The CMS administrator also acknowledged that when providers try an innovative approach, oftentimes the government thinks there's something fishy going on. Innovation is going to be the only way that the healthcare system can afford healthcare reform, he added: The choice between cutting and improving is not mere rhetoric. “It looks obvious that cutting is the way to lower cost,” Berwick said, “but it's wrong, in healthcare.”
Berwick noted a strong belief in Nashville in the business ethic of doing well by doing good and said it can be the engine that pulls the train of improving healthcare. “The entrepreneurial approach in Nashville is where the answers will come from,” Berwick added.
Berwick also seemed to revel in the ways that being the CMS administrator makes one a lightning rod. He joked about the constant wave of lobbyists for every medical specialty and sector in the industry who come to see him— “Don't send me any more lobbyists.” He noted that setting up the state health insurance exchanges as part of the Patient Protection and Affordable Care Act involves 50 different conversations: “It's not always easy, it's not always pretty, but it's authentic.” The proposed rule for accountable care organizations has drawn 1,200 comments and has been the subject of many listening sessions that, at times, Berwick acknowledged, have been “very stormy,” yet he called that level of engagement thrilling: “I think that's democracy.”
Berwick also urged the providers in the room to continue to comment on proposed rules. “Ask my wife. She knows what I'm doing in the middle of the night,” he said. “It's reading your comments.”
Vince Galloro writes about investor-owned hospital chains and the Federation of American Hospitals. Follow Vince on Twitter: @MHvgalloro.