Is Berwick’s Term Near the End?
Without congressional approval, acting CMS chief’s term to expire at year-end
It appears Donald M. Berwick’s stay as acting chief of the Centers for Medicare and Medicaid Services (CMS) won’t last past this year.
The well-known (some might say controversial) healthcare quality and efficiency expert was installed by President Obama’s administration last July as a recess appointment while the Senate was away. The move bypassed Congress and nomination hearings that most likely would have turned into a heated debate over the then recently passed Affordable Care Act.
But the recess appointment allows Berwick to serve only to the end of 2011. In January, Obama renominated Berwick to remove "acting" from his title; however, no confirmation hearings have been held or are scheduled.
A White House spokesman, Reid Cherlin, said earlier this year the president would not withdraw the nomination. "The president nominated Don Berwick because he’s far and away the best person for the job, and he’s already doing stellar work at CMS."
Earlier this year, 42 Republican senators signed a letter to the White House urging Obama to withdraw the nomination. The letter says Berwick’s "past record of controversial statements and general lack of experience managing an organization as large and complex as CMS should disqualify him being confirmed as the CMS administrator."
Even if the 58 senators who did not sign the letter support the Berwick nomination, 60 votes are still needed for confirmation.
So, if there’s little chance of Berwick’s nomination succeeding, some have speculated the Obama administration may be looking for another appointee who could eventually be confirmed. Some Democrats are beginning to urge Obama to search for another appointee, and Marilyn B. Tavenner, Berwick’s principal deputy, apparently has emerged as a prime candidate. Tavenner, a former Virginia secretary of health and human resources with extensive management experience, could probably be confirmed, lawmakers from both parties said.
In quality circles, Berwick, the former head of the Institute for Healthcare Improvement and former ASQ member, is known as a strong advocate of patient-centered care. He has repeatedly challenged doctors and hospitals to provide better care at lower costs and has said the government and insurers can increase quality and efficiency of care by basing payments on the value of services rather than volume.
Berwick’s critics, many of whom also opposed the Affordable Care Act, believe his plans are too extreme and say he supports rationing healthcare and capping spending.
Berwick hasn’t been saying much to deflect the swirling speculation and continuing uncertainty about his future.
"The real answer right now is it is an amazing job," Berwick recently told Modern Healthcare. "Every day is exciting and I am committed to getting the work done day after day, and getting to work with colleagues like Rick [Gilfillan, acting director for Medicare and Medicaid Innovation] and the rest of the team is an absolute thrill."
Made his mark?
If Berwick does depart at the end of year, some say he will have already made a substantial imprint on the U.S. healthcare system by setting his people, philosophy and some actual policy in motion.
For instance, several CMS management positions have been filled with people who share Berwick’s philosophy. And, last month, the Obama administration finalized a new Medicare plan to reward hospitals that provide high-quality care, the first in a series of steps designed to fundamentally transform the way the federal government pays for healthcare.
The Medicare plan will pay more to institutions scoring well on measures that gauge patient care and less to those that don’t hit quality benchmarks.
"Achieving lower costs through better quality is the right way," Berwick said.
—Mark Edmund, associate editor
- "Berwick Nomination a Near Impossibility," Congressional Quarterly HealthBeat, March 10, 2011, http://asq.org/qualitynews/qnt/execute/displaySetup?newsID=10810.
- Coughlin, Brett, "Sources: Dems Giving Up on Berwick," Politico, March 4, 2011, www.politico.com/news/stories/0311/50698.html.
- Daly, Rich, "A Known Unknown: The Future of Berwick," Modern Healthcare, April 22, 2011.
- Dick, Margaret, "The Case Against (and for) Donald Berwick," HealthLeaders Media, March 16, 2011, www.healthleadersmedia.com/print/HEP-263783/The-Case-Against-and-for-Donald-Berwick.
- Ertelt, Steven, "Senate Democrats Abandon Obama Rationing Czar Donald Berwick," LifeNews.com, March 5, 2011, www.lifenews.com/2011/03/05/senate-democrats-abandon-obama-rationing-czar-donald-berwick/?pr=1.
- "New Medicare Plan Rewards Quality Hospitals," McClatchy Newspapers, May 2, 2011, http://asq.org/qualitynews/qnt/execute/displaySetup?newsID=11182.
- Pear, Robert, "Rising Calls to Replace Top Man at Medicare," The New York Times, March 7, 2011, www.nytimes.com/2011/03/08/health/policy/08medicare.html?pagewanted=print.
