As you might be able to determine from reading my entries regarding the new health reform law,  I am excited about the possibilities and am looking forward to seeing how the regulations are written that implement the law. There are many agencies who will have a hand in regulation, but none more important than CMS. This agency sets the tempo and tone for the entire health care enterprise in this country. They dictate payment rules for Medicare. They dictate eligibility requirements for Medicaid. They set rules regarding the training of resident physicians. In short, although we may have believed we have a “market-based” health care system, in reality I worked in a system whose rules were dictated by some faceless bureaucrat that ran the Center for Medicare and Medicaid Services. This has been brought home to me at intervals when I am told that I have to turn my training program upside down to satisfy “CMS.”

This is why I am very excited about the news that Don Berwick will be named to head up CMS. I have been a huge fan of his organization, the Institute for Health Care Improvement, for the last 10 years. I first became aware of this organization when I decided that there must be a better way to see patients in a primary care setting than the way we were doing it. I began looking for others who believed in primary care and ran across IHI and their “Idealized design of Clinical Office Practice” project. Although we were unable to participate in these programs, I eagerly read about their efforts to incorporate:

  • Access: Care is available when patients want and need it. 
  • Interaction: Every patient is the only patient.
  • Reliability: “All and only” effective and helpful care is given.
  • Vitality: The practice is sustainable and continually innovating.

into clinical practice and we have been striving to make our changes in our clinical practice leading to enhanced care as a consequence. Much of the work of the Patient Centered Primary Care Collaborative is built on IDCOP principles.

Don Berwick’s organization has as its goals:

 No needless deaths
 No needless pain or suffering
 No helplessness in those served or serving
 No unwanted waiting
 No waste
 No one left out

and the strategy to accomplish this is to build will and optimism for change, drive broad scale adoption of sound changes, invent new solutions, build the future healthcare workforce, and to stay vital for the long haul by achieving excellence in loyalty, financial stability, and worklife for IHI.
Although I doubt he knows who I am, my interactions with Don have been rewarding and we practice better medicine because of my interactions with him and his organization. I look forward to watching him (should he be confirmed) change the culture at CMS. These are interesting times…
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