WASHINGTON – Visionary or worst choice? President Obama's recess appointment of Harvard Medical School professor Donald Berwick, MD, to lead the Centers for Medicare & Medicaid is drawing praise from healthcare IT leaders across the country even as his detractors paint him as a champion for socialism and healthcare rationing.
"Dr. Berwick's passion, intellect, and perseverance make him a perfect person to head up CMS," said Paul Tang, MD, an internist and vice president, chief medical information officer at the Palo Alto Medical Foundation in Palo Alto, Calif. Tang also serves as vice chair of the federal Health IT Policy Committee.
"This is an incredible moment in the country's history – a once-in-a-generation opportunity to fundamentally transform the U.S. healthcare system and position it for the future, when 70 million baby boomers become eligible for Medicare," Tang said. "Don's energy and strongly held values will help guide the president's top domestic agenda, and he will do it well."
The White House announced Wednesday that Berwick would start work without Senate confirmation hearings, which is permitted under the Constitution when Congress is on official recess. Under the Constitution, Berwick will be able to serve through the end of the next session of Congress – or the end of 2011.
The White House has accused Congress of stalling the hearings and thereby forcing the recess nomination. Republican Senators, though, counter the president is making an end run to avoid disclosing potentially damaging information on Berwick.
To Lois Heim, MD, who heads the American Academy of Family Physicians, the counter argument is nonsense. She and the 94,000-member organization support Berwick's appointment. Berwick is qualified to run CMS, and there can't be further delays, Heim said, noting that CMS – a 740 billion agency – has been without an administrator since 2006.
Heim views the choice of Berwick as "ideal," and cites his work as founder and president of the Institute for Health Care Improvement. The institute is well regarded, she said, for focusing on ways of "bringing value to healthcare – improving quality and lowering costs."
"Dr. Berwick's oft-stated affection for England's socialized medicine system and its rationing body, the National Institute for Clinical Excellence (NICE), is controversial and of great concern to the American people," said Twila Brase, president of the nonprofit advocacy group Citizens' Council on Health Care.
Heim discounts claims that Berwick supports rationing.
"His history is not one of rationing," Heim said. "His history is about bringing about quality."
John Halamka, MD, CIO of Beth Israel Deaconess Medical Center in Boston and Harvard Medical School, views Berwick as the best choice for CMS.
"Don is a remarkable leader and visionary," Halamka said. "He is the best person I know to implement the mandates of health reform and improve the quality, safety, and efficiency of healthcare in the U.S."
In an interview on July 1, John Glaser, CIO of Partners HealthCare in Boston, said he expected Berwick would be confirmed, but he expected the process to be complicated given the fractious nature of Congress.
"What you have here is someone who is deeply committed to quality and deeply committed to applying whatever lever one can apply to help hospitals deliver safer care and higher quality care and that kind of orientation and aspiration and desire, I think will be very important and perhaps even transformative for CMS."
He called Berwick an "intellectual and also bully pulpit leader" who could help change the reimbursement formulas and to help focus the healthcare system on the performance of care rather than the occurrence of care.
Heim added that Berwick recognizes that a primary care system is a critical foundation for achieving needed improvements to the healthcare system at large.
"His support for strengthening primary care in the Medicare and Medicaid systems will help set the path for building up the foundation of all high quality healthcare," she said.
