McCaughey falsely claims Berwick favors “social justice” over “individual patients”

McCaughey: Berwick “argues for a different focus, social justice” rather than “needs of individual patients. In her June 16 Post op-ed, McCaughey writes that Dr. Donald Berwick, Obama's nominee to serve as the Administrator of the Centers for Medicare & Medicaid Services, “laments that US health care is 'designed to focus on the acute needs of individual patients.' He argues for a different focus, social justice.”

Berwick says health system should try to improve population health and reduce costs in addition to focusing on individual care. In fact, in the May-June 2008 Health Affairs article to which McCaughey refers, Berwick does not call for replacing the current U.S. health care system's “focus on the acute needs of individual patients” with “social justice.” Instead, he calls for focusing on “improving the health of populations” and “reducing per capita costs of health care” in addition to “improving the experience of care.” Berwick also writes that “Patients experience this [current] reactive system as one providing poor service and lacking memory.” From Berwick's article:

Work to improve site-specific care for individuals should expand and thrive. In our view, however, the United States will not achieve high-value health care unless improvement initiatives pursue a broader system of linked goals. In the aggregate, we call those goals the “Triple Aim”: improving the individual experience of care; improving the health of populations; and reducing the per capita costs of care for populations.

McCaughey grossly distorts Berwick's writings on the “unit of concern”

McCaughey: Berwick says “subgroups” should be “the 'unit of concern,' not the individual patient.” McCaughey writes:

Instead of doctors making decisions autonomously in the interest of their own patients, he wants a nationwide plan allocating resources “to anticipate and shape patterns of care for important subgroups.” These subgroups -- which can be defined by age, disease affliction or socio-economic status -- should be the “unit of concern,” not the individual patient.

Berwick actually writes that you need to identify a population as a “unit of concern” in order to gather data on the population's health outcomes. Berwick writes that it is necessary to specify a population as a “unit of concern” in order to make it “possible to know about its experiences of care, its health status, and the per capita costs of caring for it.” From the Health Affairs article:

We suggest that three inescapable design constraints underlie effective accomplishment of the Triple Aim: (1) recognition of a population as the unit of concern, (2) externally supplied policy constraints (such as a total budget limit or the requirement that all subgroups be treated equitably), and (3) existence of an “integrator” able to focus and coordinate services to help the population on all three dimensions at once.

Specifying a population of concern. A “population” need not be geographic. What best defines a population, as we use the term, is probably the concept of enrollment. (This is different from the prevailing meaning of the word enrollment in U.S. health care today, which denotes a financial transaction, not a commitment to a healing relationship.) A registry that tracks a defined group of people over time would create a “population” for the purposes of the Triple Aim. Other examples of populations are “all of the diabetics in Massachusetts,” “people in Maryland below 300 percent of poverty,” “members of Group Health Cooperative of Puget Sound,” “the citizens of a county,” or even “all of the people who say that Dr. Jones is their doctor.” Only when the population is specified does it become, in principle, possible to know about its experiences of care, its health status, and the per capita costs of caring for it. Under current conditions, such registries are rare in the United States, especially for geographically defined populations. Creating them will require research, development, and investment.

McCaughey falsely suggests Berwick has only praise for UK's health system

McCaughey highlights Berwick's praise of NHS “for its central planning, frugality, wealth redistribution and rationing.” McCaughey writes:

Less care is Berwick's vision. In a speech marking the 60th birthday of the British National Health Service, he praised the NHS for deliberately creating scarcity: “You [the NHS] plan the supply; you aim a bit low; historically, you prefer slightly too little of a technology or service to much too much and then you search for care bottlenecks and try to relieve them.”

Berwick confessed, “I am a romantic about the NHS. I love it. All I have to do to rediscover the romance is to look at the health care in my own country.” He praised the NHS for its central planning, frugality, wealth redistribution and rationing.

