Wednesday, July 7, 2010

Berwick named CMS Director via recess appointment

President Obama will apparently named Donald Berwick to be Director of the Center for Medicare and Medicaid Services (CMS) via a recess appointment later today. This bypasses the need for the Senate to confirm Berwick, but also means that he can only serve in the post until late 2011 at the end of the next Congressional session.

CMS desperately needs a Director to get on with the implementation of the Medicare aspects of the health reform law recently passed, and indeed, many of the demonstrations to be done by Medcare (and Medicaid to a lesser extent) will be tests that will trickle down into the broader health care system as is typical. Most major insurance side innovations in the past 30 years in the U.S. health care system have begun in Medicare and then been adopted by private insurance. Examples include hospice, prospective payment for hospitals and changes in how physician rates have been set.

At a recent health policy conference I attended, there is bipartisan (meaning more liberal and conservative types) that Berwick is a great choice to lead CMS.

More: interesting roundtable discussion hosted by Health Affairs back in April, 2010 about the future of CMS, and issues realted to implementing health reform.


  1. Medicare pays for gastric bypass for obese, however Medicare should also pay for Gastric Sleeve surgery. The Gastric Sleeve has shown to be effective in rapid weight loss. Stand alone operation. The intestine is not bypassed, so there is less chance for malnutrtion. Take anti-inflamatory meds, fosimax, antibiotics etc. No Dumping syndrome.
    The size of stomach is size of banana not egg like gastric bypass. With gastric bypass you have dumping syndrome, Iron, vitamin B12, folic acid, and calcium deficiencies. Size of stomach pouch size of egg. Let the Patient have a choice between Gastric Bypass and Gastric Sleeve. A lot of medical insurance companies are now paying for the Gastric Sleeve. It times Medicare get with the program. Please this October add for approval Gastric Sleeve procedure.

  2. The biggest change will be for Medicare to actively begin asking these sorts of questions: 'Is gastric bypass better than gastric sleeve?' and most importantly, if no, will medicare stop paying for it? Or, how will medicare decide if both are covered, etc. There are technical issues involved, but the cultural and political issues are far more profound.

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