Reporting from Washington — Dr. Donald Berwick, President Obama's likely pick to run Medicare and Medicaid as the government embarks on a massive overhaul of the nation's health insurance system, has been a sometimes provocative advocate for more efficient delivery of patient care.
A professor of pediatrics and healthcare policy at Harvard Medical School, Berwick is best known in healthcare circles for founding and running the Institute for Healthcare Improvement, a 19-year-old think tank focused on "cultivating promising concepts for improving patient care and turning those ideas into action."
In that role, Berwick has been a blunt critic of the U.S. healthcare delivery system, declaring, for example, that it falls short of being the best in the world because of its inefficiencies and lack of information sharing.
And while some of his prescriptions for dealing with those problems are likely to stir controversy, many healthcare analysts agree with his overall diagnosis.
"He's telling the truth," said Len Nichols, a healthcare economist at George Mason University. "He knows how good it can be and how it really is."
Berwick will try to improve the quality of care in part by changing the structure of incentives for doctors and other healthcare professionals so that they are rewarded for better outcomes instead of on a per procedure basis, Nichols predicted.
Berwick could not impose such a change on the whole medical profession, but Medicare, which provides health coverage for the elderly, and Medicaid, which provides care for the poor, are such big players that changing their approach would likely ripple through the system.
Berwick has spent much of the last 15 years focusing on improving the quality of care in hospitals, and his knowledge of them -- coupled with his experience as a practicing physician -- will lend credibility to efforts to coax reforms out of the industry, said David Helms, chief executive of AcademyHealth, a professional society for health services researchers.
"I think Don Berwick as a practicing physician will be able to communicate with other practicing physicians in a way that's persuasive," Helms said.
A graduate of Harvard College and Harvard Medical School, Berwick served on President Clinton's Advisory Commission on Consumer Protection and Quality in the Healthcare Industry.
In 2005, he was appointed honorary Knight Commander of the Most Excellent Order of the British Empire -- the highest award given to non-British citizens -- for his work with the British National Health Service.
Evidence of Berwick's stature among his peers came that same year in a poll ranking the 100 most influential people in healthcare by Modern Healthcare magazine. In it, Berwick ranked third, behind then-Health and Human Services Secretary Mike Leavitt and Microsoft co-founder Bill Gates, and ahead of President George W. Bush and Sen. Edward M. Kennedy (D-Mass.).
Berwick has not been officially nominated to head the Centers for Medicare and Medicaid Services, but a senior administration official confirmed the pick over the weekend.
The selection of Berwick, 63, comes at a politically charged moment, a week after Congress passed the most sweeping healthcare legislation since the 1960s without a single supporting Republican vote. His nomination requires Senate confirmation.
A signal of concern, if not outright opposition, came from Sen. Tom Coburn (R-Okla.), a practicing obstetrician.
"One concern I have is that he's an advocate of cost comparative effectiveness," Coburn said. "There may be one or two or three ways of doing something. I want to do what's best for the patient, not necessarily what's cheapest."
Focus too much on cost effectiveness and "all of a sudden you're rationing care," Coburn said.
"It's way too early to tell" if Republicans will try to derail Berwick's nomination, Coburn said. "I think he's more than qualified. . . . I want to sit down and talk with him."
Even in the calmest of times, Berwick's assignment would be a challenge.
Together, Medicare and Medicaid cover 100 million poor, elderly or disabled people -- nearly 1 in 3 Americans.
The two programs accounted for $750 billion, or roughly 20% of all federal spending in 2009, according to the Congressional Budget Office.
The Obama healthcare overhaul contemplates key roles for both programs in extending insurance coverage to 32 million people at a cost of $938 billion over 10 years. Some of the increased coverage is to come from an expansion of Medicaid and some of the savings would come from cuts in Medicare.
If confirmed, Berwick will be the agency's first permanent chief since Mark McClellan, a physician and economist, left in 2006.
He will be taking a hefty pay cut. Government salaries top out at about $200,000 a year, less than a third of the $637,000 he earned running the Institute in 2007, according to the group's nonprofit IRS filing for that year, the most recent available.