By MAGGIE MAHAR

The rumors that I wrote about Friday are, in fact, true. President Obama will name Dr. Donald Berwick, president of the Institute for Health Care Improvement (IHI), to run Medicare and Medicaid. Berwick, who is a professor of pediatrics and healthcare policy at the Harvard Medical School and a professor of health policy and management at the Harvard School of Public Health, will have to be confirmed by the Senate Finance Committee.

Just how tough will the confirmation hearing be? I’m not worried. Berwick can handle himself.

Granted, yesterday the New York Times called Berwick “iconoclastic,” i.e., someone who “smashes sacred religious images” or “attacks cherished beliefs.”   But most who know him describe him a “visionary” and a “healer,” a man able to survey the fragments of a broken health care system and imagine how they could be made whole.  He’s a revolutionary, but he doesn’t rattle cages. He’s not arrogant, and he’s not advocating a government takeover of U.S. healthcare.

Berwick stands at the center of a healthcare movement that would reform the system from within. In 2005, Modern Healthcare, a leading industry publication, named him the third most powerful person in American health care. In contrast to others on the list, Berwick is “not powerful because of the position he holds,” Boston surgeon Atul Gawande noted at the time.  (Former Secretary of Health and Human Services ranked no. 1, while Thomas Scully, the head of Medicare and Medicaid services captured the second slot.) “Berwick is powerful,” Gawande explained, “because of how he thinks.”

Listen to some of the clips below, from the film Money-Driven Medicine, produced by Alex Gibney, and based on my book, and you’ll understand what Gawande means. Soft-spoken, and charismatic Berwick is as passionate as he is original. His style is colloquial, intimate, and ultimately absolutely riveting. He draws you into his vision, moving your mind from where it was to where it  could be.

Berwick isn’t just another ivory-tower philosopher. He’s “an extraordinary leader when it comes to inspiring people and creating the will to move forward,” Dartmouth’s Dr. Elliot Fisher told me in a phone conversation Friday. “And he can teach people how to do it. He has demonstrated his ability to teach people how to implement change in a complex system.”

That is precisely what the Institute for Healthcare Improvement (IHI), the non-profit organization that Berwick co-founded in 1991 does, spearheading pilot projects aimed at “continuous quality improvement.” IHI targets problems like asthma care or safety in coronary surgery and then invites teams of medical workers from hundreds of hospitals to collaborate in what Berwick describes in his book Escape Fire, as “results-oriented, clock-ticking projects, which may last six months or a year.”

Berwick outlines the process: “A hundred teams working to improve cardiac surgery outcomes; 70 teams working to reduce Emergency Room waits . . .—guided by teams of faculty from around the country or around the world, meeting regularly in learning sessions . . . going home, sharing what’re learning, coming back together here, sharing again.”

IHI’s website (www.ihi.org) offers an abundance of resources. a team of health care professionals can sign up online courses that focuses on reducing Clostridium difficile infections, lowering the number of heart failure readmissions or managing advanced disease and palliative care. The interactive, two- to- four month web-based courses are called “expeditions” and include: check in calls every two weeks for faculty to provide advice and mid-course adjustments;   ongoing opportunities to share with and learn from other participating organizations; opportunities for periodic check-ins with faculty.

Alternatively, readers who visit the website and scroll down to “How Did They Do That?” and discover that Models of Low-Cost, High-Quality Health Care Do Exist in the U.S.

So Berwick does that it can be done—and how to do it. Many of IHI’s initiatives have succeeded. But he also understands that reform not something that will happen in 2014 when the government flips a switch. It’s a process that already is happening –and that will continue in the years to come.  Much depends on people on the ground.

The Will to Excellence

Berwick’s vision is generous. He is convinced that there are enough like-minded people within the health care professions to create a revolution: “The will to excellence is present everywhere in Health care,” Berwick told an audience at the National Forum on Quality Improvement in Health Care. “The will to do well, the quest for pride, the joy of achievement, the warmth of serving –these are natural capital, human traits. Not of all human nature, not all of the time, bu enough, plenty enough. We can waste them and deplete them,” he adds, referring to low morale in many parts of our health care system. “But the will to have pride in work is not scarce; it is everywhere abundant.”

