What to make of the Berwick debacle

By now it is not news to say that Donald Berwick's chances of being confirmed as the head of CMS are rapidly declining from slim to next to none. Not a huge surprise really, but it is a fact made abundantly clear earlier this month when 42 Republican senators penned a contentious letter to President Obama asking him to withdraw Berwick's nomination.

Less than a week later, Montana democrat Sen. Max Baucus, chairman of the Senate Finance Committee who is charged with leading the Berwick nomination admitted that "Republicans won," after they told Baucus they would oppose his nomination under any circumstances.

Aside from a response from the White House indicating Berwick is still their choice, the silence from Pennsylvania Avenue has been deafening. Though one could make the case that nominating Berwick for a third time back in January, as the Republicans marched into Washington on the wave of their big November victory, was more than just a subtle tweak.

So that brings us to Berwick, the impending political casualty who by the end of the year (his recess appointment will expire at the end of 2011) will become the Republicans' most notable trophy head from the administration as they look to exact revenge for the passage of the Affordable Care Act.

If Donald Berwick seems bitter, or disillusioned by the political wrangling over his nomination, he certainly didn't show it last week in a presentation to an audience at America's Health Insurance Plans Policy Summit across town from the Capitol. Instead, he sounded every bit the perfect choice for the job: non-partisan, optimistic and perhaps even evangelical in his description of the possibilities--and the necessity--of coordinating healthcare in ways not available even five years ago to improve patient experience and patient outcomes while reducing costs.

If his nomination is doomed, many would expect Berwick's power to be diminished. That hardly seems to be the case. First, if he serves until the end of the year, as seems likely, he still has more than 9 months left of what would eventually be a 17-month tenure. Under his leadership, Berwick has already brought oversight of private insurance companies under the CMS umbrella, a move that has long-term implications in the industry. It also leaves ample time for Berwick to continue to staff high-level posts at CMS with healthcare innovators who share his vision.

Finally, the recent creation of the Center for Medicare and Medicaid Innovation, which falls in the sweet spot of Berwick's interests and expertise, can expect to get off to a strong start. Here, even with the relatively paltry (by government standards) $10 billion at his disposal, Berwick will have the power to fund a broad array of projects across the country that are looking to change both healthcare delivery and payment models.

Here, Berwick and his staff can fund projects, both internal to CMS and via the awarding of grants to external organizations, as a proving ground for what will and won't work in modern healthcare. From ACOs and bundled payments to best practices and comparative effectiveness research, this is where Berwick, through the center's grants, will make a difference.

So while the partisan clashes over his nomination continue to percolate amid the backdrop of health reform and many lament the sacrifice of the man who is likely the best person for job, I'd urge everyone to calm down.

If you are against Berwick running the agency, he'll be gone soon enough. If you are for him, rest assured that nearly a year and a half will provide plenty of time for him to leave a lasting legacy.