Posts Tagged ‘Dr Donald Berwick’
Tuesday, August 16th, 2011
A Medicare pilot program started in 2005 chose 10 groups for an experiment in improving quality and controlling costs. This foreshadowed some of the cost-control rules in the Patient Protection and Affordable Care Act (ACA) , with groups given bonuses for meeting approximately 15 quality measures, and for spending at least two percent less than conventional Medicare. This program is a forerunner to the Accountable Care Organization (ACO) model that is one of the prime means by which the ACA’s supporters expect it to control costs. Now that the results are in, the quality issues were met, but the issue of cost proved to be far more difficult to achieve.
Writing in The Atlantic, Megan McArdle says that Donald Berwick, the head of the Centers for Medicare and Medicaid Services (CMS), says “he is optimistic about the potential of ACOs to lower costs by coordinating care, although he acknowledged that savings from the experiment ‘were unevenly distributed, and they were modest…if care is correctly coordinated, costs fall and quality rises. To me, it’s a matter of how fast we will get there, not whether we will get there.’ He may be right; sometimes you just haven’t done a program correctly. On the other hand, sometimes programs don’t work, were never going to work, and can’t be made to work. Even in the latter case, you still hear the sort of thing that Berwick is saying from the proponents of said programs: we need more time, more money, more staff, more rules. People have usually spent years, even decades, investing in their ideas; when contrary evidence comes in, their first instinct is rarely to say, ‘Well, that’s too bad–it sure seemed like it was going to work, but I guess it didn’t!’. No, what they want to do is double down.”
Started in 2005 by the George W. Bush administration, the experiment offered “performance payments” to participants that met most of 32 measures of quality — half as many as in the proposed rule — and spent at least two percent less for Medicare patients. Despite their spotty financial progress, all 10 medical groups in the experiment met the quality requirements. Additionally the program promoted care innovations, according to administration officials, outside health policy experts and leaders of the groups.
The Obama administration recently announced new options for Medicare ACOs. The new shared savings components complement the proposed rules that will be finalized this year, Dr. Berwick said. This pioneering model has been in process for months and that the latest announcement was not in response to skepticism about the proposed rules. “This is responsive to some of the concerns on how to get started faster,” Dr. Berwick said. “That’s what we’re getting asked about a lot. The criticism is comment we’re welcoming.”
CMS’ announcement represents a step in the right direction, although additional changes to the shared savings program need to be included to assure physician involvement, said American Medical Association’s (AMA) Immediate Past President J. James Rohack, MD. “The AMA is pleased that (the innovation center) is working to assist physicians at varying stages of readiness who want to participate in Medicare ACOs,” Dr. Rohack said. “The benefits of this new care delivery model cannot be fully realized unless physicians in all practice sizes can be involved.”
The CEO of the Cleveland Clinic hates proposed federal rules for accountable care organizations, saying they create “significant barriers” and would discourage hospitals from adopting the new model of care. Toby Cosgrove made the comments in an eight-page letter addressed to Donald Berwick, though Cosgrove stressed that the Clinic supports the concept of accountable care organizations (ACOs).
“Rather than providing a broad framework that focuses on results as the key criteria for success, the proposed rule is replete with (1) prescriptive requirements that have little to do with outcomes; and (2) many detailed governance and reporting requirements that create significant administrative burdens,” according to Cosgrove.
To be considered an ACO, organizations must agree to manage all of the health needs of a minimum of 5,000 Medicare beneficiaries for at least three years. ACOs are appealing to hospitals because organizations that save Medicare money will be eligible to share in some of that savings themselves. CMS is accepting public comments on its proposed ACO rules and will issue final rules later this year. Like the Clinic, other leading hospitals have criticized the rules as being too burdensome and providing too little possibility of financial gain.
Tags: Accountable care organizations, American Medical Association, Bush administration, Centers for Medicare and Medicaid Services, Cleveland Clinic, Dr Donald Berwick, Medicare, Medicare ACOs, Obama administration, Obamacare, Patient Protection and Affordable Care Act
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Monday, June 27th, 2011
Seventy percent of Americans oppose cuts to Medicare and 57 percent are against cutting Medicaid, even when they are aware that the programs constitute an outsized weight in the federal deficit. Of the two wildly popular programs, Medicaid is the most vulnerable. 