Time and again, Berwick has seen IHI’s pilot projects work –without any financial incentives for the medical professionals involved.  Hospital workers want change. Many are horribly frustrated  to find themselves laboring in an system where the left hand and the right hand often fail to communicate, making  much of their work seem  redundant or even pointless. Berwick recognizes that these professionals would like nothing more than to turn their hospitals into efficient workplaces. And that such an opportunity might well be worth more than a 2 percent raise.

Indeed, a year ago at the American Medical Group Association meeting, Berwick compared physician performance bonuses to exhorting [doctors and nurses] “to do better,” and said both were “very poor cousins” to healthcare system redesign.  As he told Kaiser HealthCare News in an interview today: “I think we need to create more consequences for good and bad performance. But we have to learn our way unto that. . ..  The danger is that you create ‘games and gaming’—which we can ill afford.”

In a 2005 interview published in Health Affairs, Berwick expressed his concerns: “I would draw a very dark line between the incentives that apply to organization .  .  . where I do want incentives in place — and incentives for individuals. . . . I want it to be good for an organization to be safe, and I want it to be good for an organization to manage chronic illness carefully . . .”  He applauds the pilot projects in the health reform legislation that encourage Medicare to “bundle payments to doctors and hospitals,” with a  bonus added to the bundle when teamwork leads to good outcomes at a lower price.

But “at the individual level,” he insisted, I don’t trust incentives at all . . . I think it feels good to be a good doctor and better to be a better doctor. When we begin to attach dollar amounts to throughputs and individual pay, we are playing with fire.  The first and most important effect may be to disassociate people from their work.”

Here, I think Berwick is putting his finger on a potential problem in the current reform movement. Recently, I have talked to both doctors and nurses who were troubled by the new emphasis on “productivity” in organizations where they work.  How many patients have you seen today? As Berwick put it in 2005, “We’ve got to support the underlying culture and the underlying system that makes healing, not scoring, the objective.” Today, he added, “we need to stop paying for through-put.” (At the same time, he recognizes that primary care physicians must be paid more. Anyone concerned on that score should listen to the first clip from the film below)

When I was writing Money-Driven Medicine, I discussed the issue of “pay-for-performance” (which is quite different from paying an organization for good outcomes) with former Medicare director Bruce Vladeck: “Quality and improvement strategies need to focus on reinforcing the norms and values of professional responsibility rather than on undermining them through the exercise of economic muscle,” Vladeck said. “Unless we can continue to assume that most providers and administrators want to do the right thing for most patients most of the time,” he added, “we are all sunk and no amount of economic incentives can salvage the situation.”

Tapping into that underlying professionalism, Berwick has said, is “like drilling for oil. There is so much pent-up need in the health care work force that, even without financial incentives for individuals, health care workers are eager to make a change.”

To some, Berwick may sound out of touch. Over the past twenty years, the notion that pride in a job well done drives excellence has been dismissed as simply sentimental. People are motivated, we are told, by money. We’re all rats on a wheel, looking for the cheese. That’s what makes people “tick” Dr. Robert Galvin, director of Global Health at General Electric, told Berwick in that 2005 Health Affairsinterview. If we want a CEO to perform, a seven-figure salary is not enough. We must give him stock options. In this context, Berwick may sound naive.  But when I was writing Money-Driven Medicine, I didn’t find anyone in the health care industry who wanted to call him that. The sheer authenticity of his presence commands tremendous respect.

“The Enemy is Disease”

Meanwhile, Berwick understands the role that money plays in our highly-competitive for-profit system all too well.

At one of IHI’s National Forums, Berwick recalled phoning a hospital in Houston to learn about its reportedly successful innovations in pneumonia care. He was told that “the gains are enormous but the methods cannot be reported to the public—excellent pneumonia care offered the hospital local competitive advantage.”

He was stunned. “The enemy is disease,” he told his audience. The competition that matters is against disease, not one another. The purpose is healing.” Yet “in the storm of the health care crisis,” Berwick acknowledged “it is so easy to forget why we trouble ourselves in the first place. It is so easy—frighteningly easy—to become trapped in the sterile thesis  . . . that our true, deep purpose is to gain and preserve market share in a vacant terrain of others whose purpose is precisely the same.”  In other words, it is so easy to forget the patients.

In part 2 of this profile, I’ll talk about what Berwick has to say about fragmentation–and variations in care in different parts of the country. Why can’t the Kaiser Permanente model work everywhere. What does he mean when he says that we haven’t even tried “transparency”? What will Medicare ask of U.S. hospitals? Just how much waste does the think there is in the system? How quickly can Medicare move to eliminate that waste?

