Donald Berwick

Bringing real value to government-supported health care will be Dr. Berwick’s foremost challenge.  And with health care reform set to trim billions of dollars from the Medicare program while adding millions of new enrollees to Medicaid, it is a formidable challenge, indeed. 

But Dr. Berwick has two things going for him.  First, he knows what he is talking about.  His work and leadership at the Institute for Healthcare Improvement (IHI), which he cofounded nearly 20 years ago, has led to changes in the way hospitals provide health care that have saved lives, lowered costs and improved quality.  IHI’s current initiative, it’s “Improvement Map,” is perhaps its most ambitious.  

The Improvement Map is an interactive, Web-based tool designed to bring together the best knowledge available on key process improvements that lead to exceptional patient care. It offers clear guidance through the often confusing health care landscape, helping hospitals set change agendas, establish priorities, organize work and optimize resources.  The Improvement Map is also a testament to IHI’s dedication to shared learning, which it established from its beginning through collaboratives, learning networks and mentor hospitals (among these are Mercy Medical Center and St. Luke’s Hospital in Cedar Rapids, University of Iowa Hospitals and Clinics in Iowa City and Buena Vista Regional Medical Center in Storm Lake). 

But leaders succeed only when they energize followers, and that is Dr. Berwick’s other strength.  Throughout the medical world, Dr. Berwick is highly respected not only for his ideas but for his ability to bring key players to the table and keep them there.  Time and again, Dr. Berwick has been described as “a visionary.”  Hospital leaders in Iowa continue to be pleased about his nomination: 

“I was very excited to hear of the nomination of Dr. Don Berwick as the administrator for CMS,” said Jim FitzPatrick, CEO at Mercy Medical Center-North Iowa in Mason City.  “Dr. Berwick has spent his career on a quest for improving quality in the nation’s health care system.  His passion for improving processes for our patients and keeping focus on the ‘big dot’ issues to eliminate defects in care makes him the perfect leader for CMS. 

“Dr. Berwick’s appointment to CMS would be very positive for the health care industry,” said Eric Lothe, administrator at Iowa Lutheran Hospital in Des Moines.  “He has a long history of setting transformational goals for health care quality and then achieving great results.  Dr. Berwick would continue the focused work of IHI to help physicians and hospitals improve quality, reduce errors and eliminate adverse events.” 

The real question is, can Dr. Berwick’s ability to unite diverse interests come through in a U.S. Senate that remains bitterly divided over health care reform?  Can he show that not only can Medicare and Medicaid lead the way in improving care, but they can do it at less cost?  And can he hold his ground should talk of “rationing” and perhaps even “death panels” rear its ugly head? 

Answers should come fairly quickly, as Dr. Berwick’s first stop will be in front of the Senate Finance Committee and its ranking Republican, Iowa’s own Chuck Grassley.

Social media penetrates politics and the public

This leads us to today, when individuals, groups and companies are using freely available technology to engage loyal supporters and introduce their messages to people who may never have heard them before.  Aside from consumers and private-sector organizations, these users also include members of local, state and federal government.

What was once often only discussed behind closed doors or in whispers between party members is now made available to consume in the public forum.  This new age of transparency and interaction allows people to make opinions and thoughts known before they have the chance to pass through political filters or press secretaries.

Be ready for real-time feedback and responses

A recent example includes several messages sourced from Senator Chuck Grassley (R-IA) illustrating his frustration with President Obama, who was making a stop in Europe last week.  There is nothing new about Senators and politicians having disagreements with the president, but the channel through which Grassley’s views were presented and the public availability of said comments would have been unheard of just a few years earlier.

Grassley posted several messages on his Twitter account, a microblogging social network where users can exchange short messages with friends, addressing his concerns with the president:

“Pres Obama you got nerve while u sightseeing in Paris to tell us ‘time to deliver’ on health care.  We still on skedul/even workinWKEND.”

“Pres Obama while u sightseeing in Paris u said ‘time to delivr on healthcare’ When you are a ‘hammer’ u think evrything is NAIL I’m no NAIL.”

These messages from Senator Grassley were seen by at least 11,000 people who follow the senator’s messages (tweets) directly, while hundreds and perhaps thousands more read them as the media caught wind of the story.  There is nothing inherently wrong with what Grassley posted (and they are still available to see at http://twitter.com/chuckgrassley), but the message and the lesson are that we need to be aware of the tools that surround us and know how best to use them.

People are out there talking; are you ready to listen?

Conversations are taking place all over the world about the topics, issues and concerns of everyone, just as they always have.  The new problem is understanding how those messages can spread and what role we play in addressing or interacting with them.

IHA has taken a strong stance in the realm of social media – this interactive, participatory two-way type of dialogue – by establishing our own grounds online and staking claim to the issues most important to Iowa’s community hospitals.  As the voice of hospitals and health care in Iowa, it is IHA’s responsibility to be represented wherever discussions are happening, be it on Capitol Hill or Facebook.