Writing in the Washington Post about a report from the Kaiser Family Foundation about the health of Medicare and Medicaid, Ezra Klein says “It doesn’t matter whether Eric Cantor says he’s bargaining for the Ryan budget or not. The GOP cannot privatize and voucherize Medicare. They can’t even get close. It’s too easy an issue for Democrats, too dangerous an issue with seniors, and too slipshod a policy even for Michele Bachmann. The attack on Medicaid, however, is another story. That one might actually work. And if it does, it’ll actually be worse. ‘in-the-know political circles,’ says Chris Jennings, who ran President Bill Clinton’s healthcare reform efforts, ‘it’s just assumed Medicaid is going to be hit. No one is going to want to touch Medicare. Medicare is where the political juice is. But we’re going to need savings. So that leads to Medicaid.’ There are two reasons Medicaid is more vulnerable than Medicare. The first is who it serves. Medicaid goes to two groups of people: the poor and the disabled. Most of the program’s enrollees are kids from poor families, though most of the program’s money is spent on the small fraction of beneficiaries who are disabled and/or elderly. These groups have one thing in common: They’re politically powerless.”
It’s a little-known fact that Medicaid covers more people than Medicare. In 2010, according to the Department of Health and Human Services, Medicaid covered 53.9 million people, compared with Medicare’s 47.3 million. Additionally, Medicaid patients are also among society’s most vulnerable. “Kids (and) pregnant women are the vast majority,” according to Health and Human Services Secretary Kathleen Sebelius. “But then older seniors, many of whom are in nursing homes…and very disabled individuals” are also covered by Medicaid.
Although states and the federal government share the cost of Medicaid, what grates on some governors is the rules that come with the money. “Governors just want flexibility to run our states,” said Republican New Jersey Governor Chris Christie at the annual National Governors Association meeting in February. “We don’t want to pay 50 percent of the cost of Medicaid and have zero percent of the authority. And I don’t think that’s an unreasonable thing to be asking for.” Governor Haley Barbour of Mississippi agrees. “If I could get total flexibility, I would take a two percent cap in a heartbeat,” he said. Barbour’s preference is to receive a lump sum – what it gets now from the federal government, plus two percent to fund Medicaid.
Dr. Donald Berwick, administrator of the Center for Medicare and Medicaid Services, (CMS) said “There’s a right way to reform Medicare and a wrong way,” Berwick believes that the direction he is taking — modeled on his successful patient safety campaigns at the Institute for Healthcare Improvement – will bring about needed healthcare change. The Obama administration’s efforts to improve patient safety are more or less bipartisan. There is little cause to dispute CMS’ data: the agency spent $4.4 billion in 2009 caring for patients harmed in hospitals and an additional $26 billion on patients who were readmitted within 30 days. The Partnership for Patients, funded through the Patient Protection and Affordable Care Act (ACA), seeks to reduce preventable injuries by 40 percent and cut hospital readmissions by 20 percent in just two years. According to CMS, achieving the Partnership’s goals will result in 1.8 million fewer patient injuries, allow more than 1.6 million patients to recover complication-free and save up to $35 billion in health costs.
Department of Health and Human Services (HHS) Secretary Kathleen Sebelius described contentious portions of the ACA as the inaugural steps toward entitlement reform. Sebelius criticized proposals to transform federal Medicaid funding into block grants for states. When some lawmakers asked her to speak about the Obama administration’s alternative proposal to rein in entitlement spending, Sebelius pointed to two provisions of the new law. The ACA created a new board of independent experts that will recommend Medicare payment cuts. Its recommendations will take effect automatically unless Congress blocks them — and proposes equivalent savings. According to Sebelius, the panel represents “a big step in terms of entitlement reform that actually doesn’t potentially cause harm to our seniors.” She also pointed to an HHS effort to create new methods of dealing with people who are eligible for both Medicare and Medicaid because those patients represent a lopsided share of the programs’ costs.
