|Administrator of the Centers for Medicare and Medicaid Services|
July 7, 2010 – December 2, 2011
|Preceded by||Charlene Frizzera (Acting)|
|Succeeded by||Marilyn Tavenner|
September 9, 1946 |
New York City, New York, U.S.
|Alma mater||Harvard University|
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 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. On June 18, 2013, Berwick declared his candidacy for governor of Massachusetts, but lost the Democratic Party nomination to Attorney General Martha Coakley.
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. 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. In March 2012 he joined the Center for American Progress as a Senior Fellow. 
Berwick grew up in Moodus, Connecticut. His father, Philip, worked as the town's family doctor. His mother, Rosalind Fine, was the primary caretaker of Berwick and his two younger brothers until she died from ovarian cancer in 1961. 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. 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. While at Harvard, Berwick met his future wife, Ann, in his freshman biology class, where they were lab partners. The couple have four children: Ben, Dan, Jessica, and Becca. Berwick 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. 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. 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. 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. 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:
- 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
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.
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."
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."
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."
On April 19, 2010, Berwick was nominated to be Administrator of the Centers for Medicare and Medicaid, which oversees the two federal programs.
An editorial wrote that his policy ideas could cut health care costs. Conservatives 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.
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.
Conservative critics claim that "NICE decides which healthcare people will get and which they won't." Philip Klein in The American Spectator dubbed him "Obama’s Rationing Man." The chairman of NICE called these statements "outrageous lies."
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." 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.
Berwick was installed by recess appointment on July 7, 2010 before confirmation hearings were scheduled by the Democratic-controlled Senate committee. 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. 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.
2014 Massachusetts Gubernatorial Race
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.
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.   Following the conviction of former probation commissioner John O'Brien on corruption charges, Berwick added that rooting out corruption would be another priority.
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.  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. 
Awards and honors
- 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
- The 13th Annual Heinz Award for Public Policy, 2007
- Honorary Fellowship of the Royal College of Physicians of Ireland, Dublin October 20th 2012
- 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.
- Read JL, Quinn RJ, Berwick DM, Fineberg HV, Weinstein MC (1984). "Preferences for health outcomes. Comparison of assessment methods". Med Decis Making 4 (3): 315–29. doi:10.1177/0272989X8400400307. PMID 6335216..
- Berwick DM, Weinstein MC (July 1985). "What do patients value? Willingness to pay for ultrasound in normal pregnancy". Med Care 23 (7): 881–93. doi:10.1097/00005650-198507000-00005. PMID 3925259..
- Murphy JM, Berwick DM, Weinstein MC, Borus JF, Budman SH, Klerman GL (June 1987). "Performance of screening and diagnostic tests. Application of receiver operating characteristic analysis". Arch. Gen. Psychiatry 44 (6): 550–5. doi:10.1001/archpsyc.1987.01800180068011. PMID 3579501..
- Berwick, Donald M. (January 1989). "Continuous improvement as an ideal in health care". N. Engl. J. Med. 320 (1): 53–6. doi:10.1056/NEJM198901053200110. PMID 2909878..
- Perrin, James M.; Homer, Charles J.; Berwick, Donald M.; Woolf, Alan D.; Freeman, Jean L.; Wennberg, John E. (May 1989). "Variations in rates of hospitalization of children in three urban communities". N. Engl. J. Med. 320 (18): 1183–7. doi:10.1056/NEJM198905043201805. PMID 2710191..
- Ayanian JZ, Berwick DM (1991). "Do physicians have a bias toward action? A classic study revisited". Med Decis Making 11 (3): 154–8. doi:10.1177/0272989X9101100302. PMID 1881269..
- Berwick, Donald M. (1995). "The Toxicity of Pay for Performance". Quality Management in Health Care (4(1)): 27–33..
- Berwick DM (March 1996). "A primer on leading the improvement of systems". BMJ 312 (7031): 619–22. doi:10.1136/bmj.312.7031.619. PMC 2350403. PMID 8595340..