Maggie Mahar is an award winning journalist and author. A frequent contributor to THCB, her work has appeared in the New York Times, Barron’s and Institutional Investor. She is the author of “Money-Driven Medicine: The Real Reason Why Healthcare Costs So Much,” an examination of the economic forces driving the health care system. A fellow at the Century Foundation, Maggie is also the author the increasingly influential HealthBeat blog, one of our favorite health care reads, where this piece first appeared.

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79 Responses for “Who Is Don Berwick (and Why Is He Following Me?)”

  1. maggiemahar says:

    Jeff, Bev M.D. ,Gregg, Margalit,Everyone–on the various shapes that ACO’s can take, fee-for-service, Medicare payments and for-profit hospitals.
    Jeff–
    Political views shape our views of the economy. In recent years, honest economists have been acknowledging this fact. (Krugman, et. al.)
    Moreover, this is not a bad thing. Our politics are all tied up with our values. Conservatives tend to put a high priority on invdividual freedom and growth of capital. Liberals tend to make equality a top priority.. In recent years, progressives also have become increasingly skeptical about “growth for the sake of growth.” (It leads to overbuilding and concentration of capital among the wealthy, which encourages speculation and bubbles)
    Jeff– recently, on this blog, you argued against the Medicaid expansion, saying that we can’t afford it. I disagreed. The people who will now be included in Medicaid need that care–even if it means raising state income taxes on the wealthy (individual earning over $200,00; couples earning over $250,000)–or perhaps taxing unearned income over $200,000 and $250,000. The alternative is more federal help to the states (which is, in fact, part of the legislation.) But these people need health care. From a liberal perspective, this is a moral imperative. (And I’m sorry if it makes you uncomfortable, but I think it’s perfectly okay to talk about right and wrong.)
    Our different positions on expanding Medicaid reflect political differences.
    On Berwick: as Bev M.D. points out “Dr. Goldsmith’s comment [on Berwick] morphs from “doesn’t have the patience, discipline or experience to do the job” to “it’s not the highest and best use of this remarkable person.”
    Then you tell us you really don’t know him that well: “Don isn’t a a friend, merely someone I admire.”
    But you still feel free to suggest that he lacks “administrative skills” and you hope he’ll be able to learn them on the job. “The job does require a fair amount of ruthlessness, and foremost, administrative skills. Some people come to them naturally, or are quick learners. I hope that will prove the case with Don.” A tad condescending.
    Berwick has demonstrated his administrative skills while running IHI and overseeing IHI’s very large projects–not unlike the Medicare pilot projects that will be so important to Medicare reform.
    You say that you have “paid your dues.” That seems to me an odd phrase. It suggests that early in life, one tries to do good, and then “grows up” and tries to do well financially.
    When I began my career as an English professor, I didn’t feel I was “paying dues.” I loved my work then, as I do now. All of my life, I’ve either been a teacher or a writer–neither are particualrly lucrative careers, but money has never been what motivated me to work.
    Someone questioned my credibility , asking about my credentials to write about health care: Yes, I earned a Ph.D.in English lit and taught English at Yale. Then I became a financial journalist (20 years.) During that time I was an editor at the NYT, but spent most of my career as senior editor at Barron’s, writing about markets and social policy –Wall Street and Washington–mostly long cover stories.
    I covered many subjects, including healthcare, HMOs, managed care,(Ellwood, et. al.) for-profit hospitals (interviewed Rick Scott), nonprofit hospitals and their tax exemptions, Medicare, the FDA,Kessler, Genentech, TPA, AIDS, venture capital and medicine, Medicaid and state budgets, the Clinton administration (STiglitz, Laura Tyson,Robert Rubin) device-makers and Pharma.
    Once wrote a story about Pfizer: it was selling a heart device that was defective. Sometimes it broke, and when it did, the patient died. Pfizer knew this,but kept on selling it. I published the story Saturday; Sunday Pfizer’s stock stopped trading in London and Monday, it never opened in New York.
    By the time I left Barron’s in the late 1990s, I knew a lot about the ecnoomics of U.S. healthcare, the politics, the science (read a lot of medical journal articles) and the corruption.
    I then wrote a column about international markets and finance for Bloomberg for a couple of years. (I had covered int’l at Barron’s: Japan, Russia, China, Hong Kong, Iraq and Iran. Oil and the Gulf War.
    I then wrote two books.
    The first: “Bull! A History of the Boom & Bust– 1982-2003″ traced the boom, put it in the context of earlier booms, explained how an economy “hooked on growth” got into trouble, and why markets are only as rational and efficient as we are (not very.) Market solutions are rarely the best solutions. They are “too psychological” as Robert Rubin once told me.
    Warren Buffet recommended my book in Berkshire Hathaway’s annual report. (Jeff– If I’m an ideologue, I guess Warren is too.)
    Then I wrote: “Money-Driven Medicine: The Real REason Health Care Costs So Much.” Got a great review from Ezra Klein (another ideologue) and also well-reviewed in Health Affiars.
    Then Alex Gibey decided to make a movie based on the book. (I suppose Gibney is yet another ideologue who lectures people on “right and wrong”– See “Taxi to the Dark Side” and “Enron: The Smartest Guys in the Room.”
    Sorry to bore everyone with my resume, but I’m a bit tired of people on this blog saying “You have a PH.D. in English Lit” don’t you?-suggesting that this means I have no credibility as a health care writer.
    On ACO’s– Gregg has it exactly right– they will be configured in various ways– as physician groups, physicians and hospital, etc. What they will have in commmon is: an emphasis on collaboration rather than competition, payment is not likely to be fee-for-service.
