Guest post from Ken Christman, MD.
Dr. Charles Denham left a career in radiation oncology to join the “patient safety” movement. He formed his nonprofit Texas Medical Institute of Technology, became editor-in-chief of the Journal of Patient Safety, and found his way to the National Quality Forum, where he co-chaired the NQF Safe Practices Concensus Committee. There, he ardently promoted a skin antiseptic formulation that, according to Dr. Bob Wachter, would be a “home run” for CareFusion, the manufacturer of ChloraPrep.
In January, 2014, CareFusion agreed to pay a $40.1 million fine to settle U.S. Department of Justice charges that paying Dr. Denham $11.6 million constituted a kickback.
It is claimed that Dr. Denham manipulated the National Quality Forum “standards” in order to boost the sales of ChloraPrep.
Obviously, with the right contacts, the “quality” industry can pay handsomely.
Dr. Denham’s colleagues in the “patient safety” business are now looking out for their own “safety” and distancing themselves from this catastrophe. Dr. Bob Wachter wrote an article entitled “Patient Safety’s First Scandal: The Sad Case of Chuck Denham, CareFusion, and the NQF”, eerily implying that there are more scandals to come. Dr. Wachter spoke of his chairmanship of the American Board of Internal Medicine (ABIM), and detailed his relationship with Dr. Denham over the years.
The ABIM is a “nonprofit” in the “quality” business, and certifies and re-certifies physicians. Its business has mushroomed, and as of 2011, reported total revenues of over $49 million, largely as a result of its lucrative physician re-certification business. Its 2011 CEO, Dr. Christine Cassel, enjoyed a compensation package of $786,131, for what she described as a 35-hour work week. This is modest, however, in comparison to the 2009 compensation of the CEO of the American Board of Pediatrics (ABP)–$1.24 million.
The ABIM Foundation started a “Choosing Wisely” campaign, which has metastasized to other medical boards, with the stated goal of decreasing “unnecessary testing”. While waste in healthcare is almost universal (largely due to the endless proliferation of “quality” measures and products), some physicians recoil at some of the mandates, such as postponing antibiotics for children with ear infections, and not routinely screening for prostate cancer with a simple PSA test or digital rectal exam! The notion of avoiding early detection of cancer seems misguided at best. Choosing Wisely is teaming up with insurers, hospitals, and specialty medical boards, in order to pursue its goal of conserving resources by rationing healthcare.
The American Board of Medical Specialties (ABMS) is the parent to 24 specialty medical boards, and lobbies aggressively to require continuous specialty re-certification for the duration of a physician’s career, which is called Maintenance of Certification (MOC). MOC is foisted upon physicians and the public under the guise of protecting the public and improving “quality”, implying that physicians don’t keep up with changes in medicine. ABMS says doctors must commit to lifelong learning, as if they somehow quit learning when they complete training!
Some specialty medical boards intrude into physician offices, and demand to see patient records as a condition of re-certification. If the Choosing Wisely initiatives are not followed, is it possible that your doctor might lose his ability to practice? The American Board of Obstetrics and Gynecology already refuses re-certification if its specialists treat men, except under very limited circumstances.
What does this requirement have to do with “quality”?
The National Quality Forum (NQF) was formed in 1999 in order to vet and endorse quality measures. Naturally, it is a bonanza for big business to get its products and services endorsed by the famous NQF list of “safe practices”. It is obviously worth a small fortune to pay the purveyors of “quality” to engineer these products onto that list. And, it is equally enticing for physicians to quit taking care of real patients, forget the punishing Medicare regulations along with its ever-decreasing reimbursements, in order to embrace a leisurely life in pursuit of lucrative “quality” endeavors.
The NQF provides an annual report to Congress and the Secretary of the U.S. Department of Health and Human Services (HHS). Thus, there is no need to lobby, as there is ready access to legislators and government leadership.
Dr. Christine Cassel, the previous CEO of the ABIM, is now CEO of NQF. Richard Baron, M.D., the current CEO of ABIM, came from NQF! Quite obviously, the ABIM is actively furthering its Choosing Wisely and its “quality” agenda by intimately linking itself with NQF, which is a public-private partnership.
Wachter agrees with Dr. Cassel that the Denham scandal is a mortal threat and describes her as being in a “crisis mode”. Dr. Cassel claims Dr. Denham lied, while other “patient safety” experts claim ignorance of the Denham/CareFusion relationship. Why doesn’t somebody question the unholy alliance between the hugely profitable ABIM/Choosing Wisely and NQF?
NQF is funded largely by contributions from Medicare/Medicaid and the Robert Wood Johnson Foundation. So, here you see a confluence of big/business and so-called nonprofits all vying to get their products/devices/re-certifications endorsed and mandated by the U.S. Government, which is indeed helping to fund this scheme in the name of “quality”. While I would not quarrel with Wachter for labeling the Denham/CareFusion racket a “scandal”, I would also consider that one of Webster’s definitions of fascism is “the retention of private ownership of the means of production under centralized government control.” In other words, under fascism, government controllers can and will treat some groups preferentially, to the detriment of others. Why would Medicare reimburse hospitals at 180% or more for the exact same services that it pays non-hospitals? In a free market, are not identical products or services worth the same?
If there is a genuine desire to conserve resources, why not use a truly free market and pay for services at equal rates? Don’t discriminate against physicians and patients by encouraging consumption at grossly disparate rates. Don’t turn to healthcare rationing under the guise of Choosing Wisely, or some other type of “quality initiative”. Rather, discontinue all the “quality” and “patient safety” schemes which are driving up cost of healthcare and encouraging bribery. Discontinue all the physician re-certification demands, which are time-consuming, detrimental to patient care, expensive, and unnecessary. Would not Medicare conserve funds by simply shuttering NQF?
I have decided to embark on my own choosing wisely campaign, and to seek physicians who refuse re-certification initiatives, as they are most likely to possess the fortitude to resist delivery of healthcare which is not in my best interest.
Additionally, I will seek such care from those physicians who are not owned and controlled by non-physician entities. If you agree, I would encourage you to write your health insurers, hospitals, state medical boards, and legislators. Urge them to ignore the “quality” cartel, and insist that the U.S. government free your physicians to truly represent the best interests of your health and your wallet by dismantling the MOC and Choosing Wisely initiatives along with NQF.
Kenneth Christman, M.D.