Survey: Focus on Quality Solutions to Help Healthcare Worker Shortage
Quality-based initiatives, such as healthcare IT systems and emergency room (ER) checklists, could help offset a projected shortage of healthcare workers in the United States, according to a recent ASQ survey.
A growing worker shortage could mean more fragmented and uncoordinated healthcare, according to the results of a recent online poll of 475 U.S. healthcare quality professionals. The U.S. Department of Health and Human Services recently predicted that after 2014—when about 32 million more people will be insured per the healthcare reform laws and as baby boomers reach Medicare age—the number of healthcare staffing shortages will rise.
"This trend is real and could have a negative impact on a patient’s experience as heavier demands are placed on the system," said Joe Fortuna, chair of ASQ’s Healthcare Division. "That’s why it is imperative that healthcare organizations focus on enhancing their ability to prevent errors, remove waste, and improve the clinical and operational quality of the services they provide."
Survey respondents said patients will face three main quality issues because of the staffing shortages: spotty care, longer waits for primary care physician appointments and medical errors. Additionally, respondents predicted shortages of nurses, nursing assistants and laboratory professionals.
To help prevent the effects of the healthcare workers shortage, respondents prioritized a number of solutions:
- Create fast-track units, which allow patients with less serious ailments to go through an ER more quickly, allowing ER staff to focus on urgent cases.
- Install and use healthcare IT systems.
- Put checklists into practice in hospital departments.
- Develop more care teams consisting of doctors, nurses, physician assistants and disease educators.
- Implement a program to boost productivity in which scribes trail doctors, taking detailed notes for a patient’s electronic health record (EHR).
The survey results also identified EHRs as the IT system that will have the greatest influence on reducing the impact of staffing shortages. Other useful IT methods include automated dose dispensing and clinical-decision support systems.
For more information about the survey, visit ASQ’s media room at www.asq.org/media-room/press-releases/2011/index.html.
Who’s Who in Q
NAME: Murali Audipudy.
RESIDENCE: Round Lake, IL.
EDUCATION: Master’s degree in project management from the Keller Graduate School of Management in Chicago.
CURRENT JOB: Quality engineer at Hospira, a medical device maker in Lake Forest, IL.
PREVIOUS EXPERIENCE: Audipudy has worked at two other multinational medical device manufacturers.
INTRODUCTION TO QUALITY: Back in the early 1990s, Audipudy read news articles about perceived poor quality of automobiles produced throughout the world. At the same time, he was taking classes on statistical process control and control charts. From that point on, he realized he wanted to work in the quality field to make a difference and found a job at a medical device manufacturing company.
ASQ ACTIVITIES: Regularly attends ASQ’s Northeastern Illinois Section meetings.
RECENT HONOR: Recognized as one of 11 ASQ members who hold 14 of 18 ASQ certifications.
PERSONAL: Married to Chaya and has two daughters, Megana and Priya.
FAVORITE WAY TO RELAX: Includes reading Juran’s Quality Control Handbook over and over again. "Whenever I read this book, I always learn something new," he said.
QUALITY QUOTE: Any company that embraces quality to its fullest extent will have quality as a gift that keeps on giving.
NEW ENTERPRISE MEMBERS Coca Cola and Turkish Airlines have become ASQ’s latest enterprise members, joining 39 other organizations at this membership level. Visit www.asq.org/membership/organizations/enterprise.html for more information about enterprise membership.
GSA EXTENDS PACT WITH ASQ ASQ’s contract with the U.S. General Services Administration (GSA) has been renewed through April 2016. The contract extension means ASQ will continue to provide discounted training—such as Six Sigma and lean—to federal government organizations and employees, as well as other authorized organizations and individuals. Visit http://asq.org/gsa for more information on which training products are eligible for GSA pricing and a detailed catalog of training resources available to federal agencies through ASQ’s Learning Institute.
NEW BOOK COVERS LSS IN PUBLIC SECTOR Lean Six Sigma for the Public Sector: Leveraging Continuous Process Improvement to Build Better Governments is now available from ASQ Quality Press. In the new book, author Brandon Cole addresses the challenges to applying lean Six Sigma tools in the public sector, providing project examples, lessons learned, and tips and tricks. The book’s introduction, index and table of contents are available at http://asq.org/quality-press/display-item/index.html?item=H1405&xvl=76103064.
