government

New CMS chief Dr. Berwick gets recess appointment, sidestepping Senate

The AMA and other physician organizations that supported the nomination hailed the move, but some GOP senators expressed outrage.

By Chris Silva — Posted July 7, 2010

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President Obama announced July 7 that he was immediately appointing Donald M. Berwick, MD, as the next administrator of the Centers for Medicare & Medicaid Services. Because the move came during a congressional recess, the nomination no longer will require Senate approval.

As a recess appointee, Dr. Berwick -- a Harvard professor and president and CEO of the Institute for Healthcare Improvement -- will wield the same authority as a permanent appointee. However, his appointment will expire at the end of the next session of Congress, meaning he can stay at CMS only through the end of 2011 unless the Senate confirms him later through the traditional nominating process.

Obama said sidestepping the upper chamber was necessary, as he felt objections from Republican senators meant Dr. Berwick was not going to be confirmed in an expeditious manner. "It's unfortunate that at a time when our nation is facing enormous challenges, many in Congress have decided to delay critical nominations for political purposes," he said in a statement.

The move was cheered by several physician organizations, including the American Medical Association, which supported Dr. Berwick's nomination since the president first announced it in April.

"The important post of CMS administrator has been vacant for too long. Dr. Berwick is widely known and well-respected for his leadership efforts focused on optimizing the quality and safety of patient care," said AMA Immediate Past President J. James Rohack, MD. "We look forward to working with Dr. Berwick at CMS on implementation of the new health reform law and on ensuring that physicians can continue to care for seniors who rely on Medicare."

Dr. Berwick, a pediatrician, is the first permanent CMS administrator since Mark B. McClellan, MD, PhD, stepped down in October 2006. The agency has been run by a string of interim chiefs since then.

Supporters of Dr. Berwick agreed that the post was too important to continue to leave vacant, particularly in light of the national health system reform law. Under reform, the federal government will commit more public funding toward covering tens of millions of uninsured and boosting primary care, among other major changes that will require the direct involvement of CMS.

"Dr. Berwick's medical expertise and commitment to ensuring high quality care for all while managing costs will serve America well as CMS implements the reforms in the Patient Protection and Affordable Care Act," said Lori Heim, MD, president of the American Academy of Family Physicians.

But several Republican senators blasted the recess appointment as a failure of the White House's commitment to government transparency. The senators had expressed concerns about perceived problems in Dr. Berwick's background, including past comments which they interpreted as favoring government limits on health care and lauding Britain's single-payer health system.

"The American people have a right to know about [Dr.] Berwick's background, his thoughts on rationing and government-run health care, and any potential conflicts of interest," said Sen. Charles Grassley (R, Iowa), the ranking GOP member on the Senate Finance Committee. The Finance panel would have considered the nomination ahead of a full Senate vote had the recess appointment not taken place.

IHI is a Cambridge, Mass., nonprofit organization that promotes concepts to improve the quality of patient care.

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