EDITORIALS

Wisdom from Dr. Berwick

Posted Dec. 11, 2011, at 6:27 p.m.
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Dr. Donald Berwick
J. David Ake | AP file photo
Dr. Donald Berwick

Dr. Donald Berwick’s forced retirement after heading Medicare and Medicaid for 17 months is an unnecessary loss to the country, but his departing advice can help Americans understand how their health system is being improved.

He served on a recess appointment that dodged Senate conformation but expires December 31. President Barack Obama could not renominate him because 42 Republican senators had pledged a successful filibuster. Maine’s two Republican senators, Olympia Snowe and Susan Collins, had the good judgment to stay out of that stampede.

In a final interview with the New York Times, Dr. Berwick said 20 to 30 percent of health spending is a “waste” that yields no benefit to patients.

Waste is a broad term, including needless medical procedures, failure of adequate preventive measures, duplication and inefficiency, as well as outright fraud.

Hospital-acquired infections have caused the deaths of almost 100,000 Americans each year and the illness of millions more, according to the U.S. Centers for Disease Control and Prevention. Dr. Berwick has reported that these complications have added as much as $45 billion a year to hospital costs borne by taxpayers, insurers and customers. He said that some hospitals have virtually eliminated some infections that other hospitals still consider inevitable. Under the Affordable Care Act, sometimes called Obamacare, financial incentives will go to hospitals that excel in fighting these infections starting in 2015.

Unnecessary hospital readmissions add another $12 billion a year, estimates the Medicare Payment Advisory Commission. It says half or more of these readmissions could be prevented through better coordination and patient education, permitting them to recover at home rather than reentering the hospital with complications.

“Integrated care” will also reduce costs, said Dr. Berwick, by protecting patients from having to tell their stories over and over to different providers and letting a doctor know what medication they had already been given. No figure is available for the savings from automated record keeping, but it is becoming substantial.

Preventive medicine is already reducing waste, for example by detecting diseases at early stages for prompt treatment. The Affordable Care Act makes preventive benefits like cholesterol tests, mammograms and screening for colon and rectal cancer free for everyone with Medicare. The new law requires states to provide pregnant women with Medicaid coverage of tobacco-cessation services including counseling and medication.

A new fraud-prevention and enforcement action team has brought Medicare and Medicaid into collaboration with the Justice Department and the Health and Human Services inspector general’s office to prevent, identify and prosecute health care fraud.

Dr. Berwick told the Senate Finance Committee last year that the three goals for improving health care delivery were better care for individuals, better health for populations, and coordinating care for patients journeying though the system: “To be absolutely clear, I am talking about reducing costs while improving the quality of care individuals receive.

Saving money cannot be the primary purpose of the health system, but it can be a helpful side effect of improved medical practices.

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  • Anonymous

    “He served on a recess appointment that dodged Senate confirmation but expires December 31.” That darn, old constitution thing working again! How dare it!

  • Anonymous

    Paragraph 2, Line 1: That is “conFIRMation”, nummies.

    Looking forward to seeing the back of the Dr. Berwick. Search his name in the world’s leading newspaper, The Wall St. Journal, for an unblemished view of this radical.

  • Anonymous

    Dr Donald Berwick asked the question “How will this affect the patient” every time he was presented with a dilemma, problem, cost, or proposal.  He is a hero to patients, their safety, and their pocketbooks.  He pushed Patient Safety efforts from the top, by getting the Partnership for Patients rolling.  His goals were to make patients safer and to help Hospitals, Insurers and Patients save money.  His insistance on safe care benefitted us all.   Safe care is high quality care and less expensive care.  He got it right, and he is going to be a tremedous loss to the Patient Safety movement in the US.  

  • Anonymous

    Think about your statement when your safety or that of a loved one is compromised in the Hospital.  He was a hero to patients and a proponent of high quality, low cost care. 

  • Anonymous

    The Affordable Care Act makes preventive benefits like cholesterol
    tests, mammograms and screening for colon and rectal cancer free for
    everyone with Medicare.

