If healthcare reform was the storm of 2010, then the Administrator of the Centers for Medicare & Medicaid Services would be the lightning rod.
For more than three years CMS – an agency responsible for $800 billion and 90 million enrollees – has been without an administrator, functioning instead with interim leadership since 2006. After the Senate's confirmation on April 19, President Barack Obama filled the vacancy with Harvard Medical School Professor Donald Berwick, MD, on July 7.
The appointment came in a legal but uncommon way: Obama used a recess appointment to place Berwick at the helm of CMS. The downside to the recess appointment is that it will only keep him in the job until the end of 2011.
Obama said he felt the Senate was deliberately stalling in considering Berwick, delaying the confirmation at a time when CMS had a lot of work to do to position the country for the post-healthcare reform landscape.
Senate Republicans remained angry over the appointment and vowed to hammer Berwick at a November Senate Finance Committee hearing. They charged Obama with making an end-run to avoid disclosing potentially damaging information on Berwick.
Healthcare leaders, meanwhile, applauded Berwick's appointment, saying he has a good quality and fiscal approach. "What you have here is someone who is deeply committed to quality and deeply committed to applying whatever lever one can apply to help hospitals deliver safer care and higher quality care and that kind of orientation and aspiration and desire, I think, will be very important and perhaps even transformative for CMS," said John Glaser, vice president and CIO of Partners HealthCare in Boston.
Lori Heim, MD, who heads the 94,000-member American Academy of Family Physicians, said Berwick recognizes that a primary care system is critical for achieving needed improvements to the healthcare system at large.
"His support for strengthening primary care in the Medicare and Medicaid systems will help set the path for building up the foundation of all high quality healthcare," she said.
Paul Tang, MD, an internist and vice president and chief medical information officer at the Palo Alto Medical Foundation in Palo Alto, Calif., part of Sutter Health in northern California, said Berwick's "passion, intellect and perseverance make him a perfect person to head up CMS."
In a keynote given at a September Medicare conference held by America's Health Insurance Plans in Washington, D.C., Berwick said the nation's healthcare problems don't necessarily lie with its doctors or health plans.
"The problem lies with the system," he said, adding that the status quo of fragmented information and care is no longer acceptable.
"I want to make our healthcare system as good as we expect it to be, and I need your help," he told health plan executives at the AHIP conference. "You have and will continue to have a profound influence."
Berwick said his vision for improving healthcare "is embedded in the Affordable Care Act, (which) by any stretch is landmark legislation."
However, he said, the ACA is only a starting place.