Donald Berwick

Donald M. Berwick (born September 9, 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[1] a not-for-profit organization.

Don Berwick
Administrator of the Centers for Medicare and Medicaid Services
In office
July 7, 2010 – December 2, 2011
PresidentBarack Obama
Preceded byCharlene Frizzera (acting)
Succeeded byMarilyn Tavenner
Personal details
Born (1946-09-09) September 9, 1946
Political partyDemocratic
Spouse(s)Ann Berwick
Children4
EducationHarvard University (BA, MD, MPP)

On July 7, 2010, President 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.[2] On June 18, 2013, Berwick declared his candidacy for governor of Massachusetts, but lost the Democratic Party nomination to Attorney General Martha Coakley.[3]

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.[4][5][6]

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.[7] In March 2012 he joined the Center for American Progress as a Senior Fellow.[8]

Biography

Berwick grew up in Moodus, Connecticut. His father, Philip, worked as the town's family doctor.[9] His mother, Rosalind Fine, was the primary caretaker of Berwick and his two younger brothers until she died from ovarian cancer in 1961.[10] 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.[11]

Berwick said that he was motivated by his Jewish upbringing. “The ethical foundations of Judaism speak to me about being proper stewards of society and the world,” said Berwick. “It affects my views and reminds us all we are in this together and really have to help each other,” he said. “I’m worried about the failure to realize progressive issues I care about: healthcare as a human right, poverty and justice. These issues are under siege in America.”[12]

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.[13] While at Harvard, Berwick met his future wife, Ann, in his freshman biology class, where they were lab partners.[10] 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.[14] 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.[15] 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.[10] From 1987 to 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.[16] 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). In February 2013, he participated as a speaker on Voices in Leadership, an original Harvard T.H. Chan School of Public Health webcast series, in a discussion titled, "Leadership in the Next Steps on Health Reform," moderated by Dr. John McDonough.[17]

Administrator of the Centers for Medicare and Medicaid Services

Nomination and controversy

On April 19, 2010, Berwick was nominated to be Administrator of the Centers for Medicare and Medicaid Services, which oversees the two federal programs.[18]

Berwick said, "20 percent to 30 percent of health spending is 'waste' that yields no benefit to patients, and that some of the needless spending is a result of onerous, archaic regulations enforced by his agency."[19] 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."[20][21]

Berwick said Republicans had "distorted" his meaning when he said, "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."[19] For political reasons, the Obama administration didn't want Berwick to defend his past statements on the British health service, spending caps and high-technology care.[19]

Berwick said, "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."[22]

An editorial wrote that his policy ideas could cut health care costs.[23] 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.[24]

Berwick advocated 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.[25]

Conservative critics claim, "NICE decides which healthcare people will get and which they won't."[26] Philip Klein in The American Spectator dubbed him "Obama's Rationing Man".[27] The chairman of NICE called these statements "outrageous lies".[28]

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".[29] 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.[30]

Berwick was installed by recess appointment on July 7, 2010, before confirmation hearings were scheduled by the Democratic-controlled Senate committee.[31] 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.

Resignation

Berwick resigned his position at CMS on December 2, 2011.[32] In a speech on Wednesday, December 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.[33]

Work in the UK

Donald Berwick was the lead author of the Berwick Report, a seminal report into patient safety in England, following the Stafford Hospital scandal.[34]

Berwick was knighted in 2005 for his work creating new care models in five trusts in the UK’s National Health Service -- acute care hospitals, multi-specialty groups, accident emergency rooms, mental health, and nursing homes.[35]

2014 Massachusetts gubernatorial election
Don Berwick speaking at the Rappaport Center for Law and Public Service, Suffolk Law School on January 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.[36]

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.[37] Following the conviction of former probation commissioner John O'Brien on corruption charges, Berwick added that rooting out corruption would be another priority.[38]

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.[39] However, he outperformed nearly all projections and pollsters in the Democratic primary with 21% of the vote, which prompted the recognition of him being a "surprise" in the race.[40]

Berwick conceded the Democratic nomination to Massachusetts Attorney General Martha Coakley on September 9, 2014,[3] who lost to Republican Charlie Baker at the general election.

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[41]
  • The 13th Annual Heinz Award for Public Policy, 2007[42]
  • Honorary Fellowship of the Royal College of Physicians of Ireland, Dublin October 20, 2012

Selected bibliography

Books
  • Berwick DM, Cretin S, Keeler EB (1980). Cholesterol, children, and heart disease: an analysis of alternatives. Pediatrics. 68. New York: Oxford University Press. pp. 721–30. ISBN 978-0-19-502669-6. PMID 6796932.
  • Berwick DM, Godfrey AB, Roessner J (1990). Curing health care: new strategies for quality improvement. A report on the National Demonstration Project on Quality Improvement in Health Care. San Francisco: Jossey-Bass. ISBN 978-1-55542-294-3.
  • Brennan TA, Berwick DM (1996). New rules: regulation, markets, and the quality of American health care. San Francisco: Jossey-Bass. ISBN 978-0-7879-0149-3.
  • Berwick DM (2004). Escape fire. Designs for the future of health care. San Francisco: Jossey-Bass. ISBN 978-0-7879-7217-2.

