Donald Berwick

Donald Berwick
File:Donald Berwick CMS Administrator.jpg
Administrator of the Centers for Medicare and Medicaid Services
In office July 7, 2010 – December 2, 2011
President	Barack Obama
Preceded by	Charlene Frizzera (Acting)
Succeeded by	Marilyn Tavenner
Personal details
Born	(1946-09-09) September 9, 1946 New York City, New York, U.S.
Political party	Democratic
Spouse(s)	Ann Berwick
Children	Ben Dan Jessica Rebecca
Alma mater	Harvard University

Donald M. Berwick (born 1946) is a former Administrator of the Centers for Medicare and Medicaid Services (CMS). Prior to his work in the administration, he was President and Chief Executive Officer of the Institute for Healthcare Improvement a not-for-profit organization. On July 7, 2010, Barack Obama appointed Berwick to serve as the Administrator of CMS through a recess appointment. On December 2, 2011, he resigned because of heavy Republican opposition to his appointment and his potential inability to win a confirmation vote. On June 18, 2013, Berwick declared his candidacy for governor of Massachusetts, but lost the Democratic Party nomination to Attorney General Martha Coakley.

Berwick has studied the management of health care systems, with emphasis on using scientific methods and evidence-based medicine and comparative effectiveness research to improve the tradeoff among quality, safety and costs. Among IHI's projects are online courses for health care professionals for reducing Clostridium difficile infections, lowering the number of heart failure readmissions or managing advanced disease and palliative care. In March 2012 he joined the Center for American Progress as a Senior Fellow.

Biography

Berwick grew up in Moodus, Connecticut. His father, Philip, worked as the town's family doctor. His mother, Rosalind Fine, was the primary caretaker of Berwick and his two younger brothers until she died from ovarian cancer in 1961. Because of Fine's efforts to promote the construction of a new elementary school in Moodus, the school's library was named after her when it was built. Berwick graduated from Nathan Hale-Ray High School and went on to obtain his B.A. from Harvard College, where he graduated summa cum laude. While at Harvard, Berwick met his future wife, Ann, in his freshman biology class, where they were lab partners. The couple have four children: Ben, Dan, Jessica, and Becca. Berwick earned both an M.D. cum laude from Harvard Medical School and an M.P.P. from John F. Kennedy School of Government in 1972. He completed his medical residency in pediatrics at Children's Hospital Boston.

Berwick began his career as a pediatrician at Harvard Community Health Plan; in 1983 he became the plan's first Vice President of Quality-of-Care Measurement. In that position, Berwick investigated quality control measures in other industries such as aeronautics and manufacturing, in order to consider their application in health care settings. From 1987-1991, Berwick was co-founder and Co-Principal Investigator for the National Demonstration Project on Quality Improvement in Health Care, designed to explore opportunities for quality improvement in health care. Based on this work, Berwick left Harvard Community Health Plan in 1989 and co-founded the IHI (Institute for Healthcare Improvement).

Berwick is Clinical Professor of Pediatrics and Health Care Policy in the Department of Pediatrics at the Harvard Medical School and Professor of Health Policy and Management at the Harvard School of Public Health. He is also a pediatrician, Adjunct Staff in the Department of Medicine at Children's Hospital Boston, and a Consultant in Pediatrics at Massachusetts General Hospital.

Berwick has published over 129 articles in professional journals on health care policy, decision analysis, technology assessment, and health care quality management. He is the co-author of several books, including Cholesterol, Children, and Heart Disease: an Analysis of Alternatives (1980), Curing Health Care (1990), and New Rules: Regulation, Markets and the Quality of American Health Care (1996).

Nomination and controversy

Berwick said that 20-30% of health spending is "waste" with no benefit to patients, because of overtreatment, failure to coordinate care, administrative complexity and fraud, and that part of this problem was because of CMS regulations.

Berwick's critics have cited his statements about the need for health care to redistribute resources from the rich to the poor and his favorable statements about the British health service. They quote Berwick as saying, "The decision is not whether or not we will ration care - the decision is whether we will ration with our eyes open."

Berwick said that Republicans had "distorted" his meaning: "My point is that someone, like your health insurance company, is going to limit what you can get. That's the way it's set up. The government, unlike many private health insurance plans, is working in the daylight. That's a strength."

For political reasons, the Obama administration made Berwick stay evasive and avoid defending his past statements on the British health service, spending caps and high-technology care.

Critics point to statements such as this: "Any health care funding plan that is just, equitable, civilized and humane must, must redistribute wealth from the richer among us to the poorer and the less fortunate. Excellent health care is by definition redistributional."

On April 19, 2010, Berwick was nominated to be Administrator of the Centers for Medicare and Medicaid, which oversees the two federal programs.

An editorial wrote that his policy ideas could cut health care costs. Conservatives criticized Berwick, based on comments he made about health care being, by definition, redistribution of wealth, rationing care with "our eyes open" and complete lives system.

Berwick advocates cutting health costs by adopting some of the approaches of Great Britain's National Health Services (NHS) and its National Institute for Health and Clinical Excellence (NICE). NICE evaluates the costs and effectiveness of medical therapy that is covered by the NHS as guidance for local authorities to decide what to cover. Mark McClellan, who served in the Bush administration, also advocated adopting some of NICE's methods.