Tags: Block grants, Center for Medicare and Medicaid Services, Department of Health and Human Services, Disabled, Dr Donald Berwick, Ezra Klein, Governor Chris Christie, Institute for Healthcare Improvement, Kaiser Family Foundation, Kathleen Sebelius, Medicaid, Medicare, National Governors Association, Obama administration, Partnership for Patients, Patient Protection and Affordable Care Act, poor, President Bill Clinton, Representative Eric Cantor, Representative Michele Bachmann, Representative Paul Ryan, senior citizens
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Tuesday, June 7th, 2011
The Patient Protection and Affordable Care Act will save Medicare $120 billion over the next five years as a result of lower payments to insurers and hospitals. According to the Obama administration additional steps to cut fraud and abuse are providing promising results. Medicare Deputy Administrator Jonathan Blum said that the healthcare overhaul is working, resulting in real savings and making program more efficient. Payment reforms are improving quality, performance and slashing costs. When President Barak Obama signed the healthcare bill, one major goal was to cut spending on Medicare.
“Just a year after passage, we are seeing savings in Medicare begin to materialize from provisions in the Affordable Care Act,” said Donald Berwick, M.D., administrator for the Centers for Medicare and Medicaid Services (CMS). “This work is laying the groundwork for a larger transformation of Medicare and our healthcare delivery system, from simply paying for the volume of services provided to rewarding the quality of care delivered. We remain committed to achieving a healthcare system that pursues better care, better health, and lower cost through improvement.”
In addition to the projected savings, Medicare is on track to improve the quality of care members receive. CMS has implemented quality improvements and delivery system efficiencies including providing new preventive benefits, tying payment to quality standards, investing in patient safety and offering new incentives to providers who deliver high-quality, coordinated care. “These actions will produce savings, create incentives for greater efficiency in care delivery and lay the groundwork for a long-term transformation of our healthcare system as well to make it safer and prevent injuries and unnecessary readmissions to hospitals which not only harm patients but increase overall healthcare costs,” according to a CMS analysis.
Cutting Medicare spending was a priority of the healthcare overhaul that President Barack Obama signed into law in March 2010. The law is projected by the Congressional Budget Office to reduce deficits by $143 billion, partly through almost $500 billion in cuts and savings from the Medicare program over a 10-year period. Blum said the savings are in line with expectations by the Obama administration. “We’re very much consistent with where we thought we would be,” he said.
The savings come at a cost, of course. Cuts in physician reimbursement represent a 31 percent reduction. If the cuts are adjusted for practice-cost inflation, the American Medical Association says Medicare payment rates to physicians in 2013 will total less than half of what they were in 1991. “If we can’t fix this, the impact on physicians and physician practices is going to be devastating,” said Alan C. Woodward, M.D., Massachusetts Medical Society president. “Many practices are barely surviving now. Coupled with the ongoing problem of soaring professional liability costs, Medicare reimbursement is a critical issue for physician-practice viability,” Dr. Woodward said. “Failure to solve the Medicare problem will only further endanger older patients’ access to needed healthcare services.”
Writing on the White House Blog, Deputy Chief of Staff and healthcare czar Nancy-Ann DeParle says that “Many of these reforms were made possible by the Affordable Care Act. The new law rewards doctors and hospitals for providing high-quality care and offers new tools to help law enforcement and the Medicare program crack down on waste, fraud and abuse. Other steps like improving care for patients with disabilities and bringing down the cost of durable medical equipment build on initiatives undertaken at CMS that will also reduce costs. And we recently announced the launch of the Partnership for Patients, a new public-private partnership that will help improve the quality, safety, and affordability of health care for all Americans. Already, more than 3,000 organizations, including 1,500 hospitals, have signed a pledge to become part of the Partnership for Patients. This has the potential to save up to $10 billion for Medicare through 2013.”
Tags: American Medical Association, Centers for Medicare and Medicaid Services, Congressional Budget Office, deficit, Dr Donald Berwick, Healthcare czar, Medicare, Nancy-Ann DeParle, Obama administration, Partnership for Patients, Patient Protection and Affordable Care Act, White House blog
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Wednesday, May 11th, 2011
Mississippi Governor – and possible presidential hopeful — Haley Barbour and other Republican governors recently demanded that Medicaid, the state-federal health program that covers 50 million poor and disabled, be transformed into block grants. House Republicans have vowed to tackle expensive programs like Medicaid to cut federal spending. Any attempt to turn Medicaid into block grants – federal lump-sum payments to states – raises many questions. Democrats argue that a move of this type could result in loss of healthcare coverage for millions who are poor, sick and old.
