"Less discretion for doctors would improve patient safety" Says Obama's Pick for CMS

I posted earlier in the week on Robert Goldberg's American Spectator piece about Dr. Donald Berwick.  Since then I've been doing some research on Berwick, which is to say that I've been reading articles he has written.  It's quite an eye opener, as Goldberg suggested in his piece.

Berwick was recently appointed by Obama to be administrator for the Center for Medicare and Medicaid Services, formerly known as Health Care Financing Institution.  The CMS is, of course, a federal agency and comes under the Department of Health and Human Services.  The agency also oversees HIPAA and quality standards in nursing homes.

According to Wikipedia (a source I'm always dubious of but is sometimes reliable), CMS employs around 4,100 with most of those at its headquarters in Maryland.  As Goldberg explained, it's a huge job with much power.

So, what does Berwick actually stand for, or believe?

Goldberg's focus was primarily on Berwick's admiration for and obsession with Britain's National Health Service.  We've all read the horror stories over Britain's health care system, as well as the abbreviated life expectancies for patients with serious illness such as cancer.

 Berwick has made other observations and suggestions about revolutionizing the American health care system which we should make note of.

By all accounts Berwick is a personable man and delivers a powerful speech.  As Alex Gibney wrote in The Atlantic, "He is not an ideologue. He is a pragmatist, armed with data, real-life experiences and a determination to make things better. Even more important for this job, he is a great communicator who does not harangue; he persuades."

He apparently has a "folksy" good humor and  can spin a good yarn.  He hails from Connecticut and is a Harvard grad.  He practiced pediatrics and later founded the Institute for Healthcare Improvement.

What is troublesome is his affinity for the British NHS and its methods.

In 2004, in an article for Quality and Safety in Health Care, Berwick compared the British health care system to its American counterpart.  He explained that "Equity and excessive cost are far more urgent problems in the U.S., which timeliness ranks at the top of the NHS improvement agenda."

Timeliness indeed.  The stories of inferior care, refusal to fund certain drugs and long waits for care or appointments are rampant.  Yet our new CMS administrator is enamored with this system.

In the QSHC article, Berwick also said that one advantage of the UK system is that "the UK has people in charge of its health care -- people with the clear duty and much of the authority to take on the challenge of changing the system as a whole.  The US does not.  When it comes to health care as a nation, the US is leaderless."  He went on to say that the most important resource for the UK system "has been the consistent focus of government, emanating from the Prime Minister personally on raising the bar for NHS performance."

This is what we now have in America with Obamacare.  The government in charge of health care decisions. 

Not one to shy away from dissing those in the medical profession, Berwick explained that one problem in our current health care system is the inadequate training of our health care professionals.  These people are emerging from school

"...ill prepared to help.  The education of health professionals generally lacks focus on the skills in systems thinking, statistical thinking, measurement, cooperation, group process,teamwork, and pragmatic ‘‘real time science,’’ to name but a few disciplines that provide the foundation for effective citizenship in improvement."

Honestly, I'd rather have my doctor trained and experienced in say biology, cardiac care, internal medicine, pulmonary care, orthopedics, or whatever the case may be, rather than "systems thinking" or "group process teamwork."   Maybe that's just me.

In an article at The Boston Globe, Berwick is quoted as saying,

"The more I have studied it, the more I believe that less discretion for doctors would improve patient safety." He then looks down. "Doctors will hate me for saying that."

Less discretion for doctors?  And more for government, I presume?  Scientific protocols?  Death panels,anyone?

Another aspect of American health care that Berwick criticizes is what he calls "quantity over quality."  This basically seems to mean that doctors perform lots of unnecessary tests because they get paid for them.  Didn't I hear this before?  Hmmmm.  Anyway,  listen to Berwick explain this:


Don Berwick #1: "Is American Healthcare the Best in the World?" from Century Foundation on Vimeo.

 I've not yet found anything where Berwick addresses tort reform or frivolous lawsuits which might bring down the need for some of those unnecessary tests.

Berwick will undergo a confirmation hearing, but Maggie Mahar at Health Beat isn't worried.  "kcan handle himself," she said.  That may be so, but it may also be time for the rest of us to take a look at what he really stands for and how drastically he wants to revolutionize American health care.