Back in 2011, just before Medicare named the 32 providers who would test new ways to deliver care with better quality and lower costs, Don Berwick, then the leader of the Centers for Medicare and Medicaid Services (CMS) said, “for Medicare, coordinated care represents the most promising path toward financial sustainability and away from alternatives that shift costs onto patients, providers, and private purchasers,” in this New England Journal of Medicine article.

So when Berwick (who is also seriously considering a run for governor of Massachusetts) said last week that he’s advising some Pioneer ACOs in their dispute with CMS about how to measure quality, my ears perked up. Today, he clarified that he’s only spoken to one ACO executive who called to ask for his advice. Berwick points out he can’t, in accordance with federal ethics rules, get involved in direct negotiations.

Berwick says it’s important to “stay on the high road with respect to the purposes here. The idea of ACOs is important and it (quality) is an important component in the whole move toward integrated care. So let’s not throw the baby out here.”

Berwick, who is also busy helping Britian’s National Health Service recover from an “enormous illness”, offers the Pioneer ACOs some guidance.

“As you work through solutions, stay on the high road. And then, try to get to a platform where the discussion is not, will we play or not, but can we work this through at a technical level.”

The Pioneers may well create quality standards that will be put to use in hospitals across the country. Berwick explains the challenges.

“It’s very important to align metrics in this country so we don’t have so many. We have this chaotic measurement environment where the number of things people have to report is crazy so some of what has to be kept on the table is, let’s simplify and make sure the metrics align. That vocabulary is really important.”

The 32 Pioneer ACOs have told CMS they need to know before April 2nd, if the feds will accept provider recommendations on how to measure quality.

CMS is under increasing pressure from Republicans on Capitol Hill to prove that the Pioneer ACOs are worth the investment.

We’ll keep you posted. Let us know if you hear anything!

Think incumbent Gov. Deval Patrick is intensely oriented toward health care? Could be you ain’t seen nothing yet. State House News Service reports that Dr. Don Berwick, a national leader on improving the health care system, and the Obama administration’s former chief of Medicare, is considering a run for governor to succeed Patrick. From State House News:

Dr. Donald Berwick, a Boston-based pediatrician and former Obama administration health care official, is giving serious consideration to running for governor as a Democrat in 2014, injecting himself into a conversation limited so far to two statewide officeholders.

Berwick, who served for a year and a half as administrator of the Centers for Medicare and Medicaid Services before resigning in the face of Republican opposition to his permanent confirmation, has been talking with family, friends, civic and business leaders about a possible run.

He met privately on Monday with Lt. Gov. Timothy Murray in his State House office to inform the Democrat of his plans, and has also spoken with state Democratic Party officials.

“That’s correct. I’m strongly considering it,” Berwick confirmed to the News Service on Tuesday.

Berwick joins Murray and Treasurer Steven Grossman among those giving serious thought to a run for governor in 2014 when Gov. Deval Patrick plans to leave office at the end of the second term.

Readers, should he run? Why or why not?

In the Boston Globe, Dr. Donald Berwick, the widely admired former chief of Medicare and one of the nation’s leading health policy mavens, has just weighed in on the competing proposals for cost-cutting reform in Massachusetts. He argues in favor of aiming for more ambitious cost-cutting targets: The House’s tougher goal rather than the Senate’s less ambitious one, or even the still-tougher target put forth by business and religious groups.

I must say that what struck me most in his essay were the repeated references to pain for a good cause. Massachusetts needs “large-scale changes in delivery that will be temporarily uncomfortable for most providers.” Government must step in because “The changes are just too hard for most to face.” And “Undoubtedly, this transition will be wrenching.” I’m left wondering: Is there a political equivalent to Novocaine?

The whole piece is an important read but here’s an excerpt:

Bills now before the Massachusetts House and Senate can provide that will in the form of a cost target, and by creating consequences for missing it. The House would limit the growth of health care costs to the growth rate of the Massachusetts economy starting now, and then to 0.5 percentage points lower than the overall economic growth rate starting in 2016. The Senate is less ambitious; it would set a limit of 0.5 percent above economic growth until 2016, and then equal to it thereafter. Neither matches the bolder goal proposed last month by both the Associated Industries of Massachusetts and the Greater Boston Interfaith Organization: 2 percentage points lower than the overall growth rate.

