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Does Berwick *really* sound like a radical commie?

While people continue to demonize CMS Administrator Dr. Donald Berwick and President Obama essentially throws Berwick under the political bus, far too many are missing the message. Wouldn’t “radical communist thugs” like one commenter on this YouTube page labeled the Obama administration really want to dehumanize patient care?

Watch this short video of Berwick speaking in Berlin in 2009 (yes, socialist Europe). He talks about how patient care already has been dehumanized and how healthcare professionals and organizations routinely ignore the wishes of patients. Speaking of a friend who couldn’t get mammogram results over the phone, Berwick said, “Their choice trumps her choice. Period. And that’s what scares me. It scares me to be made helpless before my time, to be made ignorant when I want to know, to be made to sit when I wish to stand, or to be alone when I need to hold my wife’s hand, or to eat what I do not wish to eat, or to be named what I do not wish to be named, or to be told when I wish to be asked, or to be awoken when I wish to sleep.”

Does that sound like a “radical communist thug” or someone genuinely committed to improving the quality of care and actually humanizing the patient experience?


 

June 19, 2011 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality fast $5000 loans-cash.net with bad credit, hospital/physician practice management and healthcare finance.

Is it even possible to seem unbiased when mentioning politics?

Is it even possible anymore to seem unbiased when reporting on politics or the workings of government? As hard as I try sometimes, there’s always someone who thinks I’m taking a particular side.

The latest example came today in a story I wrote for InformationWeek about the Obama administration’s new White House Rural Council. Created by executive order last week, the council “will focus on actions to better coordinate and streamline federal program efforts in rural America, and to better leverage federal investments,” according to USDA Secretary Tom Vilsack, chair of the council.

That’s obviously the Obama administration’s line. Yet within a couple of hours of the story being posted, someone offered this comment:

Okay, let me see if I got the right? The government is spending more money than ever before, the economy is lagging, and a recession is hanging over our heads and won’t go away. What would the most intelligent man in the world do about this? Spend more money to take better heathcare to rural areas. Wow, were is the logic is this? This whole thing smells fishy, it doesn’t pass the smell test to me.

Thanks for the ‘I love Obama’ speech buddy, but I ain’t buyin’ it. Let’s see how many do come November.

Huh? How is a news story an “I love Obama” speech? All I did was report what the administration said, and included a short, unspecific comment from one of the few interest groups, the National Rural Health Association, that has said anything at all related to the healthcare aspects of this executive order. I don’t see any editorializing there.

Take issue with the administration’s plan all you want, though at least get your facts right. The White House has been pretty vague about the council to this point, but nobody has said anything about spending more money beyond what’s already been allocated for other programs. But don’t call a straightforward, fairly bare-bones news story an “‘I love Obama’ speech.”

I think it’s fair to say that some news organizations are thinly veiled cheering sections for certain political viewpoints. InformationWeek is not one of them. Has our political culture become so poisoned that it’s impossible to come off as objective anymore?

 

June 15, 2011 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality fast $5000 loans-cash.net with bad credit, hospital/physician practice management and healthcare finance.

10 years later, there’s still a quality chasm, and Senate Dems are wusses

It’s been a full decade since the Institute of Medicine published the second volume in its landmark series on patient safety and quality of care, Crossing the Quality Chasm. We appear to be not much closer to achieving a high-quality health system as we were 10 years ago.

Last week, as you may have already heard, a paper in Health Affairs from researchers at the University of Utah concluded that adverse events may be 10 times more prevalent than previously believed and that errors may occur in an astounding one-third of all hospital admissions. The research team, which included such luminaries as Dr. David Classen, Dr. Brent James and the Institute for Healthcare Improvement‘s Frank Federico, also said that their estimates probably were on the conservative side.

Patient-safety advocate Regina Holliday finagled her way into the Health Affairs briefing on the subject on Thursday, and was disappointed by her observation that patients were almost an “afterthought” in a discussion on how to close the gaping chasm. Holliday, a sometimes painter, expresses her frustration in words in this interesting blog post and on canvas. Note that she depicts Accountable Care Organizations as a unicorn.

Do I have to remind you of who used to be the driving force behind the IHI? That of course would be Dr. Donald M. Berwick, the administrator of CMS that Republicans want to kick to the curb because they think they can score political points against the Obama administration. For that matter, the Obama administration and Democrats in the Senate are willing to sacrifice Berwick because they clearly lack the cojones to stand up for better healthcare. Yes, I said cojones. Sue me.

Please read and share my series of posts on Berwick if you haven’t done so already.