Representative Fred Upton (R-MI), chairman of the House Energy and Commerce Health Subcommittee said to expect House bills on the Medicaid program’s maintenance-of-effort requirement and block grant funding to states. Because Medicaid is an entitlement program, all Americans who are eligible are guaranteed coverage. The federal government, which foots the bill for approximately 60 percent of Medicaid’s cost, is committed to helping the states cover costs; in return, it requires them to cover certain groups of people and provide specific benefits. For example, children, pregnant women who meet explicit income criteria and parents with dependent children must be given coverage.
“The governors have requested flexibility in the way they serve Medicaid patients,” Representative Joseph Pitts (R-PA), the Health Subcommittee’s chairman said. “They maintain they can provide the service better and cheaper, so we’re looking to give them that flexibility and change this maintenance-of-effort provision. I won’t be specific on the block grants, but we’re having discussions with governors.” Pitts’ comments followed a Health Subcommittee hearing in which HHS Secretary Kathleen Sebelius answered extensive questions about the Obama administration’s fiscal 2012 budget and the Patient Protection and Affordable Care Act.
Why are the block grants important? When the new healthcare law goes into full effect in 2014, approximately 16 million additional people will become eligible for Medicaid. The debate, which cuts to the heart of the social contract between the government and its citizens, has implications for the other large entitlement programs — Social Security and Medicare. In 2010, the federal government spent $1.5 trillion on those programs, or approximately 43 percent of the federal budget, according to the Congressional Budget Office. Speaker of the House John Boehner (R-OH) said House Republicans’ upcoming budget proposal would cut Social Security and Medicare, despite the political risk of taking on such popular programs. Democrats are skeptical. Changing Medicaid into a block grant means “you have no guarantee that people who are now covered will continue to be covered, or whether (the states) will simply cut back on their Medicaid program,” said Representative Henry Waxman, (D-CA), who is a primary defender of the program.
Tags: Block-grant funding, Centers for Medicare and Medicaid Services, Community-based attendant services, Congressional Budget Office, Democrats, Department of Health and Human Services, Dr Donald Berwick, Governor Haley Barbour, House Energy and Commerce Committee, House of Representatives, Kathleen Sebelius, Maintenance of effort requirement, Medicaid, Medicare, Obama administration, Patient Protection and Affordable Care Act, Representative Fred Upton, Representative Henry Waxman, Representative John Boehner, Representative Joseph Pitts, Republicans, Social contract, social security
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Wednesday, March 23rd, 2011
With the power shift in the House of Representatives, Medicare, Medicaid and Social Security are being targeted in proposed budget cuts designed to bring down the deficit. “It will likely be the first time you see a House have a prescription for Social Security, Medicare and Medicaid,” House Majority Leader Eric Cantor (R-VA) said at the Federation of American Hospitals’ annual public policy conference and business exposition in Washington.
Mississippi Governor Haley Barbour, a Republican, said that members of Mississippi’s Medicaid program saw its enrollment drop approximately 23 percent to 580,000 beneficiaries from 750,000 after the state started requiring beneficiaries to establish their eligibility in person. Barbour began this practice in his first year as governor in 2004. Senator Orrin Hatch (R-UT), the ranking Republican on the Senate Finance Committee, slammed the Patient Protection and Affordable Care Act (ACA), noting that its expansion of Medicaid will “bankrupt” the states, which already have strained budgets. Hatch also cited Congressional Budget Office figures that say the ACA’s Medicaid expansion will cost taxpayers $435 billion over the next decade.
President Barack Obama said his proposed 2012 budget was a “down payment,” on cutting the federal budget deficit, and said that more work is needed to address “long term challenges”. Cantor said that on “individual items” there were “probably some areas of agreement” between the President and Republicans. “But we can’t keep taking the savings and going to spend it,” he said. “The object here is to cut.” According to Cantor, the President’s plan “just misses the mark of living up to the expectations” Obama laid out in his State of the Union speech in January. Asked if Cantor expected adjustments to Social Security and Medicare, Cantor said he was “hopeful that we can get some cooperation from [Senate Majority Leader] Harry Reid [D-NV] and the President, because these are programs that touch the lives of every American and we don’t want, nor can we, make these changes by ourselves.”
