The United States has "set up a [health care] delivery system that is fragmented, unsafe, not patient-centered, full of waste, and unreliable," Donald Berwick, MD, told Kaiser Health News on Monday. "Despite the best efforts of the workforce, we built it wrong. It isn't built for modern times."
Berwick, who stepped down from his post as administrator of the Centers for Medicare and Medicaid Services (CMS) earlier this month, said health reform is changing how physicians and hospitals are paid and care is delivered care through such new arrangements as Accountable Care Organizations (ACOs). But he said it is unclear whether such efforts would produce results quickly enough to hold off critics, including most Republicans, who want to make more radical changes that would shift more of the burden to beneficiaries.
Berwick said during his tenure at CMS his most challenging decisions involved state requests to cut Medicaid benefits and writing regulations to encourage physicians and hospitals to form ACOs to work more closely, while not making the requirements overly burdensome.
He also criticized state efforts to limit hospital coverage for Medicaid recipients, currently under review by federal regulators. Hawaii has proposed a 10-day coverage limit on some enrollees; Arizona has proposed a 25 day limit. "If a patient needs twenty days, the patient should get twenty days," he said.
The best way to provide care is through "managed care done right," Berwick said, but if states are not ready to take on the responsibility, it can lead to restrictions that prevent people from getting the care they need.