I listened to CMS Administrator Donald Berwick, MD, give a speech on the Medicare physician pay fix and the future of the payment model earlier this week at the AMA's annual advocacy conference in downtown Washington. Dr. Berwick was warmly received and given two standing ovations. He called the AMA's incoming president-elect, Peter Carmel, MD, a "longtime friend" and "mentor" of sorts.
Before a crowd of physicians, Dr. Berwick -- a former pediatrician -- said he was "committed" to a permanent sustainable growth rate (SGR) fix. While this earned the expected applause, Dr. Berwick spent much more time discussing a dramatic overhaul of the Medicare fee-for-service system, a major change that he painted as being inevitable.
He came off as amiable and earnest and offered a touching anecdote about a hospitalized 15-year-old patient whom he asked "how can we improve what we do?" He gave the boy a sheet of paper and asked him to write three things. After some prodding, the boy wrote:
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"Tell me what you're going to do to me."
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"Talk to each other [meaning the various clinicians]."
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"Ask me what I think."
Dr. Berwick said he kept that sheet of paper taped to his computer monitor for years, and that they boil down to 1.) having a plan; 2.) working as a team; and 3.) keeping the patient constantly in mind.
These principles should be at the heart of a "better care system," which Dr. Berwick said would replace the fee-for-service model, improving quality of care and reducing costs.