    Margait– at this point we have quite a bit of evidence that outcomes are better and the cost is lower-when doctors are either on salary or paid a lump sum to keep patients well (capitated care). Fee-for-service drives unncessary treatment. It’s not conscious; doctors don’t set out ot overtreat. It’s simply what happens. We have than two decades of research on this.
    Everyone– Last summer IHI co-sponosred a conference with DArtmouth and a couple of other groups titled “How Do They Do That?” Berwick, Atul Gawande, Mark McClellan and Eliot Fisher were the main speakers.
    The conference focused on 10 communities around the country, that have managed to significantly reduce health care costs while either lifting or maintaining quality. (They had actually identified more than 10 communities that had done this–about 50 if I recall correctly–but chose 10 that were scattered in different parts of the country and illustrated different ways of achieving these goals)
    As the IHI website explains “the conference brought together teams from ten high-performing regions to explore openly the local, regional, and national factors ― including culture, financing, infrastructures, and more ― that underlie the mechanisms for delivering health care in their communities.
    “The goal for this meeting and subsequent efforts is to build awareness among the public and policy makers that successful models for achieving high-quality care at significantly reduced cost already exist in many regions and in many forms throughout America.” (see http://www.ihi.org– scroll down to Initiatives and you’ll find “How Do They”
    AT the conference, the people involved stressed the fact that physicaians, hospital administrators and leaders from within the community did this on their own–they didn’t hire and bring in health care consultants. Nor were they paid for the work. Berwick stresses how health care reform must be about entire communities–people within the community collaborating.
    The physicians and other involved were volunteering their time. As a result, they said, they felt that they “owned” the process, and this is why they co-operated so well in adapating to the changes– they had helped design the changes.
    What the communities had in common is that 1) almost all of them moved away from fee-for-service –in one city, they kept fee for services, but physicians agreed to “pool” their fees so that no one person could ratchet up his income by “doing more.” Secondly, they replaced competition with collaboration– hospitals volunarily sharing with each other, doctors and hospitals working together with one target in mind: what would be best for the patient?
    Hospital CEOs stopped thinking of themselves as revenue centers (how can I grow revenue) and began thinking of themselves as cost centers (how can I help bring down the total cost of care in this community?)
    Yes, this means that hospital revenues shrink.
    But in these communities, hospitals found that by being less wasteful, they could keep their doors open.
    The notion that Medicare underpays is a myth. A recent MedPac study of hospital payment shows that when brand-name hospitals don’t have to be efficient –because they have enough market clout to charge private insurers whatever they wish– they are not efficient.
    Private insurers wind up paying 115% to 125% of what it should cost to care for each patient. (And yes, Barry, this includes capital costs.)
    However, when hospitals don’t have a “marquee name” and are in a market where large insurers have quite a bit of clout, they are paid significantly less by private insurers–and manage to stay in the black. If they have to become efficient in order to survive, they do it. Fewer preventable readmissions. Fewer errors that lead to more treatments. Better communication and hand off’s among doctors. ETc. ETc.
    As for Medicare payments, the American Hospital Assocaition has said that Medicare pays about 97% of what it costs a hospital to take care of a patient, and that, in fact, most hospitals either break even or make a profit on their Medicare patients. It’s a relatively small number of “outlier” Medicare patieints who cost hospials money. Sometimes this is the hosptial’s fault– the patient becomes the victim of hospital error and windds up spending more time in the hospital. Sometimes it’s just that the case turns sour, the patient becomes sicker– often no one is sure why.
    MedPac (the Medicare Payment Advisory Commission) has done several years of long, detailed reports on these problems. The Bush administration ignored them. But White House budget advisor Peter Orszag and his medical adviser, Zeke Emanuel have read them — thousands of pages (as I have, and I imagine Jeff has too.) They are excellent and lay out a blueprint for the pilot projects that Medicare will be starting and expanding.
    Medicare doesn’t need to pay hospitals more. But it does need to change the way it pays hospitals–creating incentives for patient safety, and efficiency.
    Don Berwick has suggested that rather than rewarding hospitals for overtreatment, we should pay them for empty beds–rather like paying utility companies more for nano-watts in communities where energy use goes down (thanks to education by the utility.) See my most recent post on Gawande and Berwick on this idea (www.healthbeatblog.org)
    MedPac and Medicare are also very concerned about doctors and hospitals collaborating. The new legislation talks specifically about “bundling” payments to doctors and hospitals for an episode of care. (This is what Geisinger does) This would be voluntary, but if a hospital and doctors who work for the hospital or send patients to the hosopital choose to accept bundled payment, the bundle would come with a bonus–if outcomes are good and costs relatively low when compared to benchmarks (very efficient hospitals that provide high quality care.)
    On for-profit hospitals– thanks to my experience at Barron’s I know quite a bit about stocks.
    For-profit hospitals have taken investors on a roller-coaster ride– boom and bust cycles. And, unfortuately, too often, they cook their books. I’m told that HCA is getting into trouble again. . .
    As always, sorry this is so long, but this thread did raise a number of important topics.
    Thanks for commenting
    P.S. Regarding John Podesta, Matt Yglesias and The Century Fund. A troll has been following me around the blogosphere making these accusations. I’ve never met Mat. I’ve barely met Podesta. And TCF does not tell me what to write or think.