- Berwick, Donald M. (October 1996). "Quality of health care. Part 5: Payment by capitation and the quality of care". N. Engl. J. Med. 335 (16): 1227–31. doi:10.1056/NEJM199610173351611. PMID 8815948..
- Berwick DM (April 1998). "Developing and testing changes in delivery of care". Ann. Intern. Med. 128 (8): 651–6. doi:10.7326/0003-4819-128-8-199804150-00009. PMID 9537939..
- Leape LL, Berwick DM (March 2000). "Safe health care: are we up to it?". BMJ 320 (7237): 725–6. doi:10.1136/bmj.320.7237.725. PMC 1117747. PMID 10720335..
- Berwick DM (2002). "A user's manual for the IOM's 'Quality Chasm' report". Health Aff (Millwood) 21 (3): 80–90. doi:10.1377/hlthaff.21.3.80. PMID 12026006..
- Leape LL, Berwick DM, Bates DW (2002). "What practices will most improve safety? Evidence-based medicine meets patient safety". JAMA 288 (4): 501–7. doi:10.1001/jama.288.4.501. PMID 12132984..
- Berwick, D. M. (April 2003). "Disseminating innovations in health care". JAMA 289 (15): 1969–75. doi:10.1001/jama.289.15.1969. PMID 12697800..
- Berwick DM, Jain SH. "The Basis for Quality Care in Prepaid Group Practice," in Toward a 21st Century Health System: The Contributions and Promise of Prepaid Group Practice. Alain C. Enthoven & Laura A. Tollen eds. San Francisco: Jossey-Bass, 2004.
- Leape, L. L.; Berwick, DM (May 2005). "Five years after To Err Is Human: what have we learned?". JAMA 293 (19): 2384–90. doi:10.1001/jama.293.19.2384. PMID 15900009..
- Berwick, D. M.; Calkins, DR; McCannon, CJ; Hackbarth, AD (January 2006). "The 100,000 lives campaign: setting a goal and a deadline for improving health care quality". JAMA 295 (3): 324–7. doi:10.1001/jama.295.3.324. PMID 16418469..
- Berwick, D. M. (March 2008). "The science of improvement". JAMA 299 (10): 1182–4. doi:10.1001/jama.299.10.1182. PMID 18334694..
- Berwick, DM, Jain SH, and Porter ME. "Clinical Registries: The Opportunity For The Nation." Health Affairs Blogs, May 2011.
- Galewitz P. Local hospitals and doctors join forces to improve health care, restrain costs. Kaiser Health News. 2009 Jul 22. Accessed 2009 Jul 25.
- Medicare administrator Donald Berwick resigns in the face of Republican opposition Sarah Kliff, The Washington Post, 2011 Nov 23
- "For governor, it’s Coakley vs. Baker," The Boston Globe, September 10, 2014
- Rethinking Comparative Effectiveness Research.
- Interview with Donald Berwick. Katherine T. Adams, Biotechnol Healthc. 2009 June; 6(2): 35-36, 38.
- Carmichael, Mary (March 29, 2010). "Five Things You Should Know About Donald Berwick, the New Medicare/Medicaid Chief". Newsweek.
- Who Is Don Berwick and What Will He Mean for Reform? By MAGGIE MAHAR March 30, 2010.
- Obituary: Dr. Philip Berwick Derrick Stokes, Hartford Courant, 1995 Nov 8
- The Revolutionary Neil Swidey, The Boston Globe, 2004 Jan 4
- Don Berwick in governor’s race for right reasons: public service Jonathan Klate, Daily Hampshire Gazette, 2014 July 7
- Donald M. Berwick Harvard University Advanced Leadership Initiative
- The Revolutionary Neil Swidey, The Boston Globe, 2004 Jan 4
- Don Berwick stresses health care in race for Massachusetts governor The Associated Press, 2014 Feb 22
- Feder BJ. Thomas Pyle, 67, innovator in 1980s health care plans. New York Times. 2007 Jul 21
- The Revolutionary Neil Swidey, The Boston Globe, 2004 Jan 4
- Report: hospital medication errors commonplace. Talk of the Nation, National Public Radio. 2006 Jul 28. Accessed 2009 Jul 25.
