Dr. Berwick Started the Quality Movement and Now Has Other Ideas


Don Berwick, MD, was a pediatrician and the guy Barack Obama wanted to lead CMS. Berwick was also trained in public health and since the 1980s wanted to instill the type of quality metrics we use with building cars, etc. You can see an interview with him here and what I said about it here.  You can pretty much say that Berwick was the father of the quality movement.  What he missed back in 2011, explaining the benefits of making sure hands are washed in the hospital or that certain checklists that need to be completed, was that the administrators and insurers were going to expand this crap into areas where things CANNOT and SHOULD NOT be measured.

Recently, in this article called Doctors are so much more than quality metrics, here are Dr. Berwick’s most recent quotes:

  • “I’m all for transparency, but in my opinion we’ve overshot,” he says. “Any payer can ask for measurement and write their own rules as to what should be measured. It’s phenomenal, and it erodes productivity.”
  • A further potential hazard posed by metrics is what Berwick calls “managing the measurement”—that is, focusing on the metric itself rather than on patient care. He cites his experience being in charge of quality of care management at a Boston HMO. “I had an unlimited budget for breast cancer screening and follow-up and we got good results for those. The problem was, as an oncologist pointed out to me, we really decreased the amount of work on breast cancer care. So measurement, by casting a light, led us to look under the light rather than thinking more broadly about the pattern of care.”
  • “I have tremendous doubts about the accuracy and utility and overall wisdom of quality metrics at the individual level,” Berwick says. “When it’s a ‘falling off a log’ standard that you know everyone would want the same way then it’s good to know we’re adhering to the standard. The problem comes when we don’t get a chance to modify them to fit individual needs. Can we really be smart enough to write rules that get down to the level of what’s right for each individual patient? So we have to be really careful about these rule-based standards.”
  • Another problem Berwick cites is that often doctors don’t provide care in isolation. “Physicians are enmeshed in a highly interdependent system of relationships,” he notes. “So maybe Dr. Jones’s patient had a particular outcome, but Dr. Jones is working with Dr. Smith and Dr. White. It’s hard to separate who’s doing what.”
  • A subtler, but still important effect of metrics as a reimbursement tool, Berwick points out, is to discourage doctors from caring for “difficult” patients—those with behavioral health disorders, or who are just plain ornery. “If you put in a system that dings doctors for low scores on patient satisfaction or efficiency measures, but the problem lies in the variation of the patient population, you’ve done exactly the wrong thing,” Berwick says. “Instead of helping doctors take on the tough cases, you make it riskier for them.”

Everything I warned about for years Berwick is saying now.  He helped to start this!

The funny thing is that if Obama wanted him in charge of CMS today the Democrats, after reading these quotes, would block him.

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  7 comments for “Dr. Berwick Started the Quality Movement and Now Has Other Ideas

  1. DrG
    March 30, 2016 at 9:31 am

    Total horse hockey. Stop playing the insurance game which is using your charge card. Cash only and stop the craziness of the bureaucrats.

  2. Pat
    March 28, 2016 at 3:57 pm

    This piece exemplifies my contempt for many in this profession. So, so many physicians think it is acceptable to “do good” with other peoples’ time, money, and freedom of action.

    I disagree Doug, I think the Dems – and a lot of the GOP – would welcome this guy as the CMS head. The natural instinct for government, and public medicine is more control over greater numbers of people.

    I stupidly thought of medicine as a career where I would think for myself, and do what I thought was best. The experience has been just the opposite, featuring a long line of the ignorant and greedy telling me what to do and what to think. Who are the accepted experts in medicine now, but the lawyers, LELT’s, bureaucrats, and faux-docs like this traitor?

    Berwick is scum, and a liar, but this profession and our stupid electorate created a CMS to propogate his self-serving garbage.

    • Seneca
      March 28, 2016 at 5:50 pm

      You could extrapolate this comment to many fields where the so called Social Justice Warriors know what is best for all of us. Recently, they have had a lot of success in part because those of us who believe in freedom of action have not fought them.
      When I read 1984 in high school, I had no idea how Orwellian our world would become.

