Departing CMS Administrator's Top Five Accomplishments Highlighted

In Don Berwick era CMS implemented large number of complex, sometimes controversial, rules implementing health reform law; Tavenner takes his job, gets GOP support

Dr. Donald Berwick, Administratior, Centers for Medicare & Medicaid Services Dec. 4, 2011 – Last Friday was Donald Berwick's last day as administrator of the Centers for Medicare & Medicaid Services. Berwick, a 65-year-old senior citizen, a pediatrician, Harvard professor and well-known quality improvement expert, has served since July 2010.

President Barack Obama named Dr. Berwick through a recess appointment after it was clear that Senate Republicans would not vote to confirm him. They said that Berwick's 2008 praise of the British health care system was akin to endorsing government-run health care which would include rationing.

Under Berwick, CMS developed a large number of complex, and sometimes controversial, rules implementing last year’s health reform law. While some rules have received mixed reviews, Berwick generally won praise from industry leaders and consumer advocates. But congressional Republicans criticized him as a symbol of what they see as the Obama administration’s overly-aggressive intervention in the nation's health care system.

Marilyn Tavenner, previously the number two person at the agency and the former health secretary of Virginia will now run the agency.

Harris Meyer recently wrote about Berwick's CMS tenure for the journal Health Affairs.

Here is his take on Berwick's top accomplishments.

Obama's Medicare Nominee Tavenner Gets GOP Leader's Support

President Barack Obama's Medicare nominee Tuesday got unexpected support from one of Congress' Republican stars.

House Majority Leader Eric Cantor told The Associated Press that Marilyn Tavenner is "eminently qualified" to run Medicare. It may be too soon to contemplate a truce in the political wars over health care.

With Tavenner, major players on both sides may be able to shift from confrontation to problem-solving (Alonso-Zalidvar, 11/29). The Associated Press:

Berwick's Exit Interview With NY Times: 'I Came With An Agenda' For Improvement

Dec 04, 2011 - The New York Times: Health Official Takes Parting Shot at ‘Waste’

The official in charge of Medicare and Medicaid for the last 17 months says that 20 percent to 30 percent of health spending is “waste” that yields no benefit to patients, and that some of the needless spending is a result of onerous, archaic regulations enforced by his agency. The official, Dr. Donald M. Berwick, listed five reasons for what he described as the “extremely high level of waste.” They are overtreatment of patients, the failure to coordinate care, the administrative complexity of the health care system, burdensome rules and fraud (Pear, 12/3).

Meanwhile, Politico unearthed audio of Dr. Berwick's replacement, Marilyn Tavenner.

PoliticoPro: Tavenner: Berwick's Vision Will Continue
No one doubts the managerial skills Marilyn Tavenner brings to her new job as CMS administrator, but many wonder how she will fill Don Berwick’s shoes as a public ambassador for the administration's policies. ... months before she was nominated by President Barack Obama to lead CMS, she delivered a rare speech about the Affordable Care Act in March before the Nashville Healthcare Council. ... POLITICO tracked down audio of this rare appearance, which shows that she enthusiastically defends the ACA (Feder, 12/2).

1. Made CMS less bureaucratic and more responsive.

Berwick conducted the first-ever training to encourage continuous performance improvement throughout the 5,400-employee agency. He sought to shift the agency culture toward teamwork, innovation, speed, and customer focus. Many staffers say they’ve been energized and are working to get information out faster to patients and to states, though some complain this work takes up too much of their time.

Berwick also has encouraged staffers to get out into the field more to talk to patients and providers, which staffers say has been valuable in making policy. Industry experts say CMS has become more open to outside input and is moving faster to make recommended policy changes that formerly took years.

2. Made CMS a force for U.S. health improvement.

CMS traditionally has focused on administering health care payment policies. But Berwick had broader goals - what he dubbed the "Triple Aim" to achieve better public health, higher-quality health care and reduced costs. So, he led the drafting of a first-ever mission statement calling for the agency to be a force for the continual improvement of health and health care for all Americans.

3. Pushed hospitals to improve patient safety.

In April, CMS announced a quintessential Berwick initiative, the $1 billion "Partnership for Patients" to improve post-hospitalization care. It will test models for reducing nine types of medical errors, including surgical infections, pressure ulcers and complications from childbirth. The Partnership is patterned on national campaigns Berwick previously led - as chief of the Institute for Healthcare Improvement - to encourage evidence-based clinical practice. The program will award grants to partnerships of hospitals and community-based organizations with the goal of reducing hospital-acquired preventable conditions by 40 percent — and saving 60,000 lives — over the next three years.

4. Started to move Medicare from paying by the procedure to paying based on outcomes.

In October, CMS unveiled a final rule for a new Medicare demonstration program which advances accountable care organizations. ACOs are designed to encourage hospitals and physicians to cooperate to provide better, more seamless and less expensive patient care. If they succeed in delivering quality care for less money, they will share the savings with Medicare.

The preliminary ACO shared-savings rule was sharply criticized as unworkable. But Berwick and his staff won praise from provider groups for producing a final rule that is more likely to get them to participate.

Still, many say the projected Medicare savings of less than $1 billion over three years are too small to be significant.

5. Encouraged "innovative" health care delivery models.