Writing on the Huffington Post, Richard Eskow took an alarmist tone, saying that “entitlement reform” is a euphemism for allowing the elderly to die if they become ill. “’The President’s budget punts on entitlement reform,’ reads a statement by House Republicans. ‘Our budget will lead where the President has failed, and it will include real entitlement reforms.’ ‘You have to do entitlement reforms if you are serious about this budget,’ according to Representative Paul Ryan (R-WI).” Eskow counters “Reality check: Nobody’s proposing ‘entitlement reform.’ That term is a cloaking device for some very ugly intentions. It’s a meaningless manufactured phrase cooked up by some highly-paid consultant, and it diminishes the sum total of human understanding every time it’s used. The phrase is a euphemism for deep cuts to programs that are vital and even life-saving for millions of elderly and poor people, but it’s politically unpalatable to say that. So it became necessary to come up with yet another cognition-killing term designed to numb us from the human toll of our political actions. ‘Entitlement reform’ is the new ‘collateral damage.’”
The Washington Post’s Ezra Klein is more diplomatic in his assessment of the possibility of entitlement reform. “We’ll see. I wouldn’t be surprised if Obama has his name on a broader deficit-reduction bill at this time next year. If he takes the deficit away from Republicans before 2012, his reelection campaign becomes considerably easier. And on a less cynical level, his administration is stocked with deficit hawks — the same folks who actually balanced the budget under Bill Clinton. And similarly, Republicans want to deliver on the deficit-reduction promises they’ve made to their base. In theory, everyone’s incentives and ideologies are pointing in the same direction. That’s a good sign for progress.”
Tags: Centers for Medicare and Medicaid Services, Congressional Budget Office, deficit, Deficit hawks, Dr Donald Berwick, Entitlements, Ezra Klein, Federal budget, Federation of American Hospitals, Governor Haley Barbour, House of Representatives, Medicaid, Medicare, President Barack Obama, President Bill Clinton, Representative Eric Cantor, Representative Paul Ryan, Republicans, Senate Finance Committee, Senator Harry Reid, Senator Orrin Hatch, social security, State of the Union speech
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Monday, March 14th, 2011
Senate Republicans are trying to block the nomination of Harvard-educated pediatrician Dr. Donald Berwick to serve a full term as the administrator of the Centers for Medicare and Medicaid Services. Led by Senators Orrin Hatch (R-UT), the ranking member of the Senate Finance Committee, and Mike Enzi (R-WY), the ranking member of the Senate Health, Education, Labor and Pensions Committee, the senators contend that President Barack Obama’s recess appointment last year was completed before a hearing was held. The senators contend that this hindered the 111th Congress’ ability to fully consider Berwick’s nomination.
“This abrupt and unilateral action meant that no senator — Democrat or Republican — was given the opportunity to ask Dr. Berwick a single question before he was placed in charge of an agency with a budget larger than the Department of Defense; which controls four percent of our nation’s gross domestic product; and, most importantly, directly impacts more than 100 million American lives every single day,” according to the Senators’ letter. The senators say that Berwick’s “past record of controversial statements, and general lack of experience managing an organization as large as complex as CMS should disqualify him” from the post. “Once you have withdrawn his nomination, we are confident we can all work together to find a nominee for administrator we can support and confirm after appropriate hearings are held,” the letter stated.
Even some Congressional Democrats are urging the Obama administration to find another Medicare chief after concluding that the Senate is unlikely to confirm Dr. Berwick. The most-favored nominee is Dr. Berwick’s principal deputy, Marilyn B. Tavenner, a nurse and former Virginia secretary of health and human resources who has extensive management experience and would likely be confirmed. President Obama bypassed Congress and named Dr. Berwick to his post while the Senate was in recess last summer. The current appointment allows him to serve to the end of 2011.