Berwick political saga is a tragic attack on better healthcare (March 14)

More reasons why CMS needs Berwick (March 20)

Slams on Berwick getting pathetic (March 23)

 

April 10, 2011 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality fast $5000 loans-cash.net with bad credit, hospital/physician practice management and healthcare finance.

Mostashari named new national HIT coordinator

Farzad Mostashari

Farzad Mostashari, M.D. has been named the new national coordinator for health IT, effective today. Though HHS has not put out a press release or other statement, it appears this is a permanent rather than an interim appointment. I had been hearing since February that Mostashari, who previously was deputy national coordinator, would be in charge of ONC at least on an interim basis when David Blumenthal, M.D., returned to Harvard.

UPDATE, 3:25 p.m. CDT: The appointment is permanent. You can find this and more details in the story I wrote for InformationWeek today.

April 8, 2011 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality fast $5000 loans-cash.net with bad credit, hospital/physician practice management and healthcare finance.

Slams on Berwick are getting pathetic

The slams on Dr. Donald Berwick, frankly, are getting pathetic.

Today, Fox News medical contributor Dr. Marc Siegel dismissed Berwick as a “basically a policy wonk” who “hasn’t really practiced since 1989.” Siegel tried to score points with sound bites. “This guy has more quotes than Yogi Berra, and let me tell you something, these quotes are an indictment on people that want clinicians to make decisions,” Siegel said on Fox this afternoon.

According to Siegel, comparative effectiveness “doesn’t work in the real world.” Well, sure, that’s the point of clinical decision support. Best practices are for common conditions, and clinical decision support is to help physicians either follow best practices in the case of common conditions or, just as importantly, diagnose and treat ailments that they don’t often see. (Read Dr. Atul Gawande’s best seller,  “Complications,” for a description of the chaos that ensues when physicians see rare cases.)

Fox News anchor Megyn Kelly tried to feign fairness by saying of President Obama’s recess appointment that installed Berwick as CMS administrator last year, “lots of presidents do it.” But she later said that that Berwick “loves” the British National Health System, trying to paint Berwick as a socialist. Once again, this isn’t about socialism or capitalism or any other ism that has unfortunately been the focus of “health reform” in this country. It’s about trying to improve the quality of care. (It’s not about insurance, no matter how many politicians or pundits say so.)

Defending Berwick was Dr. Cathleen London, a family practitioner at the Weill Cornell Iris Cantor Women’s Health Center in New York City. London took issue with Berwick’s opponents relying on sound bites to make their thin arguments. (Siegel smugly laughed this off.)

When Kelly again tried to tie Berwick to the NHS, London said, “He likes that we do evidence-based medicine, that the British have NICE that actually oversees what the NHS should cover and shouldn’t.” Yes, the British National Institute for Health and Clinical Excellence (NICE) is an independent advisory board that helps the NHS make coverage decisions. You know, the same way any insurance system, public or private, has to decide what and what not to cover.

To his credit, Siegel praised Berwick’s work at the Institute for Healthcare Improvement for helping to reduce deaths in hospitals. “He’s apparently very well liked among patient safety advocates,” Kelly added.

London noted that former CMS Administrator Tom Scully, a George W. Bush appointee, is a fan of Berwick. Still, Siegel continued on his argument that comparative effectiveness is restributive in that it takes healthcare away from some people. “You’re not going to be able to pay for very expensive care,” Siegel said.

Why exactly would we want very expensive care in cases where less expensive but equally effective treatments are available? Is it because of the public perception that more expensive care automatically means better care? It sounds like Siegel is either trying to perpetuate that myth or protect the profits of pharmaceutical and device manufacturers. But then he made the salient point that “insurance is overused” and that healthcare reform, which he derides as “ObamaCare,” did little to address that problem.

All that says is that both sides of the political debate are wrong, and the Senate Democrats are cowards for not standing up for better care.

March 23, 2011 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality fast $5000 loans-cash.net with bad credit, hospital/physician practice management and healthcare finance.

More reasons why CMS needs Berwick

On Jan. 28, Ron Pollack, executive director of the liberal advocacy group Families USA, introduced President Obama at a Families USA event by saying, “Numerous presidents over many decades tried to secure health reform legislation that would move us toward high-quality, affordable healthcare for all Americans. You, Mr. President, actually achieved it.”

The crowd ate it up.

During the contentious debate over health reform in 2009 and 2010, countless lobbyists, pundits and politicians touted “quality healthcare” as a reason to pass the Patient Protection and Affordable Care Act. Some called for the same “Cadillac” health plans that members of Congress provided for themselves. Many opponents of the legislation countered by saying the U.S. already has the “best healthcare in the world.”

