Can Congress Legislate Quality?

Janice Simmons, for HealthLeaders Media , December 10, 2009

On the same day that the senators were introducing their amendments, Institute for Healthcare Improvement CEO and President Don Berwick asked the question at the group's annual forum on Orlando: "How could Congress possibly know enough to specify for every community the exact design for . . . care that is safe, effective, patient-centered, timely, efficient, and equitable?"

The answer is it can't know. But the home team does. Berwick used the example of Cedar Rapids, IA, where the three competing hospitals in town put aside their differences to meet with each other to cooperate on quality.

"The doctors are a free-standing group, but they constantly work with hospitals on quality and improvement. They study their own utilization patterns and they create their own protocols and stick buy them," Berwick said.

And, the hospitals are in the process of agreeing to have only one cancer center in town—"because the town needs only one." And, he said, they have only one cardiac surgery program as a way to get better results at lower costs.

The result in Cedar Rapids—and in many other areas across the country—are lower healthcare costs (27% lower than the average community, according to the Dartmouth Atlas) and quality of care "that is just about as high as any we can find in our country," Berwick said.

So back to our question of whether we can legislate quality. Berwick said Congress is leaving the redesign to the local community of healthcare providers and organizations.

But let's face it: it sure would be cool to have some great apps—in the form of payment reforms, payment rewards, improved data use, and expanded use of technology—approved at the national level to make quality healthcare a reality everywhere.

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Janice Simmons is a senior editor and Washington, DC, correspondent for HealthLeaders Media Online. She can be reached at

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