Alarms are sounding. Massachusetts hospitals and other providers are warning that too stringent a target will harm care — and harm the state’s economy when unemployment is already high.

Undoubtedly, this transition will be wrenching. But no healthy industry can maintain jobs that depend on continuing services that add no value.

Wishful thinking? Maybe.

But Donald Berwick, former administrator of the Centers for Medicare and Medicaid Services tells Kaiser Health News that despite “messaging problems,” he believes the national health law will stand. “I expect the law will be upheld,” he says.

(Next week, the U.S. Supreme Court hears arguments on the law’s constitutionality; a decision is expected in June.)

This morning, Berwick spoke to WBUR’s Tom Ashbrook and continually brought the conversation back to the huge potential of the nation’s health reform law, which he called “majestic.”

Berwick said the reason he lost his job in Washington boils down to this: “An absence of authentic dialogue on what’s needed in health care.”

Still, he said: “It’s a thrilling time in health care…major improvements are possible if we can buckle down in this country and get health care to perform how we want it to…We have to cross the bridge from fear to optimism.”

To make the health care system better, he said, “it’s going to have to change… [we have to] organize around the needs of patients: we have a system we inherited organized around volume. To change that into a system organized around value — the best kind of care instead of the most care. Now hospitals get rewarded for staying full…what we need is a health care system where hospitals make money by having people at home…there’s also a knowledge gap, people don’t know how much better things can be.”

The Affordable Care Act is the key, he said, with one part of the law a “moral” commitment to universal health coverage and the second part focused on improvements in quality that can trigger falling costs. “The act is organized around changes in care, changing payment systems…paying a hospital more when infection rates drop” for instance. The Act “takes a step toward universal health care, toward justice, making health care a human right…I think Americans want a health care system that’s just, reliable, available and available to all.”

But many remain bitter about Berwick’s departure as Medicare chief — due to GOP opposition — and the loss unleashed a groundswell of regret.

Today, Joe Nocera in an opinion piece in The New York Times expressed that sense of regret after chatting with Berwick in Newton Sunday while the doctor unpacked. “Dr. Berwick, I’m here to tell you, was the most qualified person in the country to run Medicare at this critical juncture,” Nocera writes, “and the fact that he is no longer in the job is the country’s loss.”

What did Berwick accomplish in those 17 months? A lot — though not nearly as much as he would have liked to. His focus, as it has always been, was on improving the quality of health care and cutting costs. “On my third day,” he said, “I held a staff meeting for all 5,000 members of the staff, and I said, ‘You all think that you are in the business of paying bills. Yes, you do that. But I also think Medicare can be a force for change.’ ” He added, “I tried to reconceptualize it as an improvement organization.”

As Berwick tells it — and others affirm — the Medicare staff had been hungering for such a mission. “We had a triple aim,” he says. “Better health care. Better health for the overall population. And lower costs. I thought that, my goodness, given the resources and the reach — and the great staff, which was a wonderful surprise — we ought to be able to help health care providers do much better.”

Before coming to CMS, Tavenner served as secretary of Virginia’s Health and Human Services where she oversaw 12 agencies that employed 18,000 people. Her career also included 25 years working for the Hospital Corporation of America where she started as a staff nurse and became president of outpatient services, according to an alumni profile posted on the Virginia Commonwealth University’s web site. She has also previously served as acting CMS administrator.

Tavenner, who was named interim director, will still have to face Senate confirmation, and it’s not at all clear how that will go. “The current political climate on Capitol Hill may mean that Tavenner is just as likely to see her nomination stall,” KHN reports.

Still, Tavenner appears to be prepared to take on the challenge, KHN writes:

In a 2008 Journal of Health Care Management article, Tavenner said that her career has been built on embracing opportunities “outside of my comfort zone.”

“When I reflect on my career, I am reminded of my favorite Dr. Seuss saying, ‘Oh the places we will go.’ I certainly had no idea what lay in store for me. When I finished nursing school, my goal was to be the best nurse manager ever. When I completed graduate school, my goal was to be the best hospital executive ever,” she said. “I never thought beyond those goals or where the future would take me. Along the way, however, I embraced new experiences and accepted responsibilities outside of my comfort zone. All of those experiences led me to a career path that took me from nursing to hospital administration to this current arena of public policy.”