The problem was not one of philosophical differences. The problem was a misunderstanding of a basic fact: health insurance is not the same thing as health care.

Still, politicians keep making the same mistake over and over, and the mass media keep giving them a free pass.

Anyone in the healthcare industry knows that the United States does not have the best healthcare in the world. We have the most expensive care in the world. (Another myth often passed off as truth is that more care and more expensive care automatically equals better care.) Having a “Cadillac” health plan won’t assure you better care, either. Just ask the late Rep. John Murtha (D-Pa.), who, as a member of Congress had such a plan, but still likely died as a result of a surgical error last year.

Another such episode occurred last week. James C. Tyree, chairman and CEO of financial services firm Mesirow Financial, died Wednesday at the University of Chicago Medical Center at age 53. Though Tyree had stomach cancer and pneumonia, the official cause of death was an intravascular air embolism, the result of an improperly removed catheter. That’s one of the National Quality Forum’s so-called “never events.”

As the chief executive of a financial firm, Tyree no doubt had the resources and the insurance to get what some people might call “good, quality care.” He also happened to be on the board of the U of C Medical Center, the very same institution that was so proud of being named one of U.S. News and World Report’s best hospitals in America. Yes, even at the “best” hospitals, mistakes happen, and they happen to people with money and connections.

This is yet another reason why CMS needs someone with a long record of quality improvement, even at institutions with supposedly sterling reputations. Someone like Don Berwick.

If you haven’t already, I encourage you to read the defense of Berwick that I wrote last week so you understand why politics is hijacking better healthcare in America.

March 20, 2011 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality fast $5000 loans-cash.net with bad credit, hospital/physician practice management and healthcare finance.

Spring training for Health Wonk Review

 

The sun is shining here in Chicago and the mercury is supposed to hit 60 degrees today for the first time in months. That could mean only one thing: Spring is in the air, and hope springs eternal, even for the star-crossed Cubs. Though it’s still spring training, noted Yankees fan Glenn Laffel of the Pizaazz blog is in midseason form as he hosts this week’s Health Wonk Review, with an all-star lineup of contributors.

My impassioned defense of Don Berwick makes the big-league roster among the sluggers (health policy), while health IT gets its due respect as a disruptive force by being categorized as the base-stealers.

Of note, longtime HIT blogger Shahid Shah, known as the Healthcare IT Guy, talks security. “I hear a lot of naive talk about how systems are secure because ‘we use SSL encryption’ or ‘we’re secure because we have a firewall.’  Anybody who’s been security and privacy work for more than a few months would know how false those statements are,” he writes. To continue the baseball analogy, it’s like a pitcher making a couple of light tosses over to first to keep the base runner honest, then leaving the next pitch out over the middle of the plate.

And now back to an afternoon of watching basketball, er, I mean, answering e-mail or something. o:-)

 

March 17, 2011 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality fast $5000 loans-cash.net with bad credit, hospital/physician practice management and healthcare finance.

Berwick political saga is a tragic attack on better healthcare

President Barack Obama has made plenty of mistakes in his first two-plus years in office, but none may be more serious for the future of America than his decision to install Donald M. Berwick, M.D., as a recess appointment to head the Centers for Medicare and Medicaid Services in July 2010.

Berwick really is a great choice to head CMS, but the underhanded nature of the recess appointment has provided fodder for all kinds of uninformed ideologues and assorted nut jobs to attack Obama’s healthcare reform efforts. Just as CMS is gearing up to release widely anticipated proposed regulations for Accountable Care Organizations, we get the sad news that that Berwick’s days are numbered.

After refusing to allow Berwick to testify before the Senate last year, Obama renominated Berwick on Jan. 26. Newly empowered Republicans went on the attack. “The White House’s handling of this nomination—failing to respond to repeated requests for information and circumventing the Senate through a recess appointment—has made Dr. Berwick’s confirmation next to impossible,” the widely respected Sen. Orrin Hatch (R-Utah) said, according to American Medical News.

On March 4, Politico reported that Senate Democrats had given up on the nomination, despite the fact that Berwick had the support of the Medical Group Management Association, the American Hospital Association, the American Public Health Association and, notably, the Republican-leaning American Medical Association and America’s Health Insurance Plans.

How did this happen?

As I wrote last November when Republicans proposed de-funding of the Center for Medicare and Medicaid Innovation, a key element of real reform in the widely misunderstood “healthcare reform” legislation (the main misunderstanding is that insurance is not the same thing as care):

The Patient Protection and Affordable Care Act, widely referred to as “healthcare reform” and mocked by some as a government takeover of healthcare, aka “ObamaCare,” is not popular in Republican circles. That’s no secret.

