I have always enjoyed reading what former Centers for Medicare and Medicaid Services
(CMS) administrator Donald Berwick, M.D., has to say. Dr. Berwick, president emeritus
and senior fellow at the Institute for Healthcare Improvement, is a very thoughtful
person, in my humble opinion. I have been following Dr. Berwick’s career for years
and recently read his new commentary in the Journal of the American Medical Association
(JAMA).
He described three “eras” in health care. The first, which he calls “Era 1,” is rooted
in antiquity and revolves around the idea of medicine as a noble calling that is understood
by those with special knowledge and training and requires self regulation. This entails
the idea that medicine has the right to judge its own work. While self-regulation
sounds appealing, Dr. Berwick wrote that this phase created disparities, variation
in practice and a host of other problems.
The next era, which he appropriately calls “Era 2,” replaces much of the self-regulation
with regulation through measurements, accountability and financial incentives. It
is where we are today. But, he thinks that we may have gone a bit overboard with all
of the measurement and he is concerned that the value of some of the measurements
is dubious. He also states an often-heard complaint that many physicians are frustrated
with all of the “control” that seems to surround them.
So, what is the answer?
This will not surprise you, but he says we need to go to "Era 3," which entails characteristics
of the first two, but with a twist. He wants to eliminate the protectionism of “Era
1” and the mechanical measurement of “cook book” medicine from “Era 2”. He thinks
that basically we need to simplify health care by using fewer measurements and offering
incentives that are easier to understand.
He would also like to see emphasis placed on the “Triple Aim,” which is improving
the patient experience, improving the health of a population and reducing the per
capita cost of health care. Certainly, these are good things to pursue. I had to
boil his article down to its basics, but this is what I got out of it. You can read
the entire article for yourself, and I definitely recommend it. Have a great week!