  2. Wow! I feel like I’m back at the UCLA School of Public Health with two titans in the industry (both of whom I admire and respect) have their day in health wonk ‘moot court’! This is beyond educational! Diggin’ the energies!!

  3. Jeff Goldsmith says:

    Let’s see how few words I can use to say this (without triggering another rhetorical avalanche):
    1) just because you can run a $27 million foundation and are a world thought leader in healthcare quality does not mean you can run an $800 billion federal agency whose mandate has just been, what, tripled by health reform. it’s not the highest and best use of a really valuable person.
    2) it’s time for everyone who uses this space (and Maggie is by no means the worst offender) to stop casting aspersions on peoples’ character or values because they disagree with their politics. enough.

  4. Alan P. says:

    First Maggie called me misinformed, then she called me a troll. The points I made on the distortions of incentive compensation were long ago stated by the world’s foremost quality guru.
    I’ll chalk up our differences to foundational management theory and experiences. Having worked on both the nonprofit and for-profit hospital side, I’m aware of the problems with both. However, I found for-profits more obsessed with money. HCA will go public for the fourth time in several decades. This will be a joyous, champagne toasting affair.
    I am looking forward to Dr. Berwick’s Senate hearing, especially in front of Chuck Grassley. He’s pushed the FAH line for years, nonprofit community hospitals have an unfair advantage as they don’t pay taxes.
    Chuck got his way in PPACA. Nonprofit community hospitals are now “private tax exempt facilities.” Enough to chill your heart.

  5. Well, well, well…. if we’re back in college, let me impersonate the nerdy kid in the front row who keeps asking “why” and having taught in college, I know exactly how the lecturer feels about him…
    First, I’m not too certain about capitation working so well… Salaried physicians are what we keep comparing to, but unless we plan on turning our delivery system inside out, that’s not going to happen.
    Yes, fee for service is not working very well, so I am asking about fee for time. Change the CPT system. There is a big difference. And fee for time is not the same as salary.
    Second, I am not sure why we insist on putting hospitals in charge of what physicians are paid. By all accounts here, hospitals are as bad as private insurers when it comes to profiteering from our health care resources.
    If there is one group in the system that I would be inclined to trust to look after the patient’s best interests it is the Primary Care Physician. Yes, there are exceptions, but by and large, PCP’s are the least motivated by money. And I thought that studies also show that powerful primary care can and does reduce costs. Where is the alignment here?
    I may be mistaken again, but the #1 issue we have is cutting costs, not improving quality. As our Republican friends point out frequently, we know how to provide excellent care. The #2 issue is to provide this excellent care to everybody, which of course ties back with #1.
    So if those ACOs are there to cut costs and if they are managed largely by hospitals and if most physicians remain independent, how are ACOs different than HMOs?

  6. Alan P. says:

    Margalit, your question “how are ACO’s different than HMO’s” is a good one. That remains to be seen.
    Strategic planning sessions will buzz focusing on that very issue. What do we need to look like as an ACO? Who do we partner with? Who do we buy? What competencies do we contract?
    The 90′s drove massive vertical integration, only some of which came apart the last few years. ACO’s will drive the next round.
    Should physicians not get their act together, others will design ACO’s with doctors in a subsidiary role. That includes shadow bankers, seeking large returns on their corporate health care investments. The Carlyle Group owns MultiPlan, a huge PPO. I wonder what’s going on in their strategic situation room? What role will they give physicians in any new models?

  7. Alan P. says:

    “containment of healthcare costs has become the nation’s imperative”
    http://www.modernhealthcare.com/article/20100318/NEWS/303189989/1153#
    Rest assured shadow bankers are making plans.

  8. Joseph Stevens, MD says:

    Maggy Mahar is flat out wrong about Rerwick’s compensation. Can you read?
    On page 34 of IHI’s Form 990, it reports Berwick’s compensation on the W2 as….dom de dom!!!! guess___
    $2,326,286.00 for 40 hours per week
    Not bad for a guy who wrote the report that his profitable non profit has used to further its business.

  9. Alan P. says:

    I checked IHI’s 990 filed in March 2009 and Berwick’s salary and deferred compensation, while handsome, was nowhere close to the number you posted, Dr. Stevens. When was the 990 you cited submitted to the IRS?
    While I might get into spitting contests with other bloggers, I draw the line at posting employment salaries.

  10. bev M.D. says:

    Dr. Stevens;
    I don’t really see your point about Dr. Berwick’s pay, since he will be taking a substantial pay cut to take this job, no matter whose current $$ ## you pick. So who cares? And who cares exactly what number precedes the comma in the xxx,000 patients harmed by medical errors, either. One doesn’t need external numbers for this one,only their own eyes and ears when encountering the medical system. I worked in it for 30 years and have been a patient/patient’s relative in it for an additional 5 and believe me, the errors are rampant. I know you know that, unless you practice in remote Alaska, never make a mistake, and never go near a hospital in your practice.
    In other words, cut the nitpicking. What is your real problem with Dr Berwick?
    As for Dr. Goldsmith and the insults, hahaha!! One has to have a thick skin to interact with this blog. The rewarding thing is to watch some people like Nate gradually come around, and to ignore the real loonies.

  11. Joseph Stevens, MD says:

    Pardon me. Page 36 of the Form 990 for 2008 states that compensation for Donald Berwick, MD MPP FRCP President/CEO a 40 hour per week schedule is $2,326,386.00
    Omitted earlier is additional compensation: $30,066.00
    I do not believe that the 2009 Form 990 is available. If it is, please post it.
    Believe you me, he does not need worry about a pay cut.
    Certainly, he is honorable and gave out worthy certificates to the hospitals that paid to join the safety club. Exactly what has been accomplished other than a feel good state that the call of his IOM has been addressed.

  12. Alan P. says:

    The 990 I found has only 35 pages with Dr. Berwick’s compensation on page 21. I could not find your number anywhere on the filed report. The 990 was filed with the IRS on 3-13-09.

  13. Private Citizen says:

    Some of you guys sound Cheap and Jealous. The very same people who cry that CEO should be able to rake in huge bonuses will turn around and complain that Dr.Berwick is cutting a paycut because he made money previously. Even my 5 yr old acts more reasonably. What is the problem? That he made money or that he is taking a pay cut for this job? I know our local hospitals are addressing more patient concerns than before and my nurse friends tell me that they get more training of fall prevention, hand washing etc. HEALTH CARE WORKERS WASH HANDS LESS THAN 50% of the time, does that kind of stuff need to be addressed, they do need pressure for these things to happen. Unfortunately you can make a kidergartner to wash hands after restroom use but much harder to get healthcare workers wash hands after each patient.

  14. Joseph Stevens, MD says:

    Just the facts, nothing but the facts. The IOM report garnered headlines but used flawed methodology, was roundly criticized, and if it was not the IOM’s work, would have been ignored.
    Sure there are mistakes and deaths but the number was exaggerated by the IOM study enabling the invasion of medical care by industries and do gooder charlatans and pretenders who proclaim having the solution. Should a hospital pay thousands to companies like IHI to tell health care professionals to wash their hands and put on gowns to prevent the spread of infection??
    Or would a better deployment of funds involve hiring extra janitors to keep the c diff poop cleaned from the floors?

  15. bev M.D. says:

    Well guess what; doctors have the worst record on washing hands and putting on gowns; in fact they have the worst record on all hospital policies because they don’t believe rules apply to them. So yeah – they do need somebody with an M.D. to tell them, sad to say.

  16. maggiemahar says:

    Jeff, Bev MD,Alan Private Citizen
    Jeff– Liberals see equality as a top priority– they value individual liberties, but tend to put equality first.
    Conservatives, on the other hand, emphasize the right of the individual,including an individual’s right to amass as much wealth as possible, and keep it, to hand down to his heirs, without being forced to share it with others in the society.
    I don’t think I’m “casting aspersions” on anyone’s character by saying this. Obviously I think the liberal point of view is fairer, but many people would disagree with me.
    I’m just saying that we should all own up to the fact that our values and politics shape our views about the economy and public policy. And just as I am willing to acknowledge my priorities, conservatives should acknowledge their priorities.
    And none of us should pretend that our analysis of policy or economics is value free (or not influenced by our politics and values.)
    Finally, “Ideologue” and “ideological” are words people use to characterize politics that they disagree with. In truth, the word “ideology” simply refers to a set of beliefs.
    But “ideology” began to mean “a set of Untrue and Rigid beliefs” during the McCarthy era, in the 1950s, when McCArthy attacked liberals who he viewed as communists..
    Liberals were portrayed as “ideologues” who believed in socialism or Communism–which were “ideologies.” Capitalism, on the other hand, was presented as a set of beliefs that are simply True. (Rather like the teachings of the Catholic Church.) Therefore, capitalism couldn’t be an “ideology” and those who believed in American-style capitalism could not be considered “ideologues.”
    To this day, some people continue to use “ideologue” and “ideology” as McCarthy did– as a smear, while denying that their own arguments are influenced by their values and politics.
    Bev– Yes, Berwick is taking a pay cut to go to Medicare. And, as you suggest, the brouhaha about what he earns is beside the point.
    Alan- Didn’t call you a troll. Merely said that you are repeating very peculiar allegations that a troll has been circulating in the blogoshpere
    Private Citizen– Yes, people are beginning to focus more on patient safety (washing hands, etc.) Reform is happening on the ground. This is important.
    Thank you for focusing the discussion on what matters: patients.
    T

  17. Alan P. says:

    When I posted THA CEO Dr. Dan Stultz’s comment I didn’t imply any stench. I once worked for him and found his assessment spot on. Our estate backed health system was going for-profit in 2006. With its resources, it should have been one of the last to change stripes. (The merger with Triad later failed).
    SEIU President Andy Stern called employer sponsored health insurance dead and not coming back in 2007. Who knew a health care worker union would be one of the first to cave?
    There are many unspoken themes embedded in health reform and they have nothing to do with Red or Blue talking points. A seismic shift is underway from employers to individuals and a tapped out Uncle Sam. While many cheer this move, few are creating graphs.
    More people had employer coverage in 1998 (168.5 million) than CBO projects in 2019 (162 million). That’s with over 50 million in additional population.

  18. Nate says:

    “Liberals see equality as a top priority”
    Do you actually believe this crap when you type it Maggie? Or more importatnly does anyone actually fall for this?
    Why does a liberal living in NY, MA, NJ, or any other liberal state with high taxes pay less in federal income tax then me even if we make the same amount?
    Why did liberal counties get twice as many ear marks as conservative counties?
    Why does 40% of the population pay no federal tax?
    Why did union debt holders get their claims placed ahead of those before them under existing law?
    Why did healthcare reform just grant 10 billion to unions to sure up their health plans they underfunded so they could contribute to political campaigns instead?
    Why is it illegal to discriminate against any race but whites?
    Why do young people subsidize older people for healthinsurance but when the risk is flipped like on auto insurance they are on their own?
    No single piece of liberal ideology is about equality, your entire belief structure is about placing the needs of a few above the effort of the rest.

  19. Alan P. says:

    More on those plan making shadow bankers. From FT:
    So, apart from secondary buy-outs, where will the private equity deals of the future come from? Bain’s report identified four promising areas for new investments: energy, healthcare, the Asia-Pacific region and distressed investing.
    http://www.ft.com/cms/s/0/687e7496-308e-11df-a24b-00144feabdc0.html

  20. Alan P. says:

    The Carlyle Group’s David Rubenstein expects health reform to produce 30% annual returns for his private equity underwriter (PEU):
    http://peureport.blogspot.com/2010/04/30-annual-returns-still-target-for-peu.html

  21. Alan P. says:

    Carlyle hired an ex-Wyeth CEO as Senior Adviser:
    “We see a range of opportunities in the U.S. and globally for private capital to help strengthen and improve the efficiency and effectiveness of the healthcare sector,” Essner said in a statement.
    Essner’s hire comes in the backdrop of private equity firms looking to recruit industry veterans to manage their portfolios.
    On Wednesday, former Procter & Gamble Co (PG.N) Chief Executive A.G. Lafley joined private equity firm Clayton, Dubilier & Rice as a special partner.
    http://www.reuters.com/article/idUSSGE6370FV20100408

  22. Alan P. says:

    KKR plans to double its money on HCA. That’s after milking the company via dividend distributions in the interim.
    http://www.reuters.com/article/idUSN0925156020100409
    Someone has a profitable business model, which will increase costs.
    Taking HCA private added over $1 billion in annual interest expense. How much will new shareholders expect in dividends? Wait for the prospectus.

  23. Alan P. says:

    PEU Cerberus agreed on March 25 to buy Caritas Christi Health Care, a hospital operator affiliated with the Archdiocese of Boston, in a private-equity deal valued at $830 million.
    Caritas hospitals are nonprofit community hospitals according to Guidestar. They will convert to for-profit facilities under Cerberus ownership. Besides adding debt to finance the deal, these hospitals will now be taxable. If they’re like Triad or HCA, expect interest expense to put a hurt on profits for a year or two.
    Just as Cerberus ran Chrysler into the ground, they can do likewise for health care.
    While Maggie makes inane comments about the for-profit model, a Catholic system sold out, changing stripes.

  24. Alan P. says:

    Berwick’s #2 has an interesting history as head of Virginia’s Health & Human Services.
    http://peureport.blogspot.com/2010/04/marilyn-tavenner-2-at-center-for.html

  25. Alan P. says:

    Mass AG Martha Coakley gave Caritas Christi health system a hard time before the Catholics cut a deal with hell hound Cerberus Capital Management. For the backstory:
    http://stateofthedivision.blogspot.com/2010/04/curious-case-of-caritas-christis.html

  26. Alan P. says:

    Don Berwick called pay for performance a “toxic daisy chain” and a blunt instrument.
    Listen to the horse’s mouth:
    http://www.ihi.org/IHI/Programs/IHIOpenSchool/On+Call+Does+Pay+for+Performance+Work.htm?player=wmp

  27. cgs says:

    He does not advocate a government takeover? Have you listened to his speech 2008 in the UK, he absolutely thinks we should have nationalized healthcare. And we should redistribute the wealth, a true marxist.

  28. Don says:

    I am a mere layperson, a disabled American who is forced to rely on Medicare and to be honest, this man as head of CMS scares the you know what out of me.
    He said the following in a speech in 2009:
    Any health care funding plan that is just equitable civilized and humane must, must redistribute wealth from the richer among us to the poorer and the less fortunate. Excellent healthcare is by definition redistributional.
    -and-
    NICE is extremely effective and a conscientious, valuable, and — importantly — knowledge-building system [which has] developed very good and very disciplined, scientifically grounded, policy-connected models for the evaluation of medical treatments from which we ought to learn.
    -and-
    I am romantic about the NHS; I love it. All I need to do to rediscover the romance is to look at health care in my own country.
    Source
    I have read about enough of the horror stories of government run health care and the rationing that goes along with it to be very afraid of someone with this mentality to be in charge of my healthcare.
    He may have improved the quality of health providers within our healthcare industry, but that doesn’t mean he is a good choice to run our healthcare industry.

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