Striking Back at Care’s True Rationers

Kenneth Lin

Posted 12/08/11 on Common Sense Family Doctor

In February, I predicted that Don Berwick would not survive the partisan politics surrounding his recess appointment as administrator of CMS (Centers for Medicare and Medicaid Services), and regrettably, Dr. Berwick indeed stepped down from that position last week despite a number of notable accomplishments in his too-short tenure. Speaking yesterday at the annual national forum of the Institute for Healthcare Improvement, which he led for nearly two decades, Dr. Berwick struck back fiercely at politicians who have used the myth of “death panels” to oppose health reform efforts, and others who he called the “true rationers” of health care. In his own words:

Cynicism grips Washington. It grips Washington far too much, far too much for a place that could instead remind us continually of the grandeur of democracy. … Cynicism diverts energy from the great moral test. It toys with deception, and deception destroys. Let me give you an example: the outrageous rhetoric about “death panels” – the claim, nonsense, fabricated out of nothing but fear and lies, that some plot is afoot to, literally, kill patients under the guise of end-of-life care. That is hogwash. It is purveyed by cynics; it employs deception; and it destroys hope. It is beyond cruelty to have subjected our elders, especially, to groundless fear in the pure service of political agendas.

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The Awful Dichotomy Between Health Care Politics and Policy

Robert Laszewski

First posted 7/6/11 on Health Policy and Marketplace Review

Amy Goldstein has an important article in today’s Washington Post detailing the place Don Berwick, the Medicare and Medicaid administrator, finds himself in.

It is all but certain he will have to leave his post at year’s end, when his recess appointment expires, because the Senate will not confirm him for a lack of Republican support.

Berwick is one of the most respected health care experts in the country—his career has been dedicated to improving quality first and with that the cost of care. With the new law giving his agency more opportunities to experiment with new approaches and the ability to more quickly implement the things that work, he was the ideal choice.

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Berwick on Incentivizing Health Care Value

Brian Klepper

AAFP (The American Academy of Family Physicians) News Now has an excellent interview with CMS Administrator Donald Berwick MD, in which Dr. Berwick describes his vision of more integrated and less fragmented health care delivery, and the changes in reimbursement incentives that will be required to get us there. An excerpt is below. Click the link above to read the entire piece. Worth your time.

Q. You also have talked about this being the era of health care delivery improvement. Can you explain that? 

A. Paying for value is an incentive. It is a motivation toward improvement. The underlying idea of improvement is that American health care, historically built in fragments, often cannot achieve for patients what it really wants to achieve. No one really wants that. Health delivery system reform refers to really reconfiguring care into much more seamless coordinated-care operations so that people, especially those with chronic illnesses, experience continuity of care over time and space.

So when patients come home from the hospital, there is a smooth handoff, and all the necessary information follows them. When they are seeing a specialist, that specialist is coordinating care with their primary care doctor.

In a fragmented payment system, it is so much harder to accomplish this. When payment is based on better integration, the result will be better integration of health care services. A delivery system redesign really means improving care for people when they are sick to ensure that they are safe and care is delivered according to science. And that includes improving seamless and coordinated care for patients — especially people with chronic illnesses. And then there is prevention, (including) a bigger investment in keeping people healthy, helping them to understand how to keep themselves healthy instead of waiting for illness to occur or reoccur, and educating people on how to prevent (illness). All of that involves design.

Q. You spoke briefly about the fee-for-service system. How do you feel about the AMA/Specialty Society Relative Value Scale Update Committee, or RUC?

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Newt and the Health Wonks: A Tale of Lust and Power

Michael Millenson

First published 5/13/11 on Kaiser Health News

When former House Speaker Newt Gingrich announced his bid for the GOP presidential nomination, I found myself singing a few bars from Night Moves, Bob Seger’s hard-driving tribute to teenage hormones: “I used her, she used me/But neither one cared./We were gettin’ our share.

“No, this isn’t one more commentary on the Georgia Republican’s checkered marital past. I’m referring to a different relationship, the one between Gingrich and the health policy community. A critical component of the climb back to prominence for a man who inspired nearly as much distrust in his own party as in the opposition was proving he could work harmoniously with those holding differing views on an important policy issue — how to reform U.S. health care.

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