McCaughey ignores Berwick's criticism of NHS in the same speech. In his 2008 speech, Berwick acknowledged that the NHS is “far from” perfect, and specifically cited several areas -- including “patient centeredness” -- in which the program has had “less progress”:

BERWICK: Is the NHS perfect? Far from it. Far from it. I know that as well as anyone in this room, from front line to Whitehall, I have had the privilege of observing performance and even to help to measure its performance.

[...]

There is less progress in some areas, especially with comparison to other European systems, such as in specialty access, in cancer outcomes, in patient centeredness, in life expectancy and infant mortality for socially deprived populations. In other words, in improving its quality, two facts are true: The NHS in en route, and the NHS has a lot more work ahead.

Berwick then listed “ten suggestions” for how the NHS “can do even better.”

McCaughey claim Berwick is a “radical” ignores broad support for his candidacy from AMA, AARP, health experts

McCaughey contrasts “fervent ideologue” Berwick with opinions of “most doctors.” McCaughey claimed that Berwick is a “radical” who would make “radical changes” if confirmed at CMS. She adds, “A fervent ideologue, Berwick puts social engineering ahead of the individual patient's needs. In contrast, most doctors understand that their duty is to heal each patient who comes to them.”

Fox medical contributor Coomer: Berwick is “one of the best people to” address disparities in health care. On the March 30 edition of Fox News' America's Nightly Scoreboard, Fox medical contributor Dr. Cynthia Coomer called Berwick “one of the best people” to address racial disparities in health care and said “I think he's going to be pretty good” as head of CMS due to his experience at the Institute for Healthcare Improvement.

Former AMA president: Berwick “widely respected.” An April 23 Washington Post article reported: “But the common theme in Berwick's work is 'his ability to inspire doctors and hospital administrators to work together,' said Nancy Nielsen, the immediate past president of the American Medical Association. 'Don is so widely respected because he has worked in such a collaborative way.'”

Boston Globe: “Berwick has drawn praise from health care specialists across the philosophical spectrum.” A May 14 Boston Globe article noted Sen. John Kerry's support of Berwick, who called him a “public servant who is beyond debate a dedicated pediatrician and nationally recognized expert on health care quality.'' The Globe also wrote that ”[a]s president of the Institute for Healthcare Improvement, a nonprofit, Berwick has drawn praise from health care specialists across the philosophical spectrum for his knowledge of the issue and approaches to solving the problem of increasing costs," and noted that Republicans were planning on using the nomination as “a platform to challenge the law Obama signed in March.”

Coburn called Berwick “more than qualified.” In a March 29 Tribune Newspapers article, Sen. Tom Coburn (R-OK) reportedly commented that “it's way too early to tell” if Republicans would oppose Berwick and that he “think[s] he's more than qualified ... I want to sit down and talk with him.” [Los Angeles Times, 3/29/10]

AMA has praised and partnered with Berwick. A March 29 Bloomberg article reported: “The American Medical Association, the Chicago-based group for physicians, also praised Berwick. Nancy Nielsen, the association's previous president, said in an e-mailed statement that Berwick is 'well-respected' and doctors 'look forward to working with him at CMS on implementation of the new health- reform law.' ” [Bloomberg, 3/29/10]

In 2008, Dr. Cecil B. Wilson, a member of the AMA's board of trustees, stated during a speech at the Florida Health Care Coalition's annual conference:

One of our efforts is our partnership with the Institute for Health Care Improvement (IHI) headed by Dr. Donald Berwick.

The IHI has promoted the idea that six interventions, done routinely and completely in the hospital setting, could save as many as 100,000 lives in a single year. These interventions include:

• Deploy Rapid Response Team at the first sign of patient decline;

• Deliver Reliable, Evidence-Based Care for Acute Myocardial Infarction to prevent deaths from heart attack;

• Prevent Adverse Drug Events by implementing medication reconciliation;

• Prevent Surgical Site Infection by reliably delivering the correct preoperative care;

• And Prevent Central Line Infections and Ventilator-Associated Pneumonia by implementing a series of interdependent, science-based steps for each.

