Summary: Barack Obama’s nomination of Don Berwick, MD, MPH as administrator of the Center for Medicare and Medicaid Services (CMS) merits the active support of the integrative practice community. Berwick became known to many in these fields through the 2009 IOM Summit where he articulated 8 “Basic Principles for Integrative Medicine.” The Harvard professor’s visibility had soared nationally when he responded to the IOM’s 2000 report on the awful extent of hospital and physician-caused deaths. He organized the ambitious and successful 100,000 Lives Campaign. In 2009, personal experience led Berwick to declare in Health Affairs his “extremist” views on the importance of truly putting patients at the center of care. Not surprisingly, the nomination of this right-man-at-the-right-time is proving extremely contentious. Obama and Berwick may need support from every quarter when the hearings begin later this summer. Pay attention. Be heard. Berwick is a legacy choice for this moment in US healthcare.
“The sources of suffering are in separateness and the
remedy is in
remembering that we are all in this together. Integration, if it is to
thrive, is the name of a duty to contribute what we can to a troubled
and suffering planet.”
IOM Summit on Integrative Medicine and the Health of the Public
Donald Berwick, MD, MPP, embodies a rare combination of wisdom, experience, leadership, vision and humility. He also happens to have significant familiarity with integrative health care.
Somewhat shocking is that an individual with these traits and background was been nominated to serve in the most powerful position in healthcare
delivery in the United States. On April 19, 2010, Berwick was nominated by Barack Obama as administrator of the Centers
for Medicare and
Medicaid Services (CMS).
Not surprising, Berwick’s nomination put him squarely in the sights of partisan antagonists who want this nomination killed. In the midst of expected challenges, hearings have been pushed back to mid-summer.
Everyone in the integrative practice field has skin in this game. Pay attention. Weigh in on Berwick’s behalf with your US Senators. Here are some reasons why.
Closest to home for integrative care, and thanks to the vision of the Bravewell Collaborative leaders, Berwick’s perspective on integrative medicine is on record via his presentation at the February 2009 IOM Summit on Integrative Medicine and the Health of the Public. Berwick, the founder of the Institute
for Healthcare Improvement (IHI), elucidated his “Basic Principles for Integrative Medicine.”
- Place the patient at the center.
- Individualize care.
- Welcome family and loved ones.
- Maximize healing influences within
- Maximize healing influences outside
- Rely on sophisticated, disciplined
- Use all relevant capacities – waste
- Connect helping influences with
Prior to the Summit, Berwick had already put a very public stake in the ground for Principle #1. He elevated lip-service to a patient-center to empowerment in the hub of the wheel in his widely-read Health Affairs column (28, no. 4)
based on his personal experiences of the system. He entitled his wake-up call “What
Should Mean: Confessions of an Extremist.”
Berwick’s principles are forged
through hard and extensive experience. He concluded his remarks at the IOM summit with the quotation at the top of this column: “… integration is the name of a duty to contribute …” I suspect I am not the only one for whom these words are a reminder of why we are drawn to this work.
Obama’s nomination of Berwick stimulated same-day endorsement from key stakeholders. The American Hospital Association (AHA) describes him as “a
true leader in healthcare quality improvement.” The American Medical Association (AMA) commends for Berwick for his “visionary leadership efforts.”
Notably, these are not backing for a professional who has spent his career as a political hack for organized medicine. Rather, Berwick is known for calling US hospitals and physicians to account for their most awful of failings.
In 2000, the Institute of Medicine published To Err is
Human. The report stripped the Dr. Kildare veneer from US doctors and hospitals with the revelation of deaths in the tens and perhaps hundred of thousands each year due to hospital and physician errors.
Berwick responded through IHI by founding the 100,000 Lives Campaign and then the Protecting 5 Million Lives from Harm initiative. He seized on the report as an opportunity to better healthcare and set about organizing hospitals across the nation to take on their responsibility. Here is Berwick’s later reflection on the 100,000 Lives Campaign:
“The names of the patients whose lives we
save can never be known. Our contribution will be what did not
happen to them. And, though they are unknown, we will know that mothers
and fathers are at graduations and weddings they would have missed, and
that grandchildren will know grandparents they might never have known,
and holidays will be taken, and work completed, and books read, and
symphonies heard, and gardens tended that, without our work, would never
Note how Berwick’s focus is on the individual patient, the person for whom the system is to work, rather than on some abstract CQI/TQM apparatus. This individual, who kept his eye on the prize while taking on the enormity of the challenge of literally facing death, would seem perfectly positioned for the challenges of running CMS.
Ironically, this former chair of the advisory council to the US Agency for Healthcare Research and Quality and former vice-chair of the US Preventive Services Task Force, is under assault for, among other things, inexperience.
Behind that charge are particularist interests of anti-choice activists (Berwick is not opposed to abortion) and anti-government ideologues (Berwick and Obamacare Equals Socialism on Steroids).
The fear-mongering on Berwick’s purported socialist leanings focuses on positive comments Berwick made about the National Health System (NHS) in England where care costs a fraction as much as that in the United States, with better outcomes. In Linda Bergthold’s analysis in
the Huffington Post, she notes Berwick’s “professed respect for the NHS” then adds that “he is not blind to its
faults and is no centralized planning or top down person.” Bergthold concludes:
“We don’t have a perfect health care system. The U.K. doesn’t either.
But don’t we want a person at the head of Medicare who is not afraid to
learn from other systems yet knows how to work effectively within our
own? Now that would be radical.”
If Berwick survives the Congressional confirmation process, his appointment may prove to be the best Obama has made or may ever make. Here is a chance for significant positive legacy. I urge you to support this nomination in any way you can.
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