Berwick's remarks offer insight into his healthcare worldview

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Dr. Donald Berwick of the Centers for Medicare & Medicaid Services may not have said enough to satisfy some members of the Senate Finance Committee on Wednesday, but he arguably presented some pretty defined views on healthcare.

There were not many new ideas in his speech, but his prepared statement offered insight into his underlying philosophies: creating a more seamless and less siloed system, lowering costs (while improving quality) and offering solutions based on scientific evidence.

It's also worth noting that while his speech was not particularly controversial, the new CMS administrator did mention rationing, which his opponents have accused him of supporting.

Alluding to the steep Medicare cuts in the plan, he said that the law “explicitly protects the guaranteed Medicare benefits on which so many seniors and individuals with disabilities rely. It will not cut these guaranteed benefits, nor will it ration care,” Berwick said.

Fragmented care

A major theme that ran through his commentary, which essentially was an endorsement of healthcare reform, was the need for a more integrated care system.

“Too often, health care takes place in series of fragments or episodes,” he said. “We need to make it possible for entirely new levels of seamlessness, coordination, and cooperation to emerge among the people and the entities that provide healthcare, so as to smooth the journeys of patients and families—especially those coping with chronic illness—through their care over time and place.” 

One way to provide more of this seamless care is through accountable care organizations, or a care delivery organization that combines various providers working together to cut costs and improve care, he said. He also supported the concepts of medical homes (home bases for patients that are rooted in primary care) and health homes (a process of coordinating of services for individuals with chronic conditions to prevent rehospitalizations).

Lower cost, better care

He harped on the need to lower cost and improve outcomes (a mighty lofty goal, to be sure). Berwick talked about the need to reduce unnecessary hospitalizations and cut waste in the Medicare program to promote the program's long-term sustainability. As a way to reduce costs, he spoke of the need to fight fraud; reduce payment errors in Medicare, Medicaid and the CHIP program; and cut down on improper payments.

Berwick, who has worked with the British National Health Service, said there must be a system makeover to tackle the problems of fragmentation as well as the lack of focus on prevention.

“We can address and solve these problems through sensible and effective changes in the systems through which we deliver health care,” he said. “Merely trying harder in the current system is not likely to get us very far; any doctor will admit that he or she is already trying as hard as he or she can. Better integration of care, better designed services for our beneficiaries, better measurement tools, and a focus on continual improvement can all help bring us closer to the health care system that we want and the American people deserve.”

Evidence-based healthcare

Berwick also reiterated his belief in evidence-based care—or the concept of using scientific data to inform decisions about the most effective treatments:

“High-quality health care does not necessarily mean the most expensive healthcare,” he said. “It means safe care, free from medical injuries, errors and infections; it means reliable care, based on the best available science; and it means person-centered care, in which each patient is treated with dignity and respect for his or her own unique preferences.”

More to say

While Republicans on the committee had inquiries, they felt the short one-hour hearing did not afford them enough time to fully question him. To wit: The Utah Health Care Association praised Sen. Orrin Hatch (R-UT) for asking Berwick about healthcare reform's cutting $500 billion from Medicare over 10 years.

But perhaps there was a reason Berwick wanted to keep the hearing short. He probably didn't want the hearing to be bogged down in talk of so-called death panels. It's pretty clear at this point that the term, which caught on during the summer of 2009, was a campaign trail exaggeration and misinterpretation of ideas related to end-of-of-life care.

Of course, Berwick, who was not subjected to hearings in front of the Senate, also has a responsibility to be transparent—just as he wants the healthcare system to be. He should appear before the committee in another hearing.

Still, he hardly has been cagey in offering his views on healthcare. To say he is hiding something would suggest you have not read this week's statement before the committee.

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McKnight's Daily Editors' Notes features commentary on the latest in long-term care news and issues. Entries are written by Editorial Director John O'Connor, Editor James M. Berklan, Senior Editor Elizabeth Newman and Staff Writer Marty Stempniak.

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