Dr. Donald Berwick isn’t popular among Senate Republicans, but the CMS administrator has one former Republican senator in his corner-Tennessee’s Dr. Bill Frist.
Frist interviewed Berwick this week before about 500 attendees at a luncheon organized by the Nashville Health Care Council. While Republican opposition in the Senate has doomed Berwick’s chances of a full appointment to his position, Frist made it clear from the start that he doesn’t share the disdain. By way of introduction, Frist said Berwick has a 30-year history of being three or four years ahead of the curve on quality and value in healthcare. And then Frist added perhaps the ultimate compliment in the clubby world of Nashville healthcare.
“He’s not a politician. He’s not a creature of Washington, D.C.,” Frist said. “He’s really one of us.”
Frist was less complimentary about the CMS itself. Early on, he noted that the agency is not seen as an agent of change but as a big elephant that can act only with a heavy hand. Later, after Berwick said that there was “a ton more, a ton more” fraud and abuse than he realized before he took the job, Frist said that when the CMS talks about fraud and abuse, providers in Nashville see more of that heavy hand, and this time, Frist made a fist and punched it into his other hand.
Berwick responded to the first point by saying that he quoted Gandhi-be the change you want to see-to his staff. “If we want healthcare to be reliable, we have to be reliable,” Berwick said. The CMS, he added, should be in the game rather than be the game. That means more partnerships, more collaboration between the CMS and other groups, he said.
The CMS administrator also acknowledged that when providers try an innovative approach, oftentimes the government thinks there’s something fishy going on. Innovation is going to be the only way that the healthcare system can afford healthcare reform, he added: The choice between cutting and improving is not mere rhetoric. “It looks obvious that cutting is the way to lower cost,” Berwick said, “but it’s wrong, in healthcare.”
Berwick noted a strong belief in Nashville in the business ethic of doing well by doing good and said it can be the engine that pulls the train of improving healthcare. “The entrepreneurial approach in Nashville is where the answers will come from,” Berwick added.
Berwick also seemed to revel in the ways that being the CMS administrator makes one a lightning rod. He joked about the constant wave of lobbyists for every medical specialty and sector in the industry who come to see him- “Don’t send me any more lobbyists.” He noted that setting up the state health insurance exchanges as part of the Patient Protection and Affordable Care Act involves 50 different conversations: “It’s not always easy, it’s not always pretty, but it’s authentic.” The proposed rule for accountable care organizations has drawn 1,200 comments and has been the subject of many listening sessions that, at times, Berwick acknowledged, have been “very stormy,” yet he called that level of engagement thrilling: “I think that’s democracy.”
Berwick also urged the providers in the room to continue to comment on proposed rules. “Ask my wife. She knows what I’m doing in the middle of the night,” he said. “It’s reading your comments.