It’s also well known that, in their drive to repudiate everything Obama, many Republicans, giddy over their victory in last week’s midterm election, have said they want to repeal the PPACA in its entirety, throwing out the baby with the bathwater. (You know, our healthcare system is wonderful the way it is, so we didn’t need any changes in the first place.)

What really got me was the news that some of the more conservative and libertarian elements of the GOP are specifically threatening to pull the $10 billion in funding already authorized for the Center for Medicare and Medicaid Innovation, a CMS program created by the PPACA. This is a center that CMS Administrator Dr. Donald Berwick has called “the jewel in the crown” of the reform bill, and Berwick has unfairly been labeled a socialist, granny-killing pariah by some right-wing zealots who have no idea of his life-saving work at the Institute for Healthcare Improvement.

The new Republican-majority House of Representatives could not make a bigger mistake than defunding the Center for Health Innovation. For years, conservatives have complained of Medicare’s plodding bureaucracy impeding innovation—you know, the very thing the program is intended to foster.

What the PPACA does is allow CMS, via this new innovation center, to try new ideas without having to make sure their experiments are budget-neutral from the start. (The requirement for budget neutrality is why Medicare pay-for-performance and pay-for-prevention initiatives have never really gotten off the ground.) And CMS no longer has to be content with small demonstrations. Instead, the Center for Medicare Innovation is authorized to run wider-scale pilots and then seek congressional appropriations to ramp up any program that proves successful in producing better care for less money.

That’s how you bend the cost curve, a favorite term in policy circles. Killing the Center for Medicare and Medicaid Innovation would just perpetuate the ugly status quo.

That commentary drew five responses on the site, four of which were negative. And every last one of the negative comments were written anonymously. The only commenter to list a name also happened to be the lone supportive response.

I am in no way surprised. Politically motivated lies abound about Berwick, and few of the critics want to be held accountable for misleading the public.

The week before last, I was somewhat critical of the Lucidicus Project and Jared M. Rhoads, who hosted the most recent Health Wonk Review. He did a fine job hosting HWR, but in scanning some earlier posts on the Lucidicus site—hewing closely to confused, angry, misguided ideology of the tea party—I noticed something that got my blood boiling.

On Jan. 27, Rhoads wrote that Berwick was “on a one-way path,” a path that leads to socialism and a government takeover of healthcare. “Without free-market solutions on the table, the one-way march to an NHS-like system will continue. Berwick has just one solution in mind for the problems created by government: more government.”

He also wrote, “Berwick is openly enamored of the U.K.’s National Health Service (NHS) model, in which the government essentially makes decisions for people about the care that they receive, and in which patients can be penalized for attempting to pay for additional care out of their own pockets. The system is characterized by bureaucracy, rationing, and redistribution of wealth and resources.”

At least give Rhoads credit for not cowardly hiding behind a cloak of anonymity.

Yes, it is true that Berwick has publicly spoken of his admiration for the NHS, but it was more about the British decision to make quality improvement a key element of healthcare than it was about a desire to bring an entirely government-run system to the United States. In my post about that edition of HWR, I asked if Berwick hadn’t done more to prevent needless deaths and adverse events than pretty much anyone else alive today.

That’s the same question I asked in an e-mail to the anti-reform (read “crackpot”) group called Docs4PatientCare. Why do I say crackpot? The Atlanta-based organization contacted me last fall with links to a series of videos, including one from group representative Scott Barbour, M.D. According to the original pitch to me, “Utilizing quotes from Dr. Berwick, Dr. Barbour exposed that, ‘He is not interested in better health care. He is only concerned about implementing his socialist agenda.’”

In another video, Docs4PatientCare Vice President Fred Shessel, M.D., said of Berwick, “This is a man who has made a career out of socializing medicine and rationing care for the very young, the very old and the very sick. It is a backdoor power grab. It is dragging our country down the road to socialism and we should resist it.”

I responded to this pitch with a short question: “Berwick isn’t interested in better care? Do you know anything about his work at IHI?” I never got a response. Docs4PatientCare seemingly was trying to hoodwink media that don’t know any better and/or care more about politics than facts.

Here are the facts, from another piece I wrote last year:

A longtime champion of patient safety, Berwick co-founded the Institute of Healthcare Improvement in 1989 and led it until he became CMS administrator by virtue of a controversial “recess appointment” in July 2010, preventing the Senate from questioning him about his views. At IHI, Berwick created and championed the 100,000 Lives Campaign, an effort to prevent that many deaths in an 18-month period by getting thousands of U.S. hospitals to follow simple, preventive safety measures voluntarily. The program later turned its focus to nonlethal adverse events and became the 5 Million Lives Campaign. Berwick is a pediatrician who also holds a master’s degree in public policy.

