Donald Berwick

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Donald Berwick
Donald Berwick CMS Administrator.jpg
Administrator of the Centers for Medicare and Medicaid Services
In office
July 7, 2010 – December 2, 2011
President Barack Obama
Preceded by Charlene Frizzera (Acting)
Succeeded by Marilyn Tavenner
Personal details
Born (1946-09-09) September 9, 1946 (age 68)
New York City, New York, U.S.
Political party Democratic
Spouse(s) Ann Greenberg
Children Ben
Dan
Jessica
Rebecca
Alma mater Harvard University
Website Campaign website

Donald M. Berwick (born 1946) is a former Administrator of the Centers for Medicare and Medicaid Services (CMS). Prior to his work in the administration, he was President and Chief Executive Officer of the Institute for Healthcare Improvement[1] a not-for-profit organization helping to lead the improvement of health care throughout the world. On July 7, 2010, Barack Obama appointed Berwick to serve as the Administrator of CMS through a recess appointment. On December 2, 2011, he resigned because of heavy Republican opposition to his appointment and his potential inability to win a confirmation vote.[2] On June 18, 2013, Berwick declared his candidacy for governor of Massachusetts, but ultimately lost the Democratic nomination to Attorney General Martha Coakley.[3]

Berwick has studied the management of health care systems, with emphasis on using scientific methods and evidence-based medicine and comparative effectiveness research to improve the tradeoff among quality, safety and costs.[4][5][6] Among IHI's projects are online courses for health care professionals for reducing Clostridium difficile infections, lowering the number of heart failure readmissions or managing advanced disease and palliative care.[7] In March 2012 he joined the Center for American Progress as a Senior Fellow. [8]

Biography[edit]

Berwick grew up in Moodus, Connecticut. His father, Philip, worked as the town's family doctor.[9] His mother, Rosalind Fine, was the primary caretaker of Berwick and his two younger brothers until she died from ovarian cancer in 1961.[10] Because of Fine's efforts to promote the construction of a new elementary school in Moodus, the school's library was named after her when it was built.[11] Berwick graduated from Nathan Hale-Ray High School and went on to obtain his B.A. from Harvard College, where he graduated summa cum laude.[12] While at Harvard, Berwick met his future wife, Ann, in his freshman biology class, where they were lab partners.[13] He earned both an M.D. cum laude from Harvard Medical School and an M.P.P. from John F. Kennedy School of Government in 1972.[14] He completed his medical residency in pediatrics at Children's Hospital Boston.

Berwick began his career as a pediatrician at Harvard Community Health Plan; in 1983 he became the plan's first Vice President of Quality-of-Care Measurement.[15] In that position, Berwick investigated quality control measures in other industries such as aeronautics and manufacturing, in order to consider their application in health care settings.[16] From 1987-1991, Berwick was co-founder and Co-Principal Investigator for the National Demonstration Project on Quality Improvement in Health Care, designed to explore opportunities for quality improvement in health care. Based on this work, Berwick left Harvard Community Health Plan in 1989 and co-founded the IHI (Institute for Healthcare Improvement).

Berwick is Clinical Professor of Pediatrics and Health Care Policy in the Department of Pediatrics at the Harvard Medical School and Professor of Health Policy and Management at the Harvard School of Public Health.[17] He is also a pediatrician, Adjunct Staff in the Department of Medicine at Children's Hospital Boston, and a Consultant in Pediatrics at Massachusetts General Hospital.

Based in Cambridge, Massachusetts, the IHI works to accelerate improvement by building the will for change, cultivating promising concepts for improving patient care, and helping health care systems put those ideas into action. Employing a staff of approximately 100 people and maintaining partnerships with hundreds of faculty members, IHI offers programs that aim to improve the lives of patients, the health of communities, and the satisfaction of the health care workforce. The IHI's work is funded primarily through fee-based programs and services, and also through the support of foundations, companies, and individuals. IHI provides program scholarships, research and development, professional education, and initiatives in developing countries.

