Back to government

Dr. Donald Berwick formally entered the Massachusetts governor race the day before addressing the Healthcare Financial Management Association's annual conference last week. President Barack Obama resorted to a recess appointment to install Berwick, a co-founder of the influential Institute for Healthcare Improvement, as CMS administrator during the early implementation of the ACA. Berwick drew scorn from conservatives throughout his 17 months on the job, and he resigned in December 2011 when it was clear the Senate would not confirm his nomination. Modern Healthcare News Editor Gregg Blesch sat down with him to find out what's drawing him back to government. Here is an edited excerpt:

Modern Healthcare: What do you see as the unfinished healthcare business in Massachusetts?

Dr. Donald Berwick: I am very proud of Massachusetts. The state that I come from is the first state in America to make healthcare a human right. We did that in 2006. And that's worked. We have over 98% coverage, I think, of adults, and 99% coverage of kids.

That is a great achievement. But that is not enough—you can't have healthcare guaranteed for everybody, or even most of us, unless the healthcare system is reformed.

We have a healthcare system that is very wasteful; it is unsustainably expensive and it doesn't meet people's needs. They get harmed in care, the ball gets dropped, continuity isn't present and we need a new system—one that is continuous and patient-centered. The new law in Massachusetts from last year is an attempt to do that and at the same time contain costs. And actually, that's the way to contain costs. The best way to reduce healthcare costs is to improve the care. That's been my lesson learned for 30 years.

MH: Is that a difficult message to give to hospital chief financial officers—that what they need to do is invest money in initiatives that will result in the government and consumers paying them less?

Berwick: The objective is not just to spend less; it is to give better care, and that does require pretty big changes in the way healthcare is going to operate. After all, we have a legacy system—we built it over a century—which is founded on doing more and more things for people without a lot of attention to which help and which don't.

The fee-for-service payment system rewards hospitals for staying full, rewards specialists for staying busy, and that's what we get. These are good people; they are doing what the signals ask them to do. We need to change the signals now.

The best hospital bed is an empty bed. The best MRI machine is an idle one. Idle because we don't need it. So if we refocus on health, keeping people home where they want to be, preventing the heart attack instead of just treating it, assuring continuity so errors don't happen, we will have much better care, but that means change.

I think that people of HFMA and the others who are masters of knowing how to make organizations work, they can do this, they can adapt to it.

MH: A number of efforts to change the signals are in the Patient Protection and Affordable Care Act and were embarked upon during your time at the CMS. As Dr. Richard Gilfillan leaves the CMS Innovation Center, it seems like a good time to take stock of whether they are changing the way healthcare is delivered and paid for.

Berwick: We are seeing a lot of change around the country, and it is not just happening on the public side; it is happening on the private side, too. Private payers and public payers, we are on the same journey. The whole public is on the same journey. Who doesn't want better care and who wants to keep having healthcare take all the resources from other worthy investments? So, we are en route. The Affordable Care Act is a terrific start for that.

It is a law that I have enormous respect for and I think in some ways (is) underestimated by the public. We never got the message across. The Affordable Care Act does two things: It takes a step toward making healthcare a human right in this country. But the other part of that law is to help healthcare change so it can better meet those needs by encouraging continuity, paying for the care of populations over time, paying for coordination, making sure we are paying hospitals more when they get safer, when they injure patients less and all of that is underway.

We are going to see turnover, but I think the mission is clear. The talents we have are great, and I am sure this is going to work.

MH: When you were at the CMS, it was a very ugly time in politics. How you are feeling about the prospect of getting back into government to achieve your goals?

Berwick: I want to get back into government. The experience for me was wonderful. There was nonsense. I think that many of the attacks on me were irresponsible. They were frankly lies. They were mischaracterizations of what I believe, and despite my attempts to explain what I believe, they just wanted to say what they wanted. So that was a game.

For me that was more background noise. We had a wonderful new law to try to implement. We had the ongoing work of CMS, which protects a hundred million Americans. I saw what can happen when government functions properly in terms of protecting people who need protection and helping everybody get to better healthcare.

In Massachusetts, that's what I would like to do. I think Massachusetts can be an example for the whole country of successful public and private partnership and policies that really work for people. We call Massachusetts a commonwealth, and I love that term. You know, common wealth. We are in this together.

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