Tuesday, September 7, 2010

Innovation and Politics

The "recess appointment" of Donald Berwick, MD, as head of the Federal Centers for Medicare and Medicaid Services (CMS) was politically expeditious, perhaps even necessary.  In July, when President Obama announced the appointment, sans congressional hearings, some applauded, some booed.  Fans noted that Dr. Berwick is above reproach, beyond criticism, given his impeccable track record.  They also believed that the CMS chief confirmation hearings would devolve into little more than another public debate on the President's controversial health system overhaul rather than remaining a discussion on the merits of Dr. Berwick as the head of the agency.  Detractors cried foul, describing this as just one more example of a heavy handed President hell bent on pushing an agenda regardless of opposing views. 

The critical issue before us at this point, however, is that CMS stands at the forefront of implementing the most significant health care industry overhaul in history.  Achieving the access goals while maintaining (or working towards) affordability is no easy task, and innovating on matters such as payment reform, accountable care organizations, quality and outcomes, and phasing in changes in sustainable, manageable ways will require great innovation and bold, decisive leadership. 

Boston.com reported yesterday (click here) that Dr. Berwick has taken a decidedly low profile approach during his first days as head of CMS.  That's understandable given the task before him and the manner in which he took office.

But... as we're in mid-term election season (some would say, starting offically today) and poll numbers suggesting that maintining all aspects of the health reform law will be politically tough, it's hard to envision success in this realm springing from a low profile approach.  This will be a politically charged process and many special interests will be sharpening their arguments in the coming months and years.  Dr. Berwick will need strong political backing from both Democrats and Republicans in order to succeed... and to remain in his job after the recess apointment term ends at the end of 2011.

Time will tell whether he is an interim leader or whether he can emerge as the long-term, bold innovator his track record suggests he can become.  Hopefully, pure politics won't prevail.

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