Advocate says farewell

Dr. Donald Berwick is keeping quiet about his next move after his upcoming resignation from the CMS, but some experts in the patient-safety arena say it's a safe bet he'll return to their ranks in another quality-related leadership role.

“We all expect that he'll come back to the private sector,” said Diane Pinakiewicz, president of the National Patient Safety Foundation. “I'm expecting that he'll find a way in whatever venue he chooses to be

an incredible force and provide the leadership we need to transform the system. I can't speculate about where that will be, but I have a wish list.”

Berwick announced Nov. 23 that he planned to leave his post as CMS administrator, effective Dec. 2. His July 2010 recess appointment, which was set to expire at the end of this year, sparked angry protests from Republicans, who pledged to block his full-term confirmation.

A longtime advocate of healthcare quality improvement and patient safety, Berwick co-founded and led the Cambridge, Mass.-based Institute for Healthcare Improvement until his appointment. And during the 16 months he served in the top spot at the CMS, he applied many of the strategies that had guided his initiatives at the IHI, Pinakiewicz said.

“He was responsible for the first strong interagency commitment to patients,” she said, referring to HHS' Partnership for Patients, a $1 billion public-private safety initiative unveiled in April. “He created an energy and a spirit of cooperation that I had not seen before. Suddenly, all of these agencies were working together for the betterment of patients.”

Berwick also oversaw the rollout of many of the main provisions of the healthcare reform law, including the agency's introduction of value-based purchasing, which links hospital payments to performance on selected quality measures. Berwick also led the January launch of the CMS Innovation Center, tasked with using lessons from new and existing demonstration projects to create innovative healthcare delivery models.

“He brought with him an understanding of what it takes to drive change,” said Sam Watson, senior vice president for patient safety and quality of the Michigan Health & Hospitals Association and executive director of the MHA Keystone Center, the association's safety and quality improvement organization. “He created space for innovation to occur and also supported it through demonstration projects and funding opportunities. My hope is that CMS will continue down that path.”

In a relatively short amount of time, Berwick was able to “turn the abstraction of health reform into something tangible,” said Dr. Robert Wachter, a well-known patient safety advocate and professor and chief of the division of hospital medicine at the University of California at San Francisco. Wachter pointed to the CMS' back-to-the-drawing-board revisions of the Medicare Shared Savings Program for accountable care organizations as evidence of Berwick's commitment to collaboration and adaptation. “It's sad that he got caught in the blender of right-left politics,” Wachter said in an e-mail.

In a recent Twitter post, Wachter mused that Berwick's next move might be to a presidential post at a university. It's just a guess, he said, adding that a return to the IHI for Berwick was doubtful. In fact, Wachter predicted that Berwick would likely pass on a post at any existing healthcare organization.

“I doubt that's a large enough platform for his vision,” he said. “I don't think sitting in a think tank will satisfy the activist in him. Being president of a major university might be a good fit: a very broad platform that includes areas beyond healthcare, exposure to lots of deep thinkers and learners, and a growth opportunity for him. One thing's for sure: He's not the retiring kind of guy.”