Despite the vocal opposition to Dr. Berwick, President Obama is refusing to withdraw his nomination. “The president nominated Don Berwick because he’s far and away the best person for the job, and he’s already doing stellar work at CMS: saving taxpayer dollars by cracking down on fraud, and implementing delivery system reforms that will save billions in excess costs and save millions of lives,” White House spokesman Reid Cherlin said. Unfortunately for the president, even some Senate Democrats believe that Berwick cannot be confirmed. Senate Finance Committee Chairman Max Baucus (D-MT) has said that he would not commit to a confirmation hearing, and other Democrats have acknowledged that the nomination is in trouble. “I think it would be very tough in this environment. If we can get some bipartisan products moving forward, then the answer is yes. If you can’t get some bipartisan products moving forward, it’s going to be difficult,” said Senator Ben Cardin, (D-MD).
The Medicare administrator’s job involved significant responsibilities under the healthcare law, such as establishing new insurance markets, expanding Medicaid, and overhauling the way Medicare pays providers to reward quality instead of volume. Republicans need 41 votes to block Berwick’s confirmation in the full Senate; their letter indicates they have more than enough. The loss of Berwick, a respected medical innovator and patient advocate, would be a blow to the administration as it moves ahead in its implementation of the healthcare reform law.
Five Republican senators did not sign Hatch’s letter. They are Scott Brown (R-MA), Susan Collins (R-ME), Olympia Snowe (R-ME), Lisa Murkowski (R-AK), and Rob Portman (R-OH).
Tags: 111th Congress, Centers for Medicare and Medicaid Services, Democrats, Dr Donald Berwick, education, Health insurance exchanges, healthcare reform law, Labor and Pensions Committee, Marilyn B. Tavenner, Medicaid, Medicare, President Barack Obama, Recess appointment, Reid Cherlin, Republicans, Senate, Senate Finance Committee, Senate Health, Senator Ben Cardin, Senator Lisa Murkowski, Senator Max Baucus, Senator Mike Enzi, Senator Olympia Snowe, Senator Orrin Hatch, Senator Rob Portman, Senator Scott Brown, Senator Susan Collins, White House
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Monday, March 7th, 2011
The Centers for Medicare and Medicaid Services (CMS) is planning an exhaustive patient-safety initiative that will draw from already-known strategies for safer care. “Let’s make the best the norm,” said Dr. Donald Berwick, CMS administrator, citing as evidence of the efficacy of such initiatives the unfavorable patient events that – happily — are now virtually nonexistent at some of the nation’s hospitals. Berwick is renowned for his “100,000 Lives” and “Protecting 5 Million Lives from Harm” campaigns, which he initiated when he headed the Institute for Healthcare Improvement before moving to CMS.
Berwick praised the Patient Protection and Affordable Care Act, as well as the information technology it supports to create the best possible healthcare delivery system. Both offer tools that will allow coordinated-care plans for patients and encourage caregiver teams to manage those plans. One of the tools will be accountable care organizations (ACO). Berwick said the regulations defining ACOs under Medicare as “imminent.” According to Berwick, the regulations will be in the form of a “notice of proposed rulemaking,” with a 60-day public comment period. “This will be our first stab at that definition.”
Quality News Today notes that “Motivational efforts and inspirational talk may seem more the bailiwick of Super Bowl coaches than government bureaucrats. But when one considers that Berwick’s successful career as a national leader in healthcare quality improvement boiled down to fostering an internal drive on the part of individuals and organizations to do better work, the efforts perhaps are no surprise at all.” Berwick said that CMS’ strategy will focus on building operational excellence; improving care for individuals; integrating care for populations; and improving the health of populations and communities. “We do have tremendous knowledge about how to make care safe,” Berwick said. Some organizations have remarkable records in patient safety, but there are only “pockets of excellence.” Berwick wants to “bring excellence to scale” and believes that CMS is up to the task. “We can do well with a joyous work force, we can’t without it,” Berwick said, “I myself will be teaching the first four 90-minute classes on improving the work.”
John Rother, executive vice president for policy for AARP, the Washington-based advocacy group for people 50 and older, applauds Berwick’s emphasis on patient safety. Changes have saved “lives and money,” Rother said.
