Don Berwick’s long-awaited appearance before the Senate Finance Committee turned out to be a bit anticlimactic and abbreviated, as votes taking place on the Senate floor limited the hearing to a little over an hour.  Republicans complained that they couldn’t possibly ask the Centers for Medicare and Medicaid Services Administrator all their questions in such a limited time frame; Sen. Orin Hatch (R-UT) called the hearing “pathetic.”

Republicans pressed both Chairman Max Baucus (D-MT) and Berwick to commit to a return engagement before the end of the year. Baucus said the committee would have Berwick back again, but he refused to commit to any specific timing, although he did encourage the administration to allow Berwick to respond fully to written questions submitted by Senators after the hearing.  

Ranking member Chuck Grassley (R-IA) and other Republican panel members made clear they were still annoyed that President Obama had given Berwick a “recess” appointment to his new job, bypassing both the normal confirmation hearing in front of the Finance Committee and the normal votes in the Committee and on the Senate floor. “I think that was incredibly unfortunate for you, and for the position that you now hold. I think you should have had the opportunity to come before this Committee, and explain and defend yourself and make the case – in person – that you are the right person to be the CMS administrator,” Grassley said.

Republican Jim Bunning of Kentucky asked Berwick why he accepted a recess appointment. “The reason I accepted it, sir, was that the President asked me, and I want to serve this country,” Berwick responded. He noted that he had met individually with all members of Congress who had requested meetings.

Bunning disputed Berwick’s promise in his opening statement to be “open” and “transparent.” “Open and transparent we haven’t been, Bunning argued. “But I guarantee you this … [The House] will see to it that you will be open and transparent, because they will oversee CMS very closely.” (Republicans of course took over the House in the elections on November 2.)

Working From The Ground Up, Not The Top Down

Berwick took pains to stress that the Affordable Care Act was not a Washington takeover that would ration care or invade the doctor-patient relationship.  The man who has called himself a patient-centered “extremist” said that patients should be able to get “all the care they want and need when and how they want and need it.”

Before coming to CMS, Berwick worked with Mark McClellan of the Brookings Institution, Elliot Fisher of Dartmouth, and Atul Gawande of Brigham and Women’s Hospital to identify and learn from communities that had successfully moved toward low-cost, high-quality health care, and he said he would continue this approach in implementing the Affordable Care Act at CMS. “Flexibility is essential to the future. We don’t have a one-size-fits-all solution here,” Berwick said. “State by state, there will be innovations that will surface. We can support these through waivers, through the demonstration projects that are anticipated in the new law and pre-existing legislation.”

The CMS Administrator also pointed to two “wonderful assets” in the Affordable Care Act:  the Center for Medicare and Medicaid Innovation, and the soon-to-be-launched Center for Dual Eligibles, those eligible for both Medicare and Medicaid. Yesterday, when CMS launched the Innovation Center, the agency “announced the possibility for up to 15 states to get grants to plan better care for dual-eligibles,” Berwick said.

Berwick also stressed that CMS intended to collaborate with a wide range of public and private stakeholders rather than “going it alone.” In his written testimony, he noted CMS’ participation in the Multi-payer Advanced Primary Care Practice Demonstration (MAPCP):

This demonstration marks the first time that Medicare, Medicaid and private insurers will join in a partnership with States to transform health care delivery. Advanced primary care practices, often referred to as patient-centered medical homes, utilize a team approach to health care, with the patient at the center. Under this demonstration program, Medicare will participate in existing State multi-payer health reform initiatives that include participation from both Medicaid and private health plans. Implementing a common payment method across different payers will reduce administrative burdens, align incentives, and provide participating practices with the resources needed to function as advanced primary care practices. This type of collaboration, involving CMS, private insurers, States and local practices, is essential as we work to build new systems.