IHI's vision for health care is an adaptation from the Institute of Medicine's six improvement aims for the health care system: care that is safe, effective, patient-centered, timely, efficient, and equitable:[18]

  • No Needless Deaths
  • No Needless Pain or Suffering
  • No Helplessness in Those Served or Serving
  • No Unwanted Waiting
  • No Waste
  • No One Left Out

Berwick has published over 129 articles in professional journals on health care policy, decision analysis, technology assessment, and health care quality management. He is the co-author of several books, including Cholesterol, Children, and Heart Disease: an Analysis of Alternatives (1980), Curing Health Care (1990), and New Rules: Regulation, Markets and the Quality of American Health Care (1996).

Nomination and controversy[edit]

Berwick said that 20-30% of health spending is "waste" with no benefit to patients, because of overtreatment, failure to coordinate care, administrative complexity and fraud, and that part of this problem was because of CMS regulations.[19]

Berwick's critics have cited his statements about the need for health care to redistribute resources from the rich to the poor and his favorable statements about the British health service. They quote Berwick as saying, "The decision is not whether or not we will ration care - the decision is whether we will ration with our eyes open."[20][21]

Berwick said that Republicans had "distorted" his meaning: "My point is that someone, like your health insurance company, is going to limit what you can get. That's the way it's set up. The government, unlike many private health insurance plans, is working in the daylight. That's a strength."[19]

For political reasons, the Obama administration made Berwick stay evasive and avoid defending his past statements on the British health service, spending caps and high-technology care.[19]

Critics point to statements such as this: "Any health care funding plan that is just, equitable, civilized and humane must, must redistribute wealth from the richer among us to the poorer and the less fortunate. Excellent health care is by definition redistributional."[22][23]

On April 19, 2010, Berwick was nominated to be Administrator of the Centers for Medicare and Medicaid, which oversees the two federal programs.[24]

An editorial wrote that his policy ideas could cut health care costs.[25] Conservatives[not in citation given] criticized Berwick, based on comments he made about health care being, by definition, redistribution of wealth, rationing care with "our eyes open" and complete lives system.[26]

Berwick advocates cutting health costs by adopting some of the approaches of Great Britain's National Health Services (NHS) and its National Institute for Health and Clinical Excellence (NICE). NICE evaluates the costs and effectiveness of medical therapy that is covered by the NHS as guidance for local authorities to decide what to cover. Mark McClellan, who served in the Bush administration, also advocated adopting some of NICE's methods.[27]

Conservative critics claim that "NICE decides which healthcare people will get and which they won't."[28] Philip Klein in The American Spectator dubbed him "Obama’s Rationing Man."[29] The chairman of NICE called these statements "outrageous lies."[30]

Senator John Kerry defended Berwick against "phony assertions" and accused Republicans of trying "to crank up the attack machine and make his nomination a distorted referendum on reform."[31] Former Speaker Newt Gingrich has historically been a Republican supporter of Berwick, however, writing an op-ed in the Washington Post in August 2000 praising Berwick's work.[32]

Berwick was installed by recess appointment on July 7, 2010 before confirmation hearings were scheduled by the Democratic-controlled Senate committee.[33] Berwick could thus serve until the summer of 2011 without a Senate approval. The White House had talked up the possibility of a re-nomination through the fall of 2010; on January 26, 2011, the President re-nominated Berwick. On March 4, 2011, 42 U.S. Senators wrote the White House and asked for the nomination to be withdrawn. The signers of the letter were all Republicans.

Berwick resigned his position at CMS on December 2, 2011.[34] In a speech on Wednesday, Dec. 7, 2011 in Orlando, Florida, at a meeting of the Institute for Healthcare Improvement, an organization he once led, the long-time patient-safety advocate gave an account of his time in government service and where he believes the future of healthcare is going.[35]

2014 Massachusetts Gubernatorial Race[edit]

Don Berwick speaking at the Rappaport Center for Law and Public Service, Suffolk Law School on Jan. 15, 2014

On June 17, 2013, Berwick announced his run for the Massachusetts Governor's office. Berwick framed himself as progressive on major issues and said it was crucial that Massachusetts continue to focus on health care reform and the well-being of children, topics he has focused on during his career. Berwick, who holds three degrees from Harvard, repeatedly emphasized his experience in helping health organizations deliver better care to consumers, an asset he said he would bring to being the state’s chief executive.[36]

Some of Berwick's specific goals for the governorship included focusing on job creation and economic development, instituting single-payer healthcare in Massachusetts, and ending child poverty in the state by the year 2024.[37] [38] [39] Following the conviction of former probation commissioner John O'Brien on corruption charges, Berwick added that rooting out corruption would be another priority.[40]