A NEW CD-ROM from the International Organization for Standardization (ISO) contains more than 180 standards that provide the basis for the worldwide manufacture, trade and use of pulp and paper products. The offering is the latest in the series ISO Standards on CD-ROM. For more details, visit www.iso.org/iso/pressrelease.htm?refid=Ref1423.
A NEW ISO STANDARD has been released that will help to improve the quality of medical devices and encourage manufacturers to guarantee their products do not compromise patient safety. For more details about ISO 14155:2011—Clinical investigation of medical devices for human subjects—Good clinical practice, visit www.iso.org/iso/pressrelease.htm?refid=Ref1421.
FEBRUARY’S U.S. MANUFACTURING technology consumption of $329.43 million was down 10.9% from January’s total, according to the Association for Manufacturing Technology (AMT) and the American Machine Tool Distributors’ Association. But consumption was up 99.3% when compared with the $165.31 million reported for February 2010. For more information from the report, visit www.usmtc.com/news.aspx and click on "latest press release."
WORLD ACCREDITATION DAY, a global initiative to raise awareness of the importance of accreditation-related activities and the value they can bring to government, regulators and the business community, will be observed June 9. The initiative was established by the International Accreditation Forum and International Laboratory Accreditation Cooperation. For more details, visit www.anab.org/news/2011/04/june-9-is-world-accreditation-day-2011.aspx.
QP ONLINE ON PAPER
Quick Poll Results
Each month at www.qualityprogress.com, visitors can take an informal survey, and we post the results.
Here are the numbers from a recent Quick Poll:
"How does social responsibility factor into your organization’s business plan?"
- Already included. 66.6%
- In the process of integrating it. 16.6%
- Thinking about it but want to learn more. 16.6%
- We don’t plan on including it. 0%
Visit www.qualityprogress.com for the most recent poll question:
"What’s the best way to generate ideas and innovate?"
- Brainstorm across workgroups.
- Leave it to the R&D folks.
- Solicit customer feedback.
To celebrate ASQ’s 65th anniversary this year, each month QP spotlights classic content online. This month, download "Quality in the Driver’s Seat," a special section from QP’s April 1985 edition that includes interviews with the then-presidents of the Big Three automakers.
Word to the Wise
To educate newcomers and refresh practitioners and professionals, QP features a quality term and definition each month.
Wilcoxon Mann-Whitney test
Used to test the null hypothesis that two populations have identical distribution functions against the alternative hypothesis that the two distribution functions differ only with respect to location (median), if at all. It does not require the assumption that the differences between the two samples are normally distributed.
In many applications, it is used in place of the two sample t-test when the normality assumption is questionable. This test can also be applied when the observations in a sample of data are ranks, that is, ordinal data rather than direct measurements.
- "Quality Glossary," Quality Progress, June 2007, p. 59, http://asq.org/quality-progress/2007/06/quality-tools/quality-glossary.html.
DATE IN QUALITY HISTORY
QP looks back on a person or event that made a difference in the history of quality.
June 8, 1970
Abraham Harold Maslow, a humanistic psychology thought leader, who is probably best known for his theory of human motivation and hierarchy of needs, died on this date.
One of Maslow’s most influential works is Motivation and Personality, published in 1954, in which he developed a foundational theory on motivation. He contended that every person has a basic set of needs that are, in effect, his or her wants and desires. He organized these needs into five categories, with each level building on the previous level.
Maslow’s premise was that as successive levels of needs are satisfied, other needs emerge. Quality thinkers point to Maslow’s theory as a foundation upon which to build an understanding of the reasons we do what we do. As it pertains to managing knowledge, the theory provides insight into how the workplace can parallel and support motivational needs.
Maslow first put his theory to use when he incorporated it into leadership training for the U.S. Air Force during World War II. The theory attracted interest as a basic structure for broadly understanding human motivation.
- Abraham Maslow Biography, www.abraham-maslow.com/m_motivation/biography.asp.
- Brenner, Pamela, "Motivating Knowledge Workers: The Role of the Workplace," Quality Progress, June 1999, p. 33-37. (http://asq.org/data/subscriptions/qp/1999/0199/qp0199brenner.pdf)
- Tsiakals, Joseph J., Charles A. Cianfrani and Jack West, "The Big Picture: A Context for ISO 9001 and ISO 9004," Quality Progress, January 2000, pp. 106-110. (http://asq.org/data/subscriptions/qp/2000/0100/106standards_jan2000.html)