Articles

References
  1. Galewitz P. "Local hospitals and doctors join forces to improve health care, restrain costs", Kaiser Health News, July 22, 2009; accessed July 25, 2009.
  2. "Medicare administrator Donald Berwick resigns in the face of Republican opposition", Sarah Kliff, The Washington Post, November 23, 2011
  3. "For governor, it’s Coakley vs. Baker", The Boston Globe, September 10, 2014
  4. "Rethinking comparative effectiveness research". Biotechnol Healthc. 6 (2): 35–8. 2009. PMC 2799075. PMID 22478764.
  5. "Interview with Donald Berwick". Katherine T. Adams, Biotechnology Healthcare June 2009; 6(2): 35–38.
  6. Carmichael, Mary (March 29, 2010). "Five Things You Should Know About Donald Berwick, the New Medicare/Medicaid Chief". Newsweek.
  7. "Who Is Don Berwick and What Will He Mean for Reform?" Archived May 5, 2010, at the Wayback Machine Maggie Mahar March 30, 2010.
  8. Donald Berwick Joins CAP as Senior Fellow, americanprogress.org; accessed April 28, 2017.
  9. "Obituary: Dr. Philip Berwick" Derrick Stokes, Hartford Courant, November 8, 1995
  10. "The Revolutionary" Neil Swidey, The Boston Globe, January 4, 2004
  11. Jonathan Klate, "Don Berwick in governor's race for right reasons: public service", Daily Hampshire Gazette, July 7, 2014.
  12. Massachusetts: The Next Jewish State? Four candidates are looking to make history by becoming the state's first Jewish governor. Dina Kraft, Haaretz, Aug 08, 2013
  13. "Donald M. Berwick" Archived February 21, 2014, at the Wayback Machine Harvard University Advanced Leadership Initiative
  14. "Don Berwick stresses health care in race for Massachusetts governor", Associated Press, February 22, 2014.
  15. Feder, Barnaby J. "Thomas Pyle, 67, innovator in 1980s health care plans". The New York Times. July 21, 2007.
  16. "Report: hospital medication errors commonplace". Talk of the Nation, National Public Radio. July 28, 2006. Accessed July 25, 2009.
  17. "Leadership in the Next Steps on Health Reform". Archived from the original on October 4, 2015.
  18. White House. "President Obama Nominates Dr. Donald Berwick for Administrator of the Centers for Medicare and Medicaid Services" Archived April 23, 2010, at the Wayback Machine. April 19, 2010.
  19. Robert Pear,"Health Official Takes Parting Shot at 'Waste'" The New York Times, December 3, 2011
  20. "Rethinking Comparative Effectiveness Research" Archived November 25, 2009, at the Wayback Machine. Interview with Donald Berwick. Biotechnology Healthcare June 2009
  21. "Rethinking Comparative Effectiveness Research". Biotechnology Healthcare. 6 (2): 35–38. June 2009. PMC 2799075. PMID 22478764. Interview of Donald Berwick.
  22. Ben Domenech,"Obama Nominee Donald Berwick's Radical Agenda", RedState,
  23. Editorial, "Donald Berwick, a nominee well-suited to trim the fat on health care", The Washington Post, June 29, 2010.
  24. "Obama's cynical recess appointment of Donald Berwick", Ruth Marcus, The Washington Post, July 8, 2010
  25. "The Evidence Gap: British Balance Benefit vs. Cost of Latest Drugs", Gardiner Harris, The New York Times, December 2, 2008.
  26. Anderson, Jeffrey H. (April 29, 2010). "Not NICE". The Weekly Standard. Retrieved June 4, 2010.
  27. Klein, Philip. "Obama's Rationing Man" Archived May 16, 2010, at the Wayback Machine
  28. Gardiner Harris, "Official Defends British Health Service Against 'Outrageous Lies'", The New York Times, August 21, 2009.
  29. Milligan S. "Kerry comes to defense of nominee to run Medicare, Medicaid programs", The Boston Globe. May 14, 2010.
  30. Newt Gingrich, "High-Tech Cure for Medical Mistakes". American Enterprise Institute August 2, 2000.
  31. Pear, Robert (July 6, 2010). "Obama to Bypass Senate to Name Health Official". The New York Times. Retrieved August 19, 2010.
  32. Pear, Robert (November 23, 2011). "Obama's Pick to Head Medicare and Medicaid Resigns Post". The New York Times. Retrieved December 13, 2011.
  33. Ahier, Brian (December 8, 2011). "Remember the Patient". Healthcare, Technology, and Government 2.0. Retrieved December 13, 2011.
  34. Berwick D, Bibby J, Bisognano M, Callaghan I, Dalton D, Dixon-Woods M, et al. A promise to learn – a commitment to act. Improving the Safety of Patients in England: National Advisory Group on the Safety of Patients in England, 2013(August)
  35. Single payer healthcare debate takes the stage in managed care, John Otrompke, The Lancet, 13 March 2018
  36. Joshua Miller (June 18, 2013). "Health leader Donald Berwick starts bid for governor". The Boston Globe.
  37. "Let's end child poverty". Blue Mass Group. March 24, 2014.
  38. Miller, Joshua. "Don Berwick pitches liberal agenda to business audience". The Boston Globe. Retrieved July 29, 2014.
  39. Scharfenberg, David. "Role of political outsider reconsidered". The Boston Globe. Retrieved August 2, 2014.
  40. Godlberg, Cary. "Surprise in Mass. Primary: 21 Percent for Single-Payer Candidate Berwick". www.wbur.org. WBUR. Retrieved September 11, 2014.
  41. Encore.org. Five social innovators over age 60 receive $100,000 "Purpose Prize (news release)". September 4, 2007. Accessed July 25, 2009.
  42. "Donald Berwick". The Heinz Awards.
Political offices
Preceded by
Charlene Frizzera
Acting		 Administrator of the Centers for Medicare and Medicaid Services
2010–2011		 Succeeded by
Marilyn Tavenner
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