What CMS Administrator Dr. Berwick Didn't Say...

In a wide-ranging and brief Kaiser Health News interview, CMS Administrator Don Berwick is asked about Medicaid, ACOs, the Ryan Plan and cutting costs.  Regular readers of the Disease Management Care Blog can probably predict what Dr. Berwick had to say. 

The DMCB is more interested in what he didn't say.

Medicaid: While the "flexibility" and federal "help" are the rhetoric of the Obama Administration, there was nothing in Dr. Berwick's murmurings to suggest that there will be any substantially new approaches to a deeply troubled program that is not only blowing a huge hole in State budgets, but is a disservice to patients and doctors alike.  The reason it's called "CMS," is because Medicaid (the other "M" in CMMS) remains an orphaned afterthought.

Accountable Care Organizations:  Putting a brave face on things, Dr. Berwick ignored the huge push-back by providers on the ACO regulations, spinning the comments that have been received by CMS to date as "exciting," and "of help."  To the DMCB, it suggests that the Administration doesn't really intend back off from the onerous conditions of the current proposed rule and save this sinking ship.

Medicare's Unsustainable Costs: While Dr. Berwick unsurprisingly has little appetite for any changes in funding or benefit levels, his statement that "I go to work every morning with 100 million people in mind" and "I've got the back of the Medicare beneficiary" belies the real unsaid message underlying any notions of private-public, federal-state "partnerships": an astonishing faith in central command and control by Washington DC.

Recess appointment: The lack of any discussion on reversing the hostile Senate Republicans suggests he's given up on being confirmed by the Senate.