    Really? Under the ACA the medical world provides these services gratis? How about ‘The ACA shifts the cost of these services from the patient to the taxpayer and makes their overuse more likely (doctors mine subsidies, too), driving the cost of health care up’.

  • Anonymous

    What would you expect from a Murdoch propaganda sheet? “Unblemished”? “Radical”?

  • Anonymous

    Faint praise to Maine’s Senators.  Too bad they couldn’t convince their R colleagues to give up this non-productive travesty and vendetta.  I dread to see what sort of a person they’d approve of.

  • Anonymous

    Yep, good riddance.

  • Anonymous

    patient safety is a terrific goal that every caregiver should aspire to. social medicine it in direct conflict with patient safety. low paid doctors, with no incentive to provide the best care, overwhelmed by millions of patients  newly covered by government insurance, is sure to lead to declines in heath care nation wide.

    time our government got out of every aspect of our lives. personal responsibility is required by all, its not the governments job to provide everything to everyone.

  • Anonymous

    You say that it is a good thing that the Maine senators stayed out of the  ”stampede”… ?
    How about if they had weighed in on the confirmation of this outstanding nominee in a forceful positive
    way,  that would have been the “right” thing for them to do for the good citizens of Maine.  That is what they were elected to do.  This is yet another example of the obstructionist policies of the Republican Party that Snowe and Collins support.  It is very strange that you give them not just “cover”, but kudos. 

  • Anonymous

    early care saves money for all, not to mention lives.

  • Anonymous

    why not ask yourself why the President had to use a recess appointment for this supremely 
    qualified candidate…

  • Anonymous

    I don’t care if he walks on water! The constitution is there for a reason not just when it is convenient. Can’t stand to be stymied in the great liberal quest, it becomes disconcertingly easy for some to want to simply bypass the constitution to enact their wishes…

  • Anonymous

    The Affordable Health Care Act is completely paid for.

  • Anonymous

    By whom, and with what?

  • Anonymous

    from Nobel Lauriate economist Paul Krugman,

    December 12, 2011, 8:27 PMPaying For Health ReformI’ve noticed an odd thing in comments whenever the subject of Obamacare comes up. Many commenters scoff when I say that the Obama health reform was fully paid for; not only that, but some of them confidently assert that the Congressional Budget Office says that the reform will increase the deficit.I assume that this is coming from some right-wing source. But you know, the CBO has a web site, and it’s easy to check this; there’s a convenient summary of the estimates here. .And, well, the estimates say that the reform is fully paid for:Oh, and it’s paid for year by year, too — whatever you may have heard about 10 years of taxes paying for 6 years of coverage, or whatever, they’re basically lies.If you have heard from your favorite source of information that the CBO says that Obamacare increases the deficit, you’ve just learned how reliable your source is.

  • Anonymous

    from Nobel Laureate economist Paul Krugman,

    December 12, 2011, 8:27 PMPaying For Health ReformI’ve noticed an odd thing in comments whenever the subject of Obamacare comes up. Many commenters scoff when I say that the Obama health reform was fully paid for; not only that, but some of them confidently assert that the Congressional Budget Office says that the reform will increase the deficit.I assume that this is coming from some right-wing source. But you know, the CBO has a web site, and it’s easy to check this; there’s a convenient summary of the estimates here. .And, well, the estimates say that the reform is fully paid for:Oh, and it’s paid for year by year, too — whatever you may have heard about 10 years of taxes paying for 6 years of coverage, or whatever, they’re basically lies.If you have heard from your favorite source of information that the CBO says that Obamacare increases the deficit, you’ve just learned how reliable your source is.

  • Anonymous

    here are the tables, no NEW money

  • Anonymous

    Look at the table and you’ll see that there are six years of balanced or surplus income, followed by four years of deficits: pretty exactly “10 years of taxes paying for 6 years of coverage.” The deficits don’t equal the surpluses, but out-year estimates of government spending are notoriously low.

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