Don Berwick on Medicare: Best job I’ve ever had

By Liz Kowalczyk and Chelsea Conaboy, Globe Staff

Dr. Donald Berwick doesn’t know what he’ll be doing after Dec. 31 .

The Harvard pediatrician who runs the federal Centers for Medicare and Medicaid Services needs Senate approval by the end of the year, or he’s out of a job. No confirmation hearings have been scheduled.

Berwick, who met with editors and reporters at the Globe this morning, said he doesn’t think often about his future after Medicare, both because he’s prohibited under ethics rules from interviewing for jobs and because his current work is so intense.

“This is the best job I’ve ever had and the best job in American health care,’’ he said.

During his visit to the Globe, Berwick repeatedly hit on the theme of improving care and saving money by “making care coordinated, seamless, and scientifically-based.’’ He spoke of curing the American health care system of its “addiction to volume’’ rather than to quality. At stake is “a lot’’ of money, he said, estimating that perhaps 20 percent of medical spending could be saved by eliminating unnecessary, poor care.

Berwick said that hospitals have to “start thinking far outside their walls. They have to start thinking about ‘maybe I have responsibility for the patient after they get home. Maybe communication is as important as technology.’ ’’

Berwick would not comment on negotiations with Massachusetts over renewal of its federal health care financing package, known as the Medicaid waiver, which is crucial to the state’s mandatory health insurance law.

“We’re working through it as fast as we can,’’ he said. Part of what he’s looking for from Massachusetts and other states is a plan to improve care and cut costs for patients who have both Medicare and Medicaid coverage. They are a relatively small but very sick population that eats up 40 percent of state Medicaid budgets.

Berwick was appointed by President Obama during a July 2010 recess, angering Republicans who have painted him as an overly-liberal supporter of British-style government-run health care. He said today that the Obama administration’s focus on better care, better health, and lower costs “is not dependent on any one person.”

But at a meeting this week of the Lucien Leape Institute, part of the National Patient Safety Foundation, former Treasury secretary and institute member Paul O’Neill called it “unconscionable” that confirmation hearings haven’t been scheduled for Berwick.

He “made the unfortunate mistake of telling the truth” when discussing benefits of the British health system in a 2008 speech, O’Neill said.

Dr. Carolyn Clancy, director of the Agency for Healthcare Quality and Research, said Berwick has changed Medicare. Clancy talked about staff members setting up a meeting with Berwick to discuss an “arcane” dialysis rule, to find that Berwick had invited a dialysis patient in to discuss what the rule and what health care quality mean to her.

“You hear story after story like that,” she said.