What would Berwick as CMS administrator mean?

Media already are pegging him for the next administrator of the Centers for Medicare & Medicaid Services. If in fact President Obama nominates Donald M. Berwick, MD, MPP, FRCP, president and CEO of the Institute for Healthcare Improvement, to that position, what would it mean for the health care industry?

• Jugna Shah, MPH, president and founder of Nimitt Consulting in Washington, DC, says, "The one thing about Berwick is everybody is really excited about him being the administrator. The other thing is Berwick definitely comes from the model of having worked with a lot of payers. Berwick is definitely about bundled payments. I think if Berwick is the administrator, we are definitely going to see activity around more and more bundled payments, a transformation of how health care services are paid, less fragmentation across care settings. And I think he has an eye toward quality. A lot of the work that I think he's been involved in has looked at the payment side and the quality side."

• Stuart Guterman, MA, PhD, assistant vice president for The Commonwealth Fund's program on payment system reform, says, "Berwick is going to have to make sure that he has people lined up to help run the agency. There are a lot of details that the agency has to take care of... His big job as administrator is to set the tone for the agency, and he's the kind of person who will make it oriented toward action, and I think that's certainly not a bad thing for a bureaucratic agency to have. When Mark McClellan started out at CMS, one of the first things he said was, 'I want CMS to be a primary public health agency. That that's the function I see.' And I think that's great because that basically set the tone for CMS. 'We're not an insurance company. Our primary purpose is not just to pay bills. It's to make sure that the health care that our beneficiaries get is as good as it can possibly be, and that affects the health care that the whole population gets in a positive way.' That's a great tone to set, and I think that's a big contribution for an administrator to make. And I think Berwick is the kind of person who is a visionary. He's going to say, 'OK, this is where we're headed' and then his staff are going to need to figure out how to get the agency to head in that direction, and I think that's a good thing."

• Kurt Patton, CEO of Patton Healthcare Consulting in Glendale, AZ, and former executive director of accreditation services at The Joint Commission, says, "At first I would have been concerned about quality [with the health care reform legislation]. With a large influx of new patients into the system, which has fixed resources, the bill had the potential to diminish quality. However, I see the pending appointment of Don Berwick as perhaps making a statement that quality must be enhanced. I don't see him allowing the feds to just hack at budgets aimlessly. His presence is a very good thing... I expect Don Berwick will help prevent aimless cuts, allowing for more focused cuts, which should not be as potentially harmful. Not paying for bad care can be a good thing. Small and rural [hospitals] should be helped because they have congressmen that can't afford to see them close. They fulfill an important role in their communities and must be a protected entity."

Asked if CMS will really be nickle and diming hospitals or really getting at quality, he says, "Some of both today, but I truly believe Berwick can help them get at real quality issues."