. But GOP lawmakers recently have held up administrative nominees over health policy disputes, including one involving an alleged Obama administration "gag order" on insurance companies during last year's reform debate.
Policy experts agree that if Dr. Berwick becomes the administrator, he will have a Herculean task ahead of him.
"What happens at CMS in the next few years will determine whether the new legislation actually improves quality and lowers costs," said Dr. McClellan, director of the Engelberg Center for Health Care Reform and a senior fellow at the Brookings Institution in Washington, D.C. Still, the former administrator said Dr. Berwick is the right person to carry out the job.
"Don has a unique background in both improving care on the ground and thinking about how our nation's health care policies need to be reformed to help make that happen," Dr. McClellan said.
If Dr. Berwick is confirmed by the Senate, he'll need to staff up quickly and lay out a game plan for the agency's various programs based on his areas of expertise, Thorpe said. "There's an enormous opportunity for him to improve quality and conduct prevention the right way."
A well-respected health leader
Meanwhile, organizations representing physicians and other health professionals have largely approved of Dr. Berwick as the administration's choice to lead CMS.
The American Medical Association says it has enjoyed a good working relationship with Dr. Berwick at IHI, having teamed up with the nonprofit organization on numerous quality improvement endeavors.
"Dr. Berwick 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 AMA Immediate Past President Nancy H. Nielsen, MD, PhD. "We look forward to working with him at CMS on implementation of the new health reform law and on ensuring that physicians can keep caring for seniors who rely on Medicare."
William Jessee, MD, president and CEO of the Medical Group Management Assn., called him "a leading voice in the quest for improving the quality and safety of patient care for all Americans. His knowledge of quality improvement also offers great opportunities for improving the efficiency of CMS' internal operations -- a critical factor in reducing administrative costs."