NN&I - January 2012

FIRST WORD Berwicks push for accountable care helped the ESRD program As the Centers for Medicare Medicaid Services transforms how it reimburses for health care it will need to replace administrator Donald Berwick with someone who can get the agency through the red tape Berwick stepped down Dec 2 after failing to get enough Congressional support to keep his post A pediatrician by training Berwick is a Harvard professor who founded the Institute for Healthcare Improvement a think tank that trains hospitals on how to increase patient safety and improve operations A tough job Health care reform has become one of the most debated political topics this past year and Berwick as the head of CMS was often a face for the reform Improving the nations system of paying for the health care needs of millions of Americans is a complicated task that requires patience and a willingness and ability to compromise effectively The issue itself is entangled in budgetary spending and political philosophy and a leader of reform should not be tied down by too many strong opinions about either Although there is ample evidence of his pragmatism Berwicks ideologies were his downfall Others agree The problem was his worldview says David Whelan who writes for Forbes on health care issues His approach to health reform like the Presidents promotes centralizing health care delivery and using government programs to force change But once Congressional adversaries got a hold of some of Berwicks old writings in which he had said nice things about the National Health Service in England he became the subject of an ideological confirmation battle noted Whelan The writer said Berwicks ouster is part of an ongoing brain drain where those with diverse opinions are shown the door The Berwick resignation is part of a troubling pattern where engaged interesting thinkers get booted out of positions of power wrote Whelan If youre an intellectual spark plug politicians rush to defuse you Berwick influence on ESRD The Medicare ESRD Program is one example of CMS Ms Zumoff is the assistant editor for Nephrology News Issues and web editor for NephrologyNews com By Rebecca Zumoff evolving role in shaping American health care Two New York nephrologists Premila Bhat MD and J Ganesh Bhat MD said this best in our cover story on the inner workings of the Quality Incentive Program which begins this month In its Roadmap for implementing value driven health care in the traditional Medicare Fee for Service program CMS states that a goal of value based purchasing is to move Medicare away from being a passive purchaser of services to an active purchaser of high quality efficient care In fact the bundle itself can be considered a type of value based purchasing with the QIP representing a sort of checks and balances system to ensure that CMS defined priorities for high quality care continue to be achieved in the bundled payment system This represents a fundamental shift in the way that CMS views and pays for health care and puts the ESRD program at the forefront in a new era As CMS role has changed some say Berwick was responsible for a shift in the agency itself Berwick conducted the first ever training to encourage continuous performance improvement throughout the 5400 employee agency Kaiser Health News wrote He sought to shift the agency culture toward teamwork innovation speed and customer focus Many staffers say theyve been energized and are working to get information out faster to patients and to states though some complain this work takes up too much of their time Navigating the red tape Although Berwick is now a political casualty CMS reforms are gaining momentum While the agency might be well meaning its policies often have unintended consequences Rather than promote a more relevant and effective care approach one that provides more value for payers and dialysis patients alike the QIP will stifle clinical understanding and innovation raise care costs and greatly harm patients said said authors Stephen Pollack Jonathan A Lorch and Victor E Pollak in their discussion about the QIP and anemia management in this issue CMS needs a leader who can learn from mistakes and adjust policy to fit the growing health care system who cares more about improving the delivery of health care than any one political agenda or philosophy Nephrology News Issues January 2012 Subscribe to our free eNewsletter at www NephrologyNews com 8