July 8, 2010; Source: San Francisco Examiner | Obama’s choice for the new head of the Centers for Medicaid and Medicare Services (CMS) is Dr. Donald Berwick. This is a critical position in relationship to the nonprofit sector. The fact that Obama chose to appoint him during a congressional recess has led some to charge that the President wanted to avoid a potential Republican block of the appointment, which, if it occurred, was likely to come complete with emotionally charged accusations of potential health care rationing and, yes, creeping socialism. Others have welcomed the move as the kind of decisive stroke needed in the situation, also accurately anticipating that the process would have been lengthy and part of a scheme to replay the health care debate and delay implementation.

Among those who are questioning the appointment is Sen. Charles Grassley, the ranking Republican on the Finance Committee, who wants to learn more about the donors to the Institute for Healthcare Improvement, the Massachusetts-based nonprofit that Berwick founded and ran. The organization was established “to accelerate improvement [in health care] by building the will for change, cultivating promising concepts for improving patient care, and helping health care systems put those ideas into action.” It was listed in 2008 as having $49 million in assets and 101 employees.

The recess appointment bypassed the formal questioning on IHI’s funding for now but inquiring minds should still want to know to whom Berwick might be financially connected. Some call this focus “bogus” and our own look into the grants to this group listed at the Foundation Center reveals the Robert Woods Johnson Foundation and the Gates Foundation among a few others as the Institute’s major givers but Grassley’s questions are legitimate and we hope they get answered.

And, this may pale in importance in the current context but, if you wanted to wave a red flag in front of Grassley, there is also the question of salary. Grassley has, as we know, been concerned about community benefits levels and CEO salary levels at nonprofit hospitals. According to a recent IRS survey of 485 hospitals, these salaries average $500,000. Dr. Berwick, by Grassley’s lights, might have had some explaining to do having earned $2.3 million in salary as IHI’s chief executive in 2008—up from $637K in 2007 and $585K in 2006. Such questions, do, of course figure into the cost and quality of care and Grassley has been focused on exactly how they figure in for quite some time.

Overall, this is a fascinating situation that bears watching as we all lurch towards the actual implementation of health care reform.—Ruth McCambridge