Update on Donald Berwick and Conflicts of Interest
Late yesterday afternoon CMS Administrator Donald Berwick sent a letter to Sen. Grassley responding to Sen. Grassley’s July 29 letter to Dr. Berwick that he disclose information regarding the donors who funded the Institute for Healthcare Improvement (IHI) during Dr. Berwick’s time as its CEO. The letter only discusses conflict-of-interest issues, and does not represent the “point-by-point rebuttal” to critics of his controversial writings that the New York Times reported last month Dr. Berwick is preparing. Three interesting points of note from the letter:
- With regard to Sen. Grassley’s specific request for more information regarding IHI’s donors, Dr. Berwick responded that “because the information you requested includes non-public documents in the possession of my now former employer, it is not within my power to comply with your entire request.” However, as Sen. Grassley’s letter noted, Finance Committee staff first requested the IHI donor information from Dr. Berwick on June 4, 2010 – more than one month prior to Dr. Berwick’s recess appointment, while he was still head of IHI. In other words, Dr. Berwick had the power to compel disclosure of IHI’s funding sources while he still headed that organization, but chose not to do so prior to his appointment – and is now attempting to use his recess appointment as a justification to keep the information private.
- In response to Sen. Grassley’s request about ethics waivers, Dr. Berwick replied that “two of my former clients – Kaiser Permanente and The Commonwealth Fund – would have a particularly significant role in providing input to officials at CMS on policy matters related to health care quality, Medicare payment reform, and health care reform implementation, and that it would therefore be important for me to participate in discussions that are likely to include participation by The Commonwealth Fund or Kaiser Permanente.” Dr. Berwick therefore said he will shortly seek an ethics waiver regarding these two former clients. Some may note with interest the logic that nominees should recuse themselves from matters involving former clients – unless those clients’ interests before the agency are “particularly significant,” in which case the nominee can apply for a waiver. However, Dr. Berwick did claim that his ethics waiver would be limited, and he would not participate in any matter regarding these two parties “that has a direct and predictable effect on the[ir] financial interest…including such matters as contracts, grants” and other similar proceedings.
- With regard to Dr. Berwick’s relationship with IHI, he claimed that upon his resignation from IHI “I forfeited all benefits from IHI except” his supplemental executive pension. Therefore, Dr. Berwick wrote that “IHI does not currently and will not provide any benefits to me or my family, including health care coverage.” As previously noted here and elsewhere, IHI noted in its financial statements that in 2003 it “established a postretirement health benefit plan” for Dr. Berwick, which offered coverage “from retirement until death.”
Sadly, Dr. Berwick’s apparent lack of transparency regarding his financial dealings is consistent with the Administration’s public relations strategy of not making Dr. Berwick available for interviews. But it’s yet another broken promise from an Administration that pledged “an unmatched level of transparency, participation, and accountability.” And the fact that Dr. Berwick chose not to disclose IHI’s financial information when he had the power to do so – and has not so much as taken a single question in public from Members of Congress or members of the press – speaks to the controversial nature of both his appointment and the health care law he will implement.