Apart from the IHA Web site, the blog acts as IHA’s authoritative clearinghouse for contact via social media with the public and beyond.  All of our interactive actions direct back to this home base in an effort to clarify IHA’s mission, vision and values.

As IHA continues along this path into the future of communication and dialogue, it will adapt to change, but the core existence and purpose will remain:  supporting the missions of Iowa’s hospitals.

Looking to learn more about how IHA is engaging individuals and influencers by using these social technologies? Keep reading our blog and see the about page for more details.

What questions do you have? How are you using these techologies to impact your goals?

Two-thirds of the new proposed spending cuts come from hospital payments.  The President proposed $106 billion in ‘savings’ by cutting the Medicare and Medicaid DSH programs by 75 percent.  In addition, the President proposed $110 billion in ‘savings’ by reducing inflationary updates with an annual ‘productivity adjustment,’ the greatest impact on hospitals.

These ‘savings’ are in addition to the President’s FY2010 budget proposal to cut Medicare and Medicaid spending by $309 billion. They are also in addition to the $38 billion in previously announced reform-related cuts, and $41 billion in cuts in the proposed FY 2010 inpatient PPS rule.

IHA will be analyzing the proposal’s specifics and determining as best possible the Iowa impact. IHA will also be coordinating our messages and advocacy strategy with AHA.  Please stay tuned for next action steps on this important issue.

We wrote about that earlier and noted, as the New York Times did, that Iowa is also a high-value state.  How does Iowa compare to Green Bay?  Well, a few minutes spent working with Dartmouth’s data tables revealed that the president chose well, but he could have done better by coming to Dubuque…or Mason City…or Iowa City…or Cedar Rapids.

When looking at Medicare spending during the last two years of a Medicare recipient’s life, a key measure in the Dartmouth report and in the Post story, the hospitals in those Iowa cities spend less than Green Bay, which came in at $33,334.  And the hospitals in Sioux City and even Des Moines – and the average for all of Iowa – were only about $500 higher. Overall, Iowa ($33,864) is a significantly better value than Wisconsin ($37,217).  (The national average is $46,412, while the average in the president’s hometown of Chicago is $62,565).

Patients in Dubuque and Mason City also spent less time in the hospital than in Green Bay, and patients in Mason City and Iowa City spent less time in intensive care units.  Patients in Mason City, Sioux City and Iowa City also had fewer visits with medical specialists, which helps keep costs lower.

Obviously, there are other factors at work to bring the president to Green Bay (including access to media).  But know this:  When the president talks about doing medicine the right way – the high-value way – he’s also talking about Iowa.

The campaign is called “Organizing for America (OFA)” and began June 6 with events all over the nation featuring a web address from the president.

Saturday’s events were a precursor to a “national health care day of service” scheduled to take place on June 27, 2009.

The Obama Administration takes a new approach to grassroots advocacy

The administration is taking a new approach to executive branch advocacy, and is working to utilize the millions of grassroots supporters energized and mobilized during the 2008 presidential campaign, to engage in a grassroots lobbying campaigns especially among the president’s goals on health care.

Obama also held a conference call with supporters last week from Air Force One where he said, “We need you to stay involved.”

“The election in November–that didn’t bring about change. That just gave us an opportunity for change,” Obama said.

Coming legislation will heat up the battle in Congress

Congress is in the process of releasing health care reform legislation in the coming weeks, which will set up a Congressional battle on issues such as coverage, health care payment reform and cost reduction.

IHA has outlined health care reform principles that show, from the hospital perspective, what Congress should consider while working on reform efforts this year.

What are your opinions on health care reform?

IHA is interested in hearing from citizens on the topic of health reform.

Leave a comment to tell us what you think!

The summit, structured similarly to the economic summit held the week prior, was an opportunity to bring groups together and begin discussing the initial plans to overhaul the nation’s health care system.

The president provided opening and closing remarks to attendees who spent the remainder of the day in five break-out sessions focusing on a variety of topics, including health care cost, quality, coverage and access.

During his remarks, Obama notably indicated some flexibility on the reform plan he introduced during the campaign saying, “I put forward a plan for health care reform.  I thought it was an excellent plan.  But I don’t presume that it was a perfect plan or that it was the best possible plan.”

Obama indicated that there is room for discussion on the specifics, and doesn’t believe that an entirely public nor entirely private reform plan will work and said, “If there is a way of getting this done, where we’re driving down costs and people are getting health insurance at an affordable rate…and we could do that entirely through the market, I’d be happy to do it that way.  If there was a way of doing it that involved more government regulation and involvement, I’m happy to do it that way as well.”

President Obama had said that he would like Congress to act on health care reform by the end of this year.

Details on upcoming health reform regional forums are available on the newly launched HealthReform.gov website, managed by the U.S. Department of Health & Human Services.