Here’s video of Tavenner (she appears about 4.5 minutes in) talking about how Obama’s health law benefits seniors.

(CMS)Dr. Donald Berwick

The Associated Press reports:

“WASHINGTON — The point man for carrying out President Obama’s health care law will be stepping down after Republicans succeeded in blocking his confirmation by the Senate, the White House announced Wednesday.

Medicare chief Don Berwick, a Harvard professor widely respected for his ideas on how to improve the health care system, became the most prominent casualty of the political wars over a health care overhaul whose constitutionality will be now decided by the Supreme Court.”

The AP report includes an eloquent excerpt from an email Dr. Berwick sent to his staff, describing his “bittersweet emotions”:

“Our work has been challenging, and the journey is not complete, but we are now well on our way to achieving a whole new level of security and quality for health care in America, helping not just the millions of Americans affected directly by our programs, but truly health care as a whole in our nation,” Berwick wrote.

Dr. Berwick’s exit was long expected, as we reported here, here and here. Will he return to the Cambridge institution whence he came, the Institute for Healthcare Improvement? Please stay tuned.

The regulations, released today, cut the number of performance measurements required from hospitals and physician groups, eliminates electronic health record requirements, removes financial risk for some providers and makes up-front money available for rural and small physician-owned groups.

Introducing the new regulations in a commentary in today’s New England Journal of Medicine, Donald Berwick, the administrator for the Centers for Medicare and Medicaid Services wrote that the easing of these and other restrictions should “create a more feasible and attractive on-ramp for a diverse set of providers and organizations to participate as ACOs.”

KHN reports:

The administration made several concessions to the health industry in the final rule announced Thursday.

Among the key changes:

–Providers will be able to participate in an ACO and share in savings with Medicare without risk of losing money. ACOs will be able to start sharing in the savings earlier rather than letting Medicare retain all the initial savings.

–The number of quality measures that ACOs will have to meet to qualify for performance bonuses was reduced from 65 to 33.

–The ACOs will also be told up-front which Medicare beneficiaries are likely to be part of their system. Under the earlier rule, ACOs would not know which patients were in the ACO until their contract ended.

–Community health centers and rural health clinics will be allowed to lead ACOs. They were left out of the prior proposal.

A pediatrician by training who administers the federal Centers for Medicare and Medicaid Services, Berwick is quoted saying he feels like he’s still in his 20s, which is nice, and that Medicare feels safe and secure to him — even nicer.

While some people may dread turning 65 as another milepost of getting older, the white-haired Berwick is only looking ahead. He plans a birthday dinner at a restaurant in Washington with his wife, who works in Massachusetts. They are getting ready for the birth of their second grandchild in October. “I look forward to it,” he said of joining Medicare. “I am lucky, I am employed and love my work and have no plans to retire. I see myself working for a long time, but it’s good to know Medicare is there. It’s security and it feels safe.”

There’s no mention of the political troubles facing Berwick — who was appointed by President Obama during a July 2010 recess and has faced the wrath of the GOP ever since. For instance, if he’s not confirmed by Congress Berwick’s term will end in December.

I wouldn’t go so far as to call Don Berwick a “rock star.” But here’s Meghan McCarthy, on video for The National Journal, dubbing him a sort of Mick Jagger of Medicaid and speculating on what happens to his loyal fans and groupies of the “quality” health care movement when and if Berwick is timed out of his post as administrator of the Centers for Medicare and Medicaid Services.

She writes:

As Medicare is put under the microscope in the debt-ceiling talks, the clock is running out for Centers for Medicare and Medicaid Services Administrator Donald Berwick to be confirmed by Congress. Berwick took the job of director of CMS in July of last year, getting a recess appointment from President Obama while the Senate was out on break. Republicans have been blocking the confirmation of Berwick, whose controversial academic writings about rationing health care sparked the “death-panel” debate in 2009. If he isn’t confirmed, his term will end in December. So what does that mean for health care policy?