Although Berwick was seen as the heir to the Massachusetts trend of electing political outsiders to high offices, like Governor Deval Patrick and Senator Elizabeth Warren, pundits raised concerns in the Summer of 2014 that Berwick had failed to gain the traction he needed to succeed in the primary. [41] However, he outperformed nearly all projections and pollsters in the Democratic primary with 21% of the vote. This prompted the recognition of him being a "surprise" in the race. [42]

Berwick conceded the Democratic nomination to Massachusetts Attorney General Martha Coakley on September 9, 2014.[43]

Awards and honors[edit]

  • Ernest A. Codman Award, 1999
  • Alfred I. DuPont Award for excellence in children’s healthcare, 2001
  • American Hospital Association, "Award of Honor", 2002
  • Fellow of the Royal College of Physicians in London, 2004
  • Honorary Knight Commander of the Most Excellent Order of the British Empire, 2005
  • Purpose Prize for "enlisting wide-scale cooperation and scientifically-proven protocols to help hospitals improve care and save more than 100,000 lives," 2007[44]
  • The 13th Annual Heinz Award for Public Policy, 2007[45]
  • Honorary Fellowship of the Royal College of Physicians of Ireland, Dublin October 20th 2012

Selected publications[edit]

Books
  • Berwick DM, Cretin S, Keeler EB (1980). Cholesterol, children, and heart disease: an analysis of alternatives. New York: Oxford University Press. ISBN 0-19-502669-1. 
  • Berwick DM, Godfrey AB, Roessner J (1990). Curing health care: new strategies for quality improvement. A report on the National Demonstration Project on Quality Improvement in Health Care. San Francisco: Jossey-Bass. ISBN 1-55542-294-2. 
  • Brennan TA, Berwick DM (1996). New rules: regulation, markets, and the quality of American health care. San Francisco: Jossey-Bass. ISBN 0-7879-0149-0. 
  • Berwick DM (2004). Escape fire. Designs for the future of health care. San Francisco: Jossey-Bass. ISBN 978-0-7879-7217-2. 
Articles

References[edit]