Some or all of these interventions have been adopted by 3000 hospitals across the United States. [AMA website, 3/5/08]

AARP vice president: "[A]ppointment is welcome news to Medicare beneficiaries." Bloomberg also reported that AARP executive vice president for policy John Rother said that Berwick's Institute for Healthcare Improvement saved “lives and money” and that his “appointment is welcome news to Medicare beneficiaries, as it signals that quality and safety will be at the top of the agenda.” [Bloomberg, 3/29/10]

American Hospital Association: Berwick “led a movement ... to provide better, safer care.” Bloomberg further reported: “Rich Umbdenstock, chief executive officer of the American Hospital Association, the Chicago-based trade group, said in an e-mail that Berwick has 'led a movement' through his work at the institute to 'engage hospitals, doctors, nurses and other health-care providers in the continuous quest to provide better, safer care.' ” [Bloomberg, 3/29/10]

AcademyHealth CEO praised Berwick. Tribune Newspapers also reported:

Berwick has spent much of the past 15 years focusing on improving the quality of care in hospitals and his knowledge of them -- coupled with his experience as a practicing physician -- will lend credibility to efforts to coax reforms out of the industry, said David Helms, CEO of AcademyHealth (cq), a professional society for health services researchers.

“I think Don Berwick as a practicing physician will be able to communicate with other practicing physicians in a way that's persuasive,” Helms said. [Los Angeles Times, 3/29/10]

Kaiser Health News praised Berwick as “an inspirational leader.” In an interview republished on March 28, Kaiser Health News reported that Berwick “for two decades has been both a bit of a nag and an inspirational leader encouraging front-line health workers and health care leaders to make changes to reduce hospital deaths and complications as well as making health systems more efficient.” The article went on to report: “Berwick, 63, has been a big promoter of efforts to reduce hospital infections, revamp the Medicare payment system to produce better patient outcomes and make public information on hospitals and doctor performance.”

Berwick received praise from Harvard health policy expert. Bloomberg further reported:

Berwick was one of the first U.S. researchers to introduce industrial quality controls into U.S. health care, said Lucian Leape, a Harvard health policy expert on the board of Berwick's institute.

Close to 3,000 hospitals signed up for the institute's 100,000 Lives Campaign that challenged hospitals to prevent deaths by carrying out measures such as making sure that patients get enough antibiotics before surgery, Leape said.

Berwick was the “intellectual leader” behind the 1999 report from the U.S. government-chartered Institute of Medicine, an advisory body, “To Err is Human,” which found that as many as from 44,000 to 98,000 people die each year because of medical errors. That report brought the issue of medical safety to the attention of the U.S. public, Leape said. [Bloomberg, 3/29/10]

Former editor of Medical Economics magazine: “Berwick is a giant intellect, universally respected in the healthcare field.” In a post on BNET.com, Ken Terry, former senior editor at Medical Economics magazine and author of the book Rx For Health Care Reform, wrote: “If Republicans were able to look beyond the ends of their noses, they would see in Berwick a giant intellect, universally respected in the healthcare field, who is as nonpartisan as they come.” Terry went on to state that Berwick “has saved countless lives through his organization's work with hospitals to improve their processes in very specific ways, such as reducing central-line infections and ensuring that prophylactic antibiotics are administered before surgery.”

Consumers Union analyst: Berwick is “a spectacular appointment.” The New York Times reported: “Steven D. Findlay, a health policy analyst at Consumers Union, said: 'This would be a spectacular appointment. Don has been an intellectual force in health care for decades. He helped forge many ideas incorporated in the new health care law.' ” [The New York Times, 3/27/10]

Dartmouth health policy center director praised Berwick. The New York Times also reported: “Dr. Elliott S. Fisher, director of the Center for Health Policy Research at Dartmouth Medical School, said Dr. Berwick was 'a visionary leader who can motivate people to change.' ” [The New York Times, 3/27/10]