Don Berwick Wants You To Judge the Quality, Not Quantity, of His Service

by Dan Diamond, California Healthline Contributing Editor
Don Berwick Wants You To Judge the Quality, Not Quantity, of His Service

Much of the news coverage -- and political debate -- on the federal health care overhaul has focused on long-term changes to health coverage. Although CMS head Don Berwick's full quality agenda has received less of the spotlight, his plans are intended to immediately affect millions while saving billions.

Donald Berwick may not be long for public office, but he’s determined to leave a long-lasting mark on the U.S. health care system.

The nation’s top Medicare and Medicaid official had promised in February “the largest national effort on patient safety that we’ve ever seen.” And in April, Berwick and HHS Secretary Kathleen Sebelius finally unveiled the “Partnership for Patients,” a $1 billion initiative that will target hospital performance.  

Meanwhile, Berwick has overseen a slew of new federal rules intended to revamp payment and incent higher quality care.

“[T]here’s a right way to reform Medicare and a wrong way,” Berwick wrote in a Wall Street Journal editorial last week. And he’s convinced that his reforms — which are modeled on his successful patient safety campaigns at the Institute for Healthcare Improvement — are the right prescription for true health care change.

‘Partnering’ To Lower Costs

Compared to its health insurance changes, the Obama administration’s movement to improve patient safety is relatively bipartisan and non-controversial. Few dispute CMS’ stark data: the agency says it spent $4.4 billion in 2009 on care for patients harmed in hospitals and another $26 billion on patients who were readmitted within 30 days.

The Partnership for Patients, funded through the Patient Protection and Affordable Care Act, has two main goals: reduce preventable injuries by 40% and cut hospital readmissions by 20% by 2013. CMS says that achieving the Partnership’s goals would result in 1.8 million fewer patient injuries, allow more than 1.6 million patients to recover free of preventable complications and save up to $35 billion in health costs.

HHS said it would allocate up to $1 billion in federal health reform law funds to achieve the two goals. Half of the funds are already available, siphoned through the community-based Care Transitions Program, while CMS’ Innovation Center eventually will dedicate up to $500 million for demonstration programs that seek to reduce hospital-acquired conditions.

While the Partnership will eventually target all forms of patient harm, HHS has asked hospitals initially to focus on nine types of complications and medical errors, including adverse drug reactions, childbirth complications, pressure ulcers and surgical site infections. Partnership members will identify specific ways to reduce patient complications and injuries, according to the release.

The CMS Innovation Center will help facilities adopt effective, evidence-based improvements locally by sharing strategies among public and private partners nationwide. “With new tools provided by the Affordable Care Act, we can aggressively implement programs that will help hospitals reduce preventable errors,” according to Berwick. “We will provide hospitals with incentives to improve the quality of health care, and provide real assistance to medical professionals and hospitals to support their efforts to reduce harm.”

Other CMS Initiatives Designed To Reward Quality

New regulations unveiled by CMS also are designed to boost quality of care, in partnership with the Partnership.

For example, Medicare released its Value-Based Purchasing Rule on Friday. The program — which is required under the federal health reform law — will take effect in fiscal year 2013 and reward better-performing hospitals with commensurately higher incentive payments. The payments will be based on whether acute care hospitals meet certain care quality and patient satisfaction metrics, or how much hospitals’ performance improves across a set time frame.

Meanwhile, new payment regulations to govern Medicare reimbursement, such as the recently released rule for inpatient hospitals and for inpatient rehabilitation facilities, penalize providers that fail to share quality data. The inpatient rehab rule would require data on two quality measures: urinary tract infections associated with urinary catheters, as well as new or exacerbated pressure ulcers. Facilities that don’t provide data on the conditions would have payment rates lowered by two percentage points starting in FY 2014.

Some Criticism Amid Broader Enthusiasm

The Partnership was generally met with praise. More than 500 hospitals, physicians, employers, and nurse and consumer groups already have committed to participating in the initiative. But there’s caution around the plan’s specifics and some of the reimbursement changes.

According to Leah Binder, who heads the Leapfrog Group, CMS must make Medicare and Medicaid data publicly available so “the initiatives that take place in pursuit of patient safety are done in the sunlight.” David Classen, chief medical officer for the Computer Sciences Corp’s health care group, hailed the Partnership but warned that “the details aren’t there.”

CQ HealthBeat also reported that hospital officials are growing wary as CMS continues to pile on proposals to cut their reimbursement. One health care lobbyist said several industry leaders have “been having buyer’s remorse for six months now,” noting that “[t]he full impact of the law is finally becoming real.”

Berwick’s Future: As Shaky as the Overhaul?

According to Modern Healthcare, some health care stakeholders are worried that Berwick’s own uncertain future could hurt the Partnership’s implementation. Berwick has been a target of political criticism since emerging as a candidate to head CMS in 2010 and is not expected to win Senate confirmation to remain in seat past 2011.

Leigh Hamby, the top physician and chief quality officer at Atlanta’s Piedmont Healthcare, warned that if Berwick is pushed out at CMS, the agency’s safety initiatives might lose momentum and could return to “business as usual, operating as a payer instead of an agent of change.” Other quality leaders, however, say that the effort is sustainable without Berwick — even if it would be better steered by him.

“I may not agree with him substantively on everything, but he’s definitely doing a good job,” according to Tom Scully, who led CMS under President George W. Bush. Scully added that Berwick should “go out with his chin up happily on December 31 … [T]hat may or may not be right or fair — but that’s what’s going to happen.”

Berwick’s quality reforms — and his fate at CMS — bear watching in the months ahead. Meanwhile, here’s the key health reform news from the past week. 

Rolling Out the Reform Law

On the Hill

In the States

 

 

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