  3. Beth
    March 28, 2016 at 1:20 pm

    Thanks, Steve. I couldn’t have said it better. My sentiments exactly.

  4. Randy
    March 28, 2016 at 12:24 pm

    What’s sad is that this was completely predictable and indeed many physicians did warn about the downsides of “quality metrics”. Anybody who has worked in the government, the military, participated in government audits or inspections knows you end up “managing the measurement” as Berwick puts it. Since many things can’t be measured, physicians end up focusing on the measurable and neglecting the rest.

    And RSW is right, this is a widespread bipartisan problem.

  5. RSW
    March 28, 2016 at 12:04 pm

    “if Obama wanted him in charge of CMS today the Democrats, after reading these quotes, would block him”

    Actually, faith-based belief in quality metrics is common among stupid people all across the political spectrum – look at what’s been done to teachers. MACRA passed with huge bi-partisan support.

    But Berwick’s still a steaming pile of shit.

  6. Steve O'
    March 28, 2016 at 7:44 am

    Hey Doc Berwick! Look up Useful idiot
    In political jargon, useful idiot is a term for people perceived as propagandists for a cause whose goals they are not fully aware of, and who are used cynically by the leaders of the cause.
    Don’t feel guilty, Don. They aren’t listening to your wisdom now, because they weren’t listening to you when you were riding in their parade. They just stuck their hand up your butt and used you for a meat puppet.
    They got lots of practice in foreign countries, with meat puppets like Saddam Hussein and before – Diem in Vietnam, etc. Get some local fool who speaks the lingo to represent outside interests, and silence the opposition. Now you want to wash your hands, and cry about how it’s not going right.
    Trotsky ran to the West in a screaming boo-hoo when Stalin kicked his ass. Did you know he tried to speak to the US Congress about the dangers of Stalinism? What a hypocrite! He had just as much blood on HIS hands – and his only argument was he lost to a bigger jerk. Now, Don, you’re weeping to your victims that the Revolution has been betrayed, and your feelings are hurt! SOOO sad!
    We’ve mindlessly bought the association that America, Capitalism, Corporatism, Wall Street and Big Finance are all part of the same Red-White-and-Blue bundle of pride and joy. They’re not the same thing by any means.
    Corporatists are like the Spanish Inquisition. They’re deep-down stupid – they can’t recognize any way but their own; and every other way is indecipherable to them. They are so arrogant, they think they know the One True Way, and anyone who doesn’t kiss their ass is a heretic and an enemy. They make a good role model for ISIS, don’t you think? Wall Street and the Taliban?
    Read John Perkins’ The New Confessions of an Economic Hit Man. [but first, read Darkness at Noon by Arthur Koestler and think about what you’ve done to American Medicine, just like Rubashov of the novel – another arrogant bastard who thought he could bring The New Way of Life to the peons.] See The New Confessions of an Economic Hit Man at http://economichitman.com/
    Perkins has earned his right to speak out – he used to be an international representative of the “jackals have come home to the United States — in the form of bankers, lobbyists, corporate executives and others “whose job…is to con governments and the public into submitting to policies that make the rich richer and the poor poorer.””
    New American Corporate Retail Medicine is a shell that deludes the seriously stupid, Don. It’s not a gathering of fellow intellectuals, the best and the brightest, to bring reform of an inefficient system. It’s a heartless machine that will ram a corporate transformation into medicine, making it a feeble, third-world enterprise that makes money for its masters. You licked its hand.
    Dr. Berwick, you don’t even seem to get it right now. There’s no such thing as “overshot, gone too far.” There’s no such thing as “wandered off the tracks.” They are doing now, only what they intended then – when you were licking their hand and taking their paltry hundred-thousand-dollar speakers’ fees. They wanted to use you – and you still don’t get it.
    Sorry to use Don Berwick as the punching bag – but not all THAT sorry. This NEVER was about TQM or Deming or To Err Is Human. This is about biotechnology and medical management investments – which have paid off well every year for twenty years. It’s about turning a profit off Soylent Green. Always has been.
    Don, you dummy.

Comments are closed.