In kicking off the 100,000 Lives Campaign in December 2004, Berwick made the following audacious challenge to American hospitals: “I think we should save 100,000 lives. I think we should do that by June 14, 2006. 9 a.m.” At that appointed hour 18 months later, he announced that the campaign had prevented 122,300 unnecessary deaths. Berwick was careful not to make IT a prerequisite for participating in either campaign, but he’s come to see the benefits of EMRs and clinical decision support. Now, as head of CMS, he effectively leads the “meaningful use” incentive program. Though the Stage 1 rules were mostly done by the time he took the reins, you can be sure Berwick will be pushing for true quality improvement in subsequent stages of meaningful use.

The key word in the above passage is “voluntary.” There were no mandates when the private-sector IHI encouraged hospitals to do what is right for patients.

Months later, Berwick has indeed been pushing for true quality improvement in meaningful use. I’ll have more on that later in the week.

March 14, 2011 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality fast $5000 loans-cash.net with bad credit, hospital/physician practice management and healthcare finance.

Kolodner on ONC

I just ran into Dr. Robert Kolodner at the HIMSS conference. As you know, Kolodner was the second national coordinator for health IT, serving from 2006 to 2009. While he doesn’t have any insight on who might be the next head of the Office of the National Coordinator for Health Information Technology—or if he does, he’s not sharing—he did put the decision into perspective.

The first coordinator, Dr. David Brailer, was kind of the entrepreneur, starting up the office with little money and no statutory authority, just what President George W. Bush delegated to him in an executive order. Kolodner was the one who “made it real” in terms of hiring permanent staff and setting up programs to assure the long-term viability of the office. The current coordinator, Dr. David Blumenthal, who will leave in April, is the policy guy, leader of efforts to implement the health IT provisions of the American Recovery and Reinvestment Act.

The question Kolodner has for the Obama administration is: What qualities should the next coordinator have? Do we need another policy specialist or a hands-on implementation leader?

February 22, 2011 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality fast $5000 loans-cash.net with bad credit, hospital/physician practice management and healthcare finance.

Podcast: HIMSS CEO Steve Lieber

The 2011 HIMSS conference gets underway this weekend in Orlando, Fla. For the fifth year in a row, I interviewed HIMSS President and CEO H. Steven Lieber to preview the annual conference. Check Health Data Management’s HIMSS microsite now and MobiHealthNews next week for write-ups of parts of this interview, but this is the only place you can hear the whole thing.

The audio is pretty clear, but you may hear faint music in the background. The recorder seems to have picked up some radio interference. That’s not entirely unexpected in a downtown Chicago office building, namely HIMSS headquarters at 230 E. Ohio St. Ah, well. Enjoy the podcast, and I’ll see you in Orlando.

Podcast details: Interview with HIMSS CEO Steve Lieber. MP3, stereo, 128 kbps, 30.6 MB. Running time 33:26

0:30 Attendance “well in excess of 30,000”
1:00 Increasing interest in health IT because of meaningful use
1:35 ICD-10 and 5010 somewhat “sidelined” but still important
2:40 The march toward meaningful use
3:00 25 percent of membership already at Stage 1 meaningful use
4:20 “Uncertainty” about future stages replacing confusion about what Stage 1 meaningful use is
5:15 Questions about whether early Stage 1 attestation shortens the timeline for Stage 2
6:00 Efforts by some new members of Congress to repeal or cut funding to HITECH
7:30 Questions about meaningful use he hears from HIMSS members
8:40 Balancing meaningful use with 5010 and ICD-10 compliance efforts
12:00 Incentives from private payers
12:40 Quality vs. cost savings
14:00 Public perception of healthcare reform
16:10 PPACA hasn’t had time to make an impact yet
16:55 Expectations for David Blumenthal’s HIMSS keynote and politicization of health IT
19:10 Speculation about next national coordinator?
21:25 New, parallel HIT X.0 conference-within-a-conference
24:30 Mobile and wireless technology at HIMSS and in healthcare
27:10 Hype cycle in mobile apps
28:10 Home care and telehealth reimbursement
30:00 Technology and ACOs
31:00 Berwick speaking at HIMSS this year after several previous attempts to get him

February 18, 2011 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality fast $5000 loans-cash.net with bad credit, hospital/physician practice management and healthcare finance.