By John Ballard
Everyone following healthcare reform already knows, but for casual readers here are two very readable links regarding Dr. Berwick's too-brief tenure as Director of CMS. His nomination was mired in so much political baggage that Obama put him in charge using one his few recess appointments. His leaving is a loss that should never have happened.
Berwick�s name first surfaced as a possible appointee to head CMS during early 2009, as the newly installed Obama administration was laying down its markers for health reform legislation. He was not the only candidate being considered to lead CMS; other health system leaders were interviewed for the job. Some observers voiced concerns that Berwick lacked the administrative background for the position. Meanwhile, a long vetting process closely examined the funding of the Institute for Healthcare Improvement (IHI), which Berwick cofounded twenty years before, and Berwick�s compensation as the institute�s head. The process ultimately led to a green light for the nomination from government ethics watchdogs.
Finally, on April 19, 2010, just under a month after President Barack Obama signed the Affordable Care Act into law, Berwick was officially nominated to head CMS. Conservatives� fury at the passage of health reform seemed for a time to be squarely focused on Berwick.
The main line of attack was that Berwick was a proponent of �socialized medicine� and �rationing,� or the withholding of beneficial care from people purely on the basis of cost. Critics zeroed in on a speech Berwick had made in July 2008 at a celebration of the sixtieth anniversary of England�s National Health Service. Although Berwick noted in the speech that the National Health Service was �far from perfect,� he also lauded its fundamental premise. �Any health care funding plan that is just, equitable, civilized, and humane must�must�redistribute wealth from the richer among us to the poorer and less fortunate,� he said. �Excellent health care is by definition redistribution. Britain, you chose well.�
Amid the firestorm of criticism, even the Obama administration�s ostensible Democratic allies in the Senate dragged their feet on scheduling a nomination hearing for Berwick and a confirmation vote. In July 2010, with Congress away on its traditional Fourth of July holiday, Obama invoked his power under the Constitution to install Berwick at the helm of CMS via a recess appointment.
That is from a five and a half thousand word article in Health Affairs (online edition only) which tells the whole story.
?Health Official Takes Parting Shot at �Waste� (NY Times)
Donald M. Berwick, listed five reasons for what he described as the �extremely high level of waste.� They are
- overtreatment of patients,
- the failure to coordinate care,
- the administrative complexity of the health care system,
- burdensome rules and
- fraud.
�Much is done that does not help patients at all,� Dr. Berwick said, �and many physicians know it.�
?Click here to for the post I put up abour Dr. Berwick in March, 2010, which includes a short video.
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Follow-up
Dr. John Halamka elaborates on those five items in a post at The Health Care Blog.
Halamka is not just another doctor with opinions. He's a true expert who deals with information management every day. Check his credentials at the link.
Patients are over treated
When I was an emergency department resident 20 years ago, the faculty and staff of Harbor-UCLA medical center taught me best practices for safe, quality, efficiency care. When I make decisions today, I reflect back on that intense training. However, thousands of journal articles have been written since then, there�s new evidence suggesting more effective treatment plans, and new therapies are available. How do I ensure the just the right amount of care is delivered � neither too much, nor too little? Decision support embedded in electronic health records.
EHRs can provide alerts and reminders � just in time advice as to what my patients need. Educational materials and literature can be embedded in the workflow for easy reference. Population/panel health tools can identify those patients who need followup or are deviating from care plans.
There is not enough coordination
The United States does not have a healthcare system � it has a disconnected array of clinics, pharmacies, labs, hospitals, and imaging centers. Meaningful Use Stage 2 is likely to require significant healthcare information exchange as well as the transport, vocabulary, and content standards needed to support it. Although the journey to a completely connected healthcare system will take a few years, the next 24 months will include a quantum leap in care coordination as state health information exchanges connect patients, providers, and payers.
US healthcare is burdened with excessively complex administrative system
Like the tax code, healthcare regulations are dizzying in their complexity and volume. Some are so arcane that experts cannot agree on the interpretation. If rules can be built into EHRs such as the precise definitions for quality reporting, automated electronic coding of visits based on structured documentation/natural language processing, and payments made on objectively measured processes/outcomes instead of the quantity of care delivered, regulatory complexity can be reduced and money saved.
The enormous burden of the rules
Approximately 25% of my IS staff work on compliance related software requests � building new functional or purchasing new products to meet every increasing numbers of rules. We all want to do the right thing, but if no one can understand the rules and the amount of overhead needed to comply is financially unsustainable, the rules are too burdensome.
Electronic health records can enforce automated care plans, provide feedback at the point of care and support administrative simplification with bidirectional electronic transactions between payers and providers.
Fraud
Although no system is foolproof, electronic health records can reduce fraud by automating the kind of data transfers that will help detect fraud and abuse. Emerging new analytics companies are already working on techniques to discover patterns of care that do not make sense � Medicare billing for deceased patients, redundant procedures or services, and variation in billing practices among physicians that can identify outliers.
In addition to these 5 areas of waste reduction, electronic health records are an essential part of a learning healthcare system which gathers data for clinical trials, clinical research, and unique population health measurement such as pharmacovigelence, syndromic surveillance, and immunization compliance. Don Berwick is a great supporter of the EHR�s potential to increase quality, safety, and efficiency while reducing waste.
Although healthcare reform is controversial, healthcare IT reform � the federal 5 year plan to increase the use of electronic health records and healthcare information exchange � has broad bipartisan support.
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