- Institute of Medicine Vision and Values 
- Health Official Takes Parting Shot at ‘Waste’ By Robert Pear, New York Times, December 3, 2011
- Rethinking Comparative Effectiveness Research. Interview with Donald Berwick. Biotechnology Healthcare Magazine June, 2009
- National Center for Biotechnology Information Biotechnology Interview Questions & Answers - Not PHP file as previous citation
- Obama Nominee Donald Berwick's Radical Agenda by Ben Domenech, May 12, 2010
- '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
- White House. President Obama Nominates Dr. Donald Berwick for Administrator of the Centers for Medicare and Medicaid Services. 10 April 19.
- Editorial, "Donald Berwick, a nominee well-suited to trim the fat on health care", The Washington Post, June 29, 2010
- Obama's cynical recess appointment of Donald Berwick, By Ruth Marcus, The Washington Post, July 8, 2010; 2:50 PM ET,
- The Evidence Gap: British Balance Benefit vs. Cost of Latest Drugs, By GARDINER HARRIS, New York Times, December 2, 2008
- Anderson, Jeffrey H (2010-04-29). "Not NICE". The Weekly Standard. Retrieved 2010-06-04.
- Klein P. "http://spectator.org/archives/2010/05/13/obamas-rationing-man" American Spectator. 2010 May 13.
- Official Defends British Health Service Against ‘Outrageous Lies’, By GARDINER HARRIS, New York Times, August 21, 2009
- Milligan S. Kerry comes to defense of nominee to run Medicare, Medicaid programs. Boston Globe. 2010 May 14.
- Newt Gingrich, High-Tech Cure for Medical Mistakes American Enterprise Institute August 2, 2000
- Pear, Robert (July 6, 2010). "Obama to Bypass Senate to Name Health Official". New York Times. Retrieved August 19, 2010.
- Pear, Robert (November 23, 2011). "Obama’s Pick to Head Medicare and Medicaid Resigns Post". New York Times. Retrieved December 13, 2011.
- Ahier, Brian (December 8, 2011). "Remember the Patient". Healthcare, Technology, and Government 2.0. Retrieved December 13, 2011.
- Miller, Joshua. "Don Berwick pitches liberal agenda to business audience". www.bostonglobe.com. The Boston Globe. Retrieved 29 July 2014.
- Scharfenberg, David. "Role of political outsider reconsidered". www.bostonglobe.com. The Boston Globe. Retrieved 2 August 2014.
- Godlberg, Cary. "Surprise in Mass. Primary: 21 Percent for Single-Payer Candidate Berwick". www.wbur.org. WBUR. Retrieved 11 September 2014.
- "For governor, it’s Coakley vs. Baker," The Boston Globe, September 10, 2014
- Encore.org. Five social innovators over age 60 receive $100,000 Purpose Prize (news release). 2007 Sep 4. Accessed 2009 Jul 25.
- The Heinz Awards, Donald Berwick profile
|Wikimedia Commons has media related to Donald Berwick.|
- Institute for Health Care Improvement
- Profiles in Leadership: Don Berwick
- Dr. Berwick at Harvard Medical School
- Donald Berwick at the Institute of Medicine of the National Academies
- Donald Berwick collected news and commentary at The Washington Post
- Appearances on C-SPAN
- Works by or about Donald Berwick in libraries (WorldCat catalog)
- Money-Driven Medicine a documentary featuring Dr. Donald Berwick based on the book by Maggie Mahar
- Blog posts
- Who Is Don Berwick and What Will He Mean for Reform?, Maggie Mahar, TheHealthCareBlog, March 30, 2010. Blog post citing WP:RS sources favorable to Berwick
- Obama Nominee Donald Berwick’s Radical Agenda, Ben Domenech, RedState.com, May 12, 2010. Blog post citing WP:RS sources unfavorable to Berwick
- In a Surprise Move, Administration Appoints Berwick to Head CMS By Maggie Mahar, TheHealthCareBlog, July 2010. Analysis of White House decision to appoint Berwick to top job in CMS, favorable to Berwick.
|Administrator of the Centers for Medicare and Medicaid Services