  1. ^ Galewitz P. Local hospitals and doctors join forces to improve health care, restrain costs. Kaiser Health News. 2009 Jul 22. Accessed 2009 Jul 25.
  2. ^ Medicare administrator Donald Berwick resigns in the face of Republican opposition Sarah Kliff, The Washington Post, 2011 Nov 23
  3. ^ "For governor, it’s Coakley vs. Baker," The Boston Globe, September 10, 2014
  4. ^ Rethinking Comparative Effectiveness Research.
  5. ^ Interview with Donald Berwick. Katherine T. Adams, Biotechnol Healthc. 2009 June; 6(2): 35-36, 38.
  6. ^ Carmichael, Mary (March 29, 2010). "Five Things You Should Know About Donald Berwick, the New Medicare/Medicaid Chief". Newsweek. 
  7. ^ Who Is Don Berwick and What Will He Mean for Reform? By MAGGIE MAHAR March 30, 2010.
  8. ^ http://www.americanprogress.org/issues/2012/03/berwick.html
  9. ^ Obituary: Dr. Philip Berwick Derrick Stokes, Hartford Courant, 1995 Nov 8
  10. ^ The Revolutionary Neil Swidey, The Boston Globe, 2004 Jan 4
  11. ^ Don Berwick in governor’s race for right reasons: public service Jonathan Klate, Daily Hampshire Gazette, 2014 July 7
  12. ^ Donald M. Berwick Harvard University Advanced Leadership Initiative
  13. ^ The Revolutionary Neil Swidey, The Boston Globe, 2004 Jan 4
  14. ^ Don Berwick stresses health care in race for Massachusetts governor The Associated Press, 2014 Feb 22
  15. ^ Feder BJ. Thomas Pyle, 67, innovator in 1980s health care plans. New York Times. 2007 Jul 21
  16. ^ The Revolutionary Neil Swidey, The Boston Globe, 2004 Jan 4
  17. ^ Report: hospital medication errors commonplace. Talk of the Nation, National Public Radio. 2006 Jul 28. Accessed 2009 Jul 25.
  18. ^ Institute of Medicine Vision and Values [1]
  19. ^ a b c Health Official Takes Parting Shot at ‘Waste’ By Robert Pear, New York Times, December 3, 2011
  20. ^ Rethinking Comparative Effectiveness Research. Interview with Donald Berwick. Biotechnology Healthcare Magazine June, 2009
  21. ^ National Center for Biotechnology Information Biotechnology Interview Questions & Answers - Not PHP file as previous citation
  22. ^ Obama Nominee Donald Berwick's Radical Agenda by Ben Domenech, May 12, 2010
  23. ^ 'Death panels' were an overblown claim – until now By Michael Tanner | Published: 05/27/10 at 12:00 AM | Updated: 05/27/10 at 2:06 PM
  24. ^ White House. President Obama Nominates Dr. Donald Berwick for Administrator of the Centers for Medicare and Medicaid Services. 10 April 19.
  25. ^ Editorial, "Donald Berwick, a nominee well-suited to trim the fat on health care", The Washington Post, June 29, 2010
  26. ^ Obama's cynical recess appointment of Donald Berwick, By Ruth Marcus, The Washington Post, July 8, 2010; 2:50 PM ET,
  27. ^ The Evidence Gap: British Balance Benefit vs. Cost of Latest Drugs, By GARDINER HARRIS, New York Times, December 2, 2008
  28. ^ Anderson, Jeffrey H (2010-04-29). "Not NICE". The Weekly Standard. Retrieved 2010-06-04. 
  29. ^ Klein P. "http://spectator.org/archives/2010/05/13/obamas-rationing-man" American Spectator. 2010 May 13.
  30. ^ Official Defends British Health Service Against ‘Outrageous Lies’, By GARDINER HARRIS, New York Times, August 21, 2009
  31. ^ Milligan S. Kerry comes to defense of nominee to run Medicare, Medicaid programs. Boston Globe. 2010 May 14.
  32. ^ Newt Gingrich, High-Tech Cure for Medical Mistakes American Enterprise Institute August 2, 2000
  33. ^ Pear, Robert (July 6, 2010). "Obama to Bypass Senate to Name Health Official". New York Times. Retrieved August 19, 2010. 
  34. ^ Pear, Robert (November 23, 2011). "Obama’s Pick to Head Medicare and Medicaid Resigns Post". New York Times. Retrieved December 13, 2011. 
  35. ^ Ahier, Brian (December 8, 2011). "Remember the Patient". Healthcare, Technology, and Government 2.0. Retrieved December 13, 2011. 
  36. ^ http://www.bostonglobe.com/metro/2013/06/17/donald-berwick-former-obama-administration-official-kicks-off-bid-for-governor/BC7WaXd1eojBIgNSlMDX9L/story.html
  37. ^ http://www.berwickforgovernor.com/issue-statement/jobs-economy
  38. ^ http://www.washingtonpost.com/blogs/wonkblog/wp/2014/05/07/obamas-former-medicare-chief-on-why-he-wants-to-bring-single-payer-to-massachusetts/
  39. ^ http://bluemassgroup.com/2014/03/don-berwick-we-can-end-child-poverty/
  40. ^ Miller, Joshua. "Don Berwick pitches liberal agenda to business audience". www.bostonglobe.com. The Boston Globe. Retrieved 29 July 2014. 
  41. ^ Scharfenberg, David. "Role of political outsider reconsidered". www.bostonglobe.com. The Boston Globe. Retrieved 2 August 2014. 
  42. ^ Godlberg, Cary. "Surprise in Mass. Primary: 21 Percent for Single-Payer Candidate Berwick". www.wbur.org. WBUR. Retrieved 11 September 2014. 
  43. ^ "For governor, it’s Coakley vs. Baker," The Boston Globe, September 10, 2014
  44. ^ Encore.org. Five social innovators over age 60 receive $100,000 Purpose Prize (news release). 2007 Sep 4. Accessed 2009 Jul 25.
  45. ^ The Heinz Awards, Donald Berwick profile

External links[edit]

Blog posts
Political offices
Preceded by
Charlene Frizzera
Acting
Administrator of the Centers for Medicare and Medicaid Services
2010–2011
Succeeded by
Marilyn Tavenner