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Don Berwick

Don Berwick

Curious about Donald Berwick?

Maggie Mahar at the Health Care Blog gives us plenty of reasons to be excited by Obama’s choice of Berwick to head Medicare and Medicaid, but my favorite bit was this:

In a 2005 interview published in Health Affairs, Berwick expressed his concerns: “I would draw a very dark line between the incentives that apply to organization .  .  . where I do want incentives in place — and incentives for individuals. . . . I want it to be good for an organization to be safe, and I want it to be good for an organization to manage chronic illness carefully . . .”  He applauds the pilot projects in the health reform legislation that encourage Medicare to “bundle payments to doctors and hospitals,” with a  bonus added to the bundle when teamwork leads to good outcomes at a lower price.

But “at the individual level,” he insisted, I don’t trust incentives at all . . . I think it feels good to be a good doctor and better to be a better doctor. When we begin to attach dollar amounts to throughputs and individual pay, we are playing with fire.  The first and most important effect may be to disassociate people from their work.”


Few of us are willing to question the orthodoxy of monetary incentives, but those who do will generate some powerful new ideas, I think.

One Comment

  1. kayvon alizadeh wrote:

    I must say that the “pay for performance,” model reminds me of third grade again, when my mom would give me an extra special desert if I took the trash out and did the dishes in the same night . I mean what happened to altruism? What happened to wanting to take care of patients at their worst, most vulnerable state? Why are the most competitive residencies those that are life-style and reinbursement heavy?
    Call me a communist, but I believe all physicians should be salaried equally for hours worked-period (less the cosmetic surgeons, which could really be classified as glorified barbers). I dont care if you scored 295 on your boards, I want to know if you genuinely CARE for people–that’s what it’s all about. I will always remember what a pediatric cardiothoraic surgeon told me once, he said, “a great doctor is a concerned doctor, not a smart doctor.” In my 7 years in surgery nothing has been more true. I’ve seen average intelligence people become some of the best surgeons/physicians, and not infrequently super smart guys demostrate their lack of interest in doctoring and make major errors in patient care.
    It’s not surprising to me that financial incentives have found their way into medicine; we are a money crazy society, and those insurance companies dangle a nice gold-painted carrot for all doctors to bite.
    Its not that im against captialism. I just think if you want to make money then go into investment banking (maybe I should have done this?). If you want to care for pts. then go into medicine. I mean isn’t that what every person applying to medical school writes on their personal statements-’I want to care, I want to help, i’m generous’ etc etc, not ‘I want to be a radiologist making $40,000 every two weeks with weekends off’? Maybe we as physicians should be required to carry our personal statements in our not-so-white coats at all times?!

    Friday, April 2, 2010 at 7:28 pm | Permalink

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