Conservative critics claim that "NICE decides which healthcare people will get and which they won't." Philip Klein in The American Spectator dubbed him "Obama’s Rationing Man." The chairman of NICE called these statements "outrageous lies."

Senator John Kerry defended Berwick against "phony assertions" and accused Republicans of trying "to crank up the attack machine and make his nomination a distorted referendum on reform." Former Speaker Newt Gingrich has historically been a Republican supporter of Berwick, however, writing an op-ed in the Washington Post in August 2000 praising Berwick's work.

Berwick was installed by recess appointment on July 7, 2010 before confirmation hearings were scheduled by the Democratic-controlled Senate committee. Berwick could thus serve until the summer of 2011 without a Senate approval. The White House had talked up the possibility of a re-nomination through the fall of 2010; on January 26, 2011, the President re-nominated Berwick. On March 4, 2011, 42 U.S. Senators wrote the White House and asked for the nomination to be withdrawn. The signers of the letter were all Republicans.

Berwick resigned his position at CMS on December 2, 2011. In a speech on Wednesday, Dec. 7, 2011 in Orlando, Florida, at a meeting of the Institute for Healthcare Improvement, an organization he once led, the long-time patient-safety advocate gave an account of his time in government service and where he believes the future of healthcare is going.

2014 Massachusetts Gubernatorial Race

File:DonBerwick RappaportCenter 2014.jpg

Don Berwick speaking at the Rappaport Center for Law and Public Service, Suffolk Law School on Jan. 15, 2014

Main article: Massachusetts gubernatorial election, 2014

On June 17, 2013, Berwick announced his run for the Massachusetts Governor's office. Berwick framed himself as progressive on major issues and said it was crucial that Massachusetts continue to focus on health care reform and the well-being of children, topics he has focused on during his career. Berwick, who holds three degrees from Harvard, repeatedly emphasized his experience in helping health organizations deliver better care to consumers, an asset he said he would bring to being the state’s chief executive.

Some of Berwick's specific goals for the governorship included focusing on job creation and economic development, instituting single-payer healthcare in Massachusetts, and ending child poverty in the state by the year 2024. Following the conviction of former probation commissioner John O'Brien on corruption charges, Berwick added that rooting out corruption would be another priority.

Although Berwick was seen as the heir to the Massachusetts trend of electing political outsiders to high offices, like Governor Deval Patrick and Senator Elizabeth Warren, pundits raised concerns in the Summer of 2014 that Berwick had failed to gain the traction he needed to succeed in the primary. However, he outperformed nearly all projections and pollsters in the Democratic primary with 21% of the vote. This prompted the recognition of him being a "surprise" in the race.

Berwick conceded the Democratic nomination to Massachusetts Attorney General Martha Coakley on September 9, 2014.

Awards and honors

• Ernest A. Codman Award, 1999
• Alfred I. DuPont Award for excellence in children’s healthcare, 2001
• American Hospital Association, "Award of Honor", 2002
• Fellow of the Royal College of Physicians in London, 2004
• Honorary Knight Commander of the Most Excellent Order of the British Empire, 2005
• Purpose Prize for "enlisting wide-scale cooperation and scientifically-proven protocols to help hospitals improve care and save more than 100,000 lives," 2007
• The 13th Annual Heinz Award for Public Policy, 2007
• Honorary Fellowship of the Royal College of Physicians of Ireland, Dublin October 20th 2012

Selected publications

Books

Articles

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• Berwick DM, Jain SH. "The Basis for Quality Care in Prepaid Group Practice," in Toward a 21st Century Health System: The Contributions and Promise of Prepaid Group Practice. Alain C. Enthoven & Laura A. Tollen eds. San Francisco: Jossey-Bass, 2004.
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• Berwick, DM, Jain SH, and Porter ME. "Clinical Registries: The Opportunity For The Nation." Health Affairs Blogs, May 2011.

External links

• Profiles in Leadership: Don Berwick
• Dr. Berwick at Harvard Medical School
• Donald Berwick at the Institute of Medicine of the National Academies
• Donald Berwick collected news and commentary at The Washington Post
• Appearances on C-SPAN
• Works by or about Donald Berwick in libraries (WorldCat catalog)
• Money-Driven Medicine a documentary featuring Dr. Donald Berwick based on the book by Maggie Mahar

Blog posts

• Who Is Don Berwick and What Will He Mean for Reform?, Maggie Mahar, TheHealthCareBlog, March 30, 2010. Blog post citing WP:RS sources favorable to Berwick
• Obama Nominee Donald Berwick’s Radical Agenda, Ben Domenech, RedState.com, May 12, 2010. Blog post citing WP:RS sources unfavorable to Berwick
• In a Surprise Move, Administration Appoints Berwick to Head CMS By Maggie Mahar, TheHealthCareBlog, July 2010. Analysis of White House decision to appoint Berwick to top job in CMS, favorable to Berwick.

Political offices
Preceded by Charlene Frizzera Acting	Administrator of the Centers for Medicare and Medicaid Services 2010–2011	Succeeded by Marilyn Tavenner