Unfortunately — and despite excellent intentions — errors still occur in hospitals, even with the new safeguards. Ten years ago, the Institute of Medicine published its landmark report “To Err Is Human: Building a Safer Health System.” The report estimated that 44,000 to 98,000 deaths occur every year because of preventable medical errors in American hospitals. According to Manoj Jain, an infectious-disease specialist and an adjunct assistant professor at the Rollins School of Public Health at Emory University in Atlanta, “But, to make hospitals really safe, we need to take a leap. We need to build a culture in which patient safety is the priority not just for the quality improvement director but also for every nurse, doctor, administrator, aide, housekeeper, dietary worker and hospital board member.”
Tags: 000 Lives, 100, AARP, Accountable care organizations, Alliance for Academic Internal Medicine, Caregivers, Centers for Medicare and Medicaid Services, Dr Donald Berwick, Institute for Healthcare Improvement, Institute of Medicine, Patient Protection and Affordable Care Act, Patient Safety, Protecting 5 Million Lives from Harm, Quality News Today, Rollins School of Public Health, Unfavorable patient events
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Tuesday, January 4th, 2011
Dr. Donald Berwick, Administrator of the Center for Medicare and Medicaid Services (CMS), “can’t imagine a worse idea” than repealing the Patient Protection and Affordable Care Act healthcare reform law. “Without the individual mandate, the intention to extend coverage, especially to people with chronic illnesses, would unravel,” Berwick said in a recent speech to the Commonwealth Club of California. According to Berwick, the requirement is “bearing your share of responsibility for your health.”
Berwick believes the new healthcare reform law “has got more resources in it and texture than I imagined.” One of the law’s biggest opportunities, Berwick said, is accountable-care organizations (ACOs); CMS is planning to release proposed ACO regulations in January. Berwick said that there is no single approach to creating an ACO because of differences between local resources, providers, and even geography. “I think we are going to see a rebirth of organizations able to make care a journey and not fragmentation. Organizations will have memories about patients, not amnesia,” Berwick said. “Withholding needed care is one of the worst plans you can imagine.”
Berwick warned that there will be two sides to the transformation that healthcare reform will bring. One will be “authentic, they will be the real partners on a great national expedition,” he said. Others “will become cloaks of the status quo.” The federal government has committed $10 billion over the next decade to the new Center for Medicare and Medicaid Innovation, a program that will test new approaches – as well as models of care and payment — that can improve health services.
Tags: Accountable care organizations, Center for Medicare and Medicaid Innovation, Center for Medicare and Medicaid Services, Commonwealth Club of California, Dr Donald Berwick, healthcare reform, Individual mandate, Patient Protection and Affordable Care Act
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Thursday, July 29th, 2010
The federal government has issued revised standards for the “meaningful use” of electronic medical records that will financially reward physicians and hospitals who adopt the new technology. According to the Department of Health and Human Services, physicians and hospitals could receive as much as $27 billion over the next decade if they put patients’ medical records on computer instead of paper. Physicians can be paid up to $44,000 under Medicare and $63,750 for Medicaid. Depending on their size, hospitals have the potential to receive millions of dollars. In 2015, hospitals and physicians face financial penalties under Medicare if they fail to use electronic medical records by the deadline.
Dr. Donald Berwick, the new administrator of the Centers for Medicare and Medicaid Services (CMS) said electronic medical records will lead to “better, smoother care, more reliable care.” Department of Health and Human Services (HHS) Secretary Kathleen Sebelius said “Only 20 percent of doctors and 10 percent of hospitals use even basic electronic health records.” Taking a slightly different perspective, Richard J. Umbdenstock, president of the American Hospital Association (AHA), said the new standards are an improvement over the rules initially proposed but was not convinced that doctors or hospitals would adopt the new technology.
Some physicians believe that using electronic medical records will reduce errors and save patients’ lives. The new standards are flexible and require physicians to meet 15 specific requirements, as well as another five selected from a list of 10 objectives. To fulfill the new standards, physicians will have to submit 40 percent of prescriptions electronically. “We are delaying some of the more ambitious requirements,” said Dr. David Blumenthal, the national coordinator for health information technology.
Tags: American College of Cardiology, American Hospital Association, Centers for Medicare and Medicaid Services, Department of Health and Human Services, Dr Donald Berwick, electronic medical records, Kathleen Sebelius, Medicaid, Medicare, Obama administration, President Barack Obama
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