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DJP Update 7-9-2010 late edition – 2nd Update of today; this for breaking news: Death of Dr. Daniel Cloud, former AMA President; Special message from AMA Board Chair re Dr. Berwick

DJP Update 7-9-2010 late edition – 2nd Update of today; this for breaking news: Death of Dr. Daniel Cloud, former AMA President; Special message from AMA Board Chair re Dr. Berwick

DJP Comment: I just got this information, minutes after sending DJP Update 7-9-2010 a few minutes ago.

First, the wonderful Dr. Dan Cloud has died. He was AMA President 1981-82 and was an excellent caring doctor who was kind to all. I knew of him by reputation but then I met him one day in coffee shop of Hilton in Chicago after AMA meeting ended. I told him hello and he invited me to sit with him. He was a great storyteller and always helpful to me. He also wrote a terrific suspense thriller, “The Aesculapian” that dealt with the AMA. Amazon has some copies at http://www.amazon.com/Aesculapian-Dan-Cloud/dp/0913720984

It should have been a best-seller. I encourage you to read it. He will be missed. Robin and I send our sincerest condolences to his family.

Second: I am passing on to you the information I just received from AMA Board Chair about Dr. Berwick and AMA’s support. No further comment by me except to say I don’t recall the 3 person candidate committee during my 9 years on the board. Maybe I need the memory medicine being developed in the NIH tweet I sent a few minutes ago. Regardless of what your view is about the person nominated, it is NOT a good procedure for 3 people to make such decisions as the decisions reflect on the entire AMA. The Board of Trustees has that responsibility for decisions that put AMA on record for such important considerations. Just my opinion!

NOW THE AMA MESSAGE and all of the article quotes are sent by AMA:

A Message from Dr Ardis Hoven, Chair, AMA Board of Trustees on the Berwick Appointment

We want to take this opportunity to address questions and criticism of the decision by the AMA leadership to support the nomination of Dr. Donald Berwick as CMS Administrator.

History

The AMA’s support for Dr. Berwick as CMS Administrator is based on our work with him in his role as the CEO of the Institute for Healthcare Improvement, an award winning partnership with physicians and hospitals to improve quality and patient safety. We announced our support for Dr. Berwick in a press release on April 19, 2010 and it was reported by AM News as well as other media outlets.

CMS has been directed by an Acting Administrator since 2006.

AMA Process For Supporting Candidates for Federal Appointments

For at least two decades, decisions regarding AMA support candidates for federal appointments have been made by the Candidate Selection Committee comprised of the AMA Chair, Chair-elect and AMA President. The full AMA Board does not vote on these matters.

Controversial Statements Made by Dr. Berwick

AMA support for Dr. Berwick is based on our direct involvement with him on quality improvement and patient safety initiatives. Over the years, Dr Berwick has made a number of controversial statements regarding the British health care system, single payer and other issues. The AMA remains a strong opponent of a single payer approach and we do not agree with some other views expressed by Dr. Berwick. That said, we believe Dr Berwick has the leadership track record and expertise to direct CMS activities. A broader perspective on Dr Berwick is provided in the article below developed by the Kaiser Health News.

Whatever Dr Berwick’s personal views may be on policy issues, he cannot operate outside the authority prescribed by Congress.

Recess Appointment

The decision to utilize the authority for a recess appointment is a reflection of the Washington political environment. We do not have control or standing of process issues determined by government leaders. Like others, we believe the committee hearing process and full Senate debate is the preferred course of action. We are also cognizant that Senate rules allow a unified minority to block action by lining up 41 votes to oppose a cloture motion.

The recess appointment authority has been used extensively by President of both parties. President George W. Bush used recess appointment authority 171 times and President Clinton employed this option for 139 appointments.

Medicine’s Agenda

Dr Berwick is legally authorized to serve as CMS Administrator through December, 2011. There is a long list of important regulatory and implementation decisions that need to be made by the CMS Administrator as a result of the health system reform law enacted in March. We believe physicians and patients will be best served by focusing on securing the desired outcome on pending policy matters such as repealing the flawed Medicare payment formula and implementation of the new health reform statute rather than dwelling on a matter that has been decided through established legal authority.

From the Kaiser Health News

Dr. Donald Berwick – A Resource Guide

Jul 08, 2010

President Barack Obama appointed Dr. Donald Berwick head of the Centers for Medicare and Medicaid Services Wednesday. Berwick, known as a passionate advocate for improving the health care system, was nominated earlier this year but his nomination turned out to be controversial. Some Republicans accuse him of favoring health care rationing — a charge Democrats dismiss as nonsense. To shed light on Dr. Berwick, and the controversy surrounding him, KHN’s Allison Fero assembled this resource guide.

Background | In His Own Words | Summaries of News Coverage

Who Is Donald Berwick?

Berwick is currently President and CEO of the Institute for Healthcare Improvement.

An edited excerpt of his biography, from the IHI website:

Donald M. Berwick, MD, MPP, FRCP, is also Clinical Professor of Pediatrics and Health Care Policy at the Harvard Medical School, and Professor in the Department of Health Policy and Management at the Harvard School of Public Health. Dr. Berwick has served as vice chair of the US Preventive Services Task Force, the first “Independent Member” of the Board of Trustees of the American Hospital Association, and chair of the National Advisory Council of the Agency for Healthcare Research and Quality.

He is a recipient of numerous awards, including … the 2002 American Hospital Association’s Award of Honor … the 2007 William B. Graham Prize for Health Services Research, and the 2007 Heinz Award for Public Policy from the Heinz Family Foundation. In 2005, he was appointed “Honorary Knight Commander of the British Empire” by the Queen of England in honor of his work with the British National Health Service. Dr. Berwick is author of numerous articles and the books Curing Health Care and Escape Fire.

Media Profiles

Who Runs Gov : “Berwick is famous in the health-care system for advocating its destruction. An academic who has spent his career looking for ways to deliver care more efficiently and effectively, Berwick has been called a “revolutionary.” He believes the structure of the health-care system encourages good people to make harmful medical errors and waste millions of dollars. If he could, he’d blow the whole thing up and start over.”

CBS Evening News : “Two years ago, he launched the 100,000 Lives Campaign. That’s the number of lives he hoped to save by getting hospitals to have standard operating procedures for the way they care for patients.

Enlarge Video

This includes hooking up a ventilator properly to eliminate the risk of pneumonia and ensuring that a patient’s medication is monitored from the ICU to the hospital room to home.”

Berwick says even something as simple as uniform hand-washing requirements would cut hospital infections in half” (Feb. 2007).

The Boston Globe : “Berwick gets irritated when health care leaders complain about a lack of resources. There’s too much money in the system already, he says. His critique takes aim at the medical profession’s exalted view of itself. He’s convinced that the fundamentals of the current system — the same fundamentals Boston used to build its reputation as the world’s medical leader — are so screwed up that it is no longer possible for the medical profession to provide reliable, high-quality care, no matter how many innovations its renowned doctors roll out, no matter how many awards they rack up.” (Jan. 4, 2004).

NPR : “Berwick has built the Institute for Healthcare Improvement into a considerable force for change. … Berwick’s institute has been working on reforms with thousands of doctors offices and hospitals around the country and the world” (July 16, 2002).

In His Own Words

Excerpts of Berwick’s speeches or writings, with links to the entire article or video.

Kaiser Health News, Checking In With Dr. Donald Berwick

Enlarge Video

“Hospitals and health care systems are making phenomenal strides in quality and my optimism is very high. But the structures are still broken. We have fragmented payment systems and fragmented institutional boundaries. The enemy is fragmentation. We just don’t seem to form into the coalitions, the communities we need to make progress. Until we fix structures and finance it is going to be very hard to make fast progress” (Nov. 12, 2009)

New York Times Editorial, 10 Steps to Better Health Care

“There is a lot of troubling rhetoric being thrown around in the health care debate. But we don’t need to be trapped between charges that reforms will ration care and doing nothing about costs and coverage. We must instead look at the communities that are already redesigning American health care for the better, and pursue ways for the nation to follow their lead” (Berwick was one of four authors, Aug. 12, 2009).

Institute for Healthcare Improvement Video, Defining Quality: Aiming for a Better Health Care System

“If you’re buying a car, there are dimensions of quality: safety, fuel efficiency, comfort, fun in driving, durability and so on. We’re used to that. But what are the dimensions of ‘goodness’ in health care?” (Oct. 2008).

Speech To Britain’s National Health Service KHN Transcript of Speech Excerpts

“Here, in the NHS, you have historically put primary care – general practice – where it belongs: at the forefront. The NHS is a bridge, it’s a towering bridge, between the rhetoric of justice, and the fact of justice. No one in their right mind could expect that to be easy. … You could have protected the wealthy and the well, instead of recognizing that sick people tend to be poorer and that poor people tend to be sicker, and that 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 less fortunate. Excellent healthcare is by definition redistribution. Britain, you chose well. … Is the NHS perfect? Far from it, far from it. I know that as well as anyone in this room. From the front line to Whitehall, I have had the privilege to observe its performance and even to help to measure its performance. … [but] the NHS has more evidence-based care, lower mortality rates for some major disease groups (especially cardiovascular diseases), you have lower waiting times for hospital, outpatient, and cancer care now, more staff and technologies are available, you have in many places better community-based mental health care, and you are starting to see falling rates of hospital infection” (July 1, 2008). NHS video of speech excerpts.

The Journal of the American Medical Association, The Science of Improvement

“Academic medicine has a major opportunity to support the redesign of health care systems; it ought to bear part of the burden for accelerating the pace, confidence, and pervasiveness of that change. Health care researchers who believe that their main role is to ride the brakes on change—to weigh evidence with impoverished tools, ill-fit for use—are not being as helpful as they need to be. ‘Where is the randomized trial?’ is, for many purposes, the right question, but for many others it is the wrong question, a myopic one. A better one is broader: ‘What is everyone learning?’ Asking the question that way will help clinicians and researchers see further in navigating toward improvement.” (Mar. 12, 2008).

Boston Globe Editorial, Dirty Words In Healthcare

“Managed healthcare was a great idea when it first emerged, before the term got hijacked by insurance companies that claimed to manage care but in many cases only managed money. … The innovations that managed care and capitation made possible were good for almost everyone. … Thousands of people avoided needless hospital visits; they got more appropriate, less expensive, better coordinated care in office settings” (Feb. 27, 2008).

British Medical Journal (via the U.S. National Institutes of Health), Steadying The NHS

“We believe, and refuse to be dissuaded, that the National Health Service, with its moral intent, commitment to equity, and store of knowledge, has the inherent capability to become the greatest healthcare system of any nation. Yet, lately, it seems like a boxer on the ropes, not the champion it should be…. The NHS is not just a national treasure; it is a global treasure. As unabashed fans, we urge a dialogue on possible forms of stabilisation to better provide the NHS with the time, space, and constancy of purpose to realise its enormous promise” (July 10, 2006).

Newsweek Editorial, Keys to Safer Hospitals

“Here’s the problem. Instead of helping me, health care might kill me. In 1999, the Institute of Medicine shocked the nation with an authoritative report on hospital errors. The report concluded that up to 98,000 Americans each year die in hospitals, not from the diseases that brought them there but from injuries caused by their medical care. … We have identified six basic measures that could save as many as 100,000 lives a year if even 2,000 hospitals adopted them. It’s surprising to learn that these standards aren’t already the norm–but the norms may finally be changing” (Dec. 12, 2005).

Health Affairs, ‘A Deficiency Of Will And Ambition’: A Conversation With Donald Berwick

“I have said before, and I’ll stand behind it, that the waste level in American medicine approaches 50 percent. It’s certainly in double digits, and this has to be absolutely pasted onto the quality agenda. There is no difference between quality and efficiency …. a lot of people make a lot of money on inefficiency—on production of things that have no value. So the minute you try to become truly efficient, you’re going to run into stakeholders who are going to tell you that you’re harming care, and the knee-jerk reactions of doctors and others will be to reinforce that idea” (Jan. 12, 2005).

The New England Journal of Medicine, Errors Today and Errors Tomorrow

“First, in local settings, our workforce largely remains blind to the enemy — patient injury. … The invisibility of injuries to patients makes them seem trivial or infrequent. Until we find ways to make errors and injuries routinely visible in local health care settings, the national will to improve safety will be hard to translate into local intent. Second, even when hospitals find ways to notice the injuries to their patients, their theories of cause often remain scientifically Neanderthal. They cling to unsound but deeply entrenched beliefs” (June 2003).

Health Affairs, A User’s Manual For The Institute of Medicine’s “Quality Chasm” Report

“The report therefore suggests to any careful reader that whether we wish to tackle the problem of quality as payers, regulators, executives, managers, or clinicians, we will improve health care as it needs to be improved, either all together or not at all” (May/June 2002).

Escape Fire: Lessons for the Future of Health Care

“This has been a tough year for my family, and especially for my wife, Ann, who last spring began developing symptoms of a rare and serious autoimmune spinal cord problem. … this has been the formative experience for me overall in the past year … The people work well, by and large, but the system often does not. Every hour of our care reminded me, and alerted Ann, about the enormous, costly, and painful gaps between what we got in our days of need, and what we needed. The experience did not actually surprise me, but it did shock me. Put in other terms, as a friend of mine said: Before this, I was concerned; now, I am radicalized” (First from a speech at the IHI National Forum, Dec. 9,1999; later part of a Commonwealth Fund book with same title). Watch the related video.

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End of this DJP Update late edition.

Stay well,

Donald

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