Berwick’s ouster at CMS a loss for infection prevention

January 12th, 2015

I once crossed swords with Don Berwick in an interview, questioning the accuracy of the 44,000 to 99,000 annual death estimate for medical errors he cited as one the principals behind the 1999 Institute of Medicine report To Err is Human .

I really sort of knew better, since the CDC estimates that some 100,000 die of HAIs alone, which were not even a central thrust of the IOM report. Accordingly, Berwick rejected my skepticism and said the IOM figures were very likely underestimates. But the implication of my question was really this, “Aren’t you more of an advocate -- dare I say an activist -- than an objective health care quality researcher?”

And of course, he is, and that’s why his ouster as head of the Centers for Medicare and Medicaid Services hurts infection prevention and related health care quality fields. It's a loss for patient safety. In a speech after taking over the CMS last year in a controversial “recess” appointment, Berwick drew on some personal anecdotes, imagining that his late physician father — who made house calls and delivered babies — would be somewhat shocked at the state of health care today.

"He would have laughed if anyone had called his practice 'a medical home' or said he practiced 'patient-centered care,'" he said. "I suspect he would have asked, 'What other care is there?' It was just his work to him, embedded in his community. But that's what it was — that's what he was — home base for the people who needed him. And that is the image etched in my mind permanently as what health care is. 'Patient-centered care' is my father's car starting in the middle of the night. . . . The world of commitment and caring that my father represents to me is not gone. It is far too important to lose. And I took this job to do whatever I can to make sure that it thrives."

The Affordable Care Act is a watershed moment, a turning point in access, coverage, quality, and cost of health care, he said. Of course, his support of the law made him a political target, thus the recess appointment and his eventual ouster when its tenure expired.

As a New York Times op-ed notes, Berwick “was the most qualified person in the country to run Medicare at this critical juncture, and the fact that he is no longer in the job is the country’s loss. .. His focus, as it has always been, was on improving the quality of health care and cutting costs. “On my third day,” he said, “I held a staff meeting for all 5,000 members of the staff, and I said, ‘You all think that you are in the business of paying bills. Yes, you do that. But I also think Medicare can be a force for change.’ ” He added, “I tried to reconceptualize it as an improvement organization.”