Clipboard: Dr. Don Berwick’s last week

By Chelsea Conaboy, Globe Staff

Visit msnbc.com for breaking news, world news, and news about the economy

Thursday was Dr. Don Berwick’s last day as administrator of the Centers for Medicaid and Medicare Services. His resignation, which came after Republican senators vowed to block his nomination, has prompted many people to reflect on Berwick’s impact at the agency, despite his short tenure.

In an MSNBC interview with Chris Hayes, “The Doctor is Out,” Berwick talked about how improving health care quality is key to controlling costs. He said he felt lucky to have had the experience of leading the agency, but was frustrated with how he was “misunderstood” and treated by his opponents in the Senate with “a lack of authenticity and inquiry.”

He said one Republican senator approached him by say, “Dr. Berwick, I haven’t seen a single thing that you’ve said or written that I agree with.”

“That’s not a framework for a conversation,” he said. “These soundbites kept coming at me.”

In an interview with the New York Times, Berwick said up to 30 percent of health care spending is waste rooted in overtreatment, fragmented care, administrative complexities, fraud, and burdensome rules. John Halamka, chief information officer at Beth Israel Deaconess Medical Center and an emergency room physician, reflects on those topics in a blog post this morning.

In the Times story, Berwick also made the case for people to support efforts at overhauling the system initiated under the Affordable Care Act:

But, Dr. Berwick said, just as Americans supported manned missions to the moon without knowing the details of rocket science, they ought to support the new law because of its ultimate destination.

“We are a nation headed for justice, for fairness and justice in access to care,” Dr. Berwick said. “We are a nation headed for much more healing and much safer care. There is a moon shot here. But somehow we have not put together that story in a way that’s compelling.”

Health Affairs, in its December issue, has a profile of Berwick that highlights not only his contributions to the agency -- summarized here -- but also his leadership style, including this exchange leading up to the announcement of rules dictating accountable care organizations:

Even with the hustle and pressure, before the news conference started Berwick asked the CMS staffers sitting along the side wall, who’d worked long hours to finalize the rule: “Who’s in the up-all-night crowd?” Several weary heads nodded, and he thanked them, joking that at 65, he was too old to pull all-nighters. He praised Richard Gilfillan, the head of the CMS Center for Medicare and Medicaid Innovation, who was sitting next to him, and patted him on the shoulder.

Then Berwick, a Harvard pediatrics and health policy professor who is one of the nation’s leading champions of high-quality, patient-centered care, opened the news conference. Characteristically, he began by talking about how accountable care organizations will improve patients’ experience of care—mainly by putting them and their families first. “Every doctor, nurse, and pharmacist wants to give this kind of care, but it hasn’t always been rewarded,” Berwick told the reporters. Accountable care, he asserted, would allow these providers to “be the team they want to be.”

The setup and the message were classic Berwick: graciously recognizing others for their work, focusing on the patient impact, and insisting that health care professionals want to do the best job possible.

What’s your take on Berwick’s work at CMS and his departure?

(If you’re a regular reader of White Coat Notes, you likely have noticed that we’ve discontinued our Daily Check Up items. There are lots of bloggers out there writing daily digests of health news. WBUR’s Commonhealth bloggers do a great job. For a national perspective, check out the Kaiser Health News daily policy report.

With Clipboard items, we’ll take a slightly deeper dive into one hot topic each day. This is a place where you can come to weigh in on the issues that have people in health care talking.)