The top executive of the country's premier health care quality organization is resigning from the boards of two health care companies amid questions about the ethics of the relationships.

As ProPublica reported, Dr. Christine Cassel has earned six-figure compensation from the companies, which have an interest in National Quality Forum endorsements that influence practices adopted by medical providers across the country.

The Quality Forum said in