President Obama has promised that medical quality and costs will improve with more government control of “quality and efficiency” through Obamacare. He and others have pointed to “hundreds of thousands” of deaths that can be prevented if doctors and hospitals merely practice medicine as they are told by government committees. It turns out that patient safety is not the true driving force behind the governments “quality” agenda, but it is the oldest motivator in the book: money. The quasi-governmental bodies setting quality standards have been rocked this year by a major scandal involving $11.6 million in bribes to a powerful committee co-chair Dr. Charles Denham. Dr. Denham, founder of the “Health Care Concepts” for-profit corporation and the past chair of the Texas Medical Institute of Technology was the subject of a whistle blower lawsuit brought by the U.S. Department of Justice. He abused his position on the “Safe Practices Committee” of a major quality organization (NQF) to push the adoption of specific skin cleansing devices used in surgery known as Chloraprep.
Carefusion, the company that makes “Chloraprep”, entered into an $11.6 million contract with Denham’s company that was designed to conceal kickbacks to Dr. Denham. The company, according to the U.S. government, was paying off Denham to influence his decisions to ensure that the National Quality forum (NQF) would recommend use of Chloraprep around the country as a “patient safety” recommendation. Carefusion settled with the DOJ for $40 million in payments to the U.S. government over the case. This author is a practicing neurosurgeon and witnessed the inexplicable appearance of Chloraprep in hospital operating rooms and procedure kits in multiple St. Petersburg hospitals. The betadine prep solutions were often removed from the work area and had to be requested for use by surgeons. Hospital committees and administrators would routinely accuse doctors not using the agent as practicing low quality medicine and affecting their performance scores. Hospitals with low performance scores are penalized by Medicare with lower payments in a model called “pay for performance”.
Dr. Denham co-chaired the Safe Practices Committee of the National Quality Forum and was shown to push the formula contained in Chloraprep as a required agent for prevention of surgical infection. There was little evidence to support it, but the powerful position allows other motivations to dominate over science. Choraprep solution (2% Chlorhexadine and isopropyl alcohol combination) is still recommended for us for inserting central venous lines into patients in the NQF safety standards.* Dr. Denham, like so many pushing the “patient safety” agenda, hide behind feel good stories and dramatics to mask their true corrupt nature. For instance, he has gained fame for appearing with actor Randy Quaid in a film that discusses medical errors effecting his twin babies and that pushes the false “patient safety” agenda.
Dr. Denham has now been dissociated from the NQF and NQF President and CEO, Dr. Christine Cassell, is having to remove herself from the paid Board positions with Kaiser and Premier as the conflict of interest scandal grows. Carefusion also makes electrical surgical clippers that have been recommended for use by NQF over standard disposable razors. Electrical clippers are pushed as a method of decreasing surgical incision infection, but the science clearly shows otherwise. Carefusion also makes the “Pyxis” medication dispensing machines used by nurses and hospitals as part of a command and control electronic medical record system of health care. This is merely the tip of the iceberg and serious investigation will certainly reveal many more examples of corruption within the “quality” industry – a new “Medical-Industrial Complex”.
The new Obamacare domination of medicine means hospitals and doctors are not paid for their time and skill or service to the patient. Rather they are penalized if they fail to comply with government created guidelines of so-called “quality” and “efficiency”. This “pay for performance” scheme is not about true quality and cost management, but only about making money for well-connected corporations and insurance companies through rationing (see here also). It is also designed to give politicians undue credit as they claim to improve quality and decrease cost. Insurance companies and politicians will falsely accuse good doctors of practicing “low quality” and “high cost” medicine based on the unwillingness of true professionals to follow bureaucratic procedures that are based on corruption. As the corporatists and collectivists pursue centralized payment systems for medical payment, they also hypocritically and inappropriately demonize “fee for service” as corrupt and the source of high prices and low quality. Think about that the next time your insurance company or Medicare gives your doctor a low “quality” rating and accuses them of being “inefficient”.
F.A. Hayek described the behavior of technocrats gaining power in his classic “Road to Serfdom”. In it the technocrats, who can’t convince professionals using science and fact, instead gain power in bureaucratic processes. They abuse the power to make sure that they and their friends are enriched. It is the classic model of central economic planning and collectivism that is purported to eliminate the “greed” of corporations. Instead, the opposite happens, the greedy seek the power of government to force unnatural profits for themselves while demonizing and oppressing all who disagree with them or expose them.
* This author also participated as a representative of Neurosurgery in the Surgical Quality Alliance and Ambulatory Quality Alliance – groups affiliated with NQF and witnessed firsthand the undue influence of business and financial interests over the quality process. Based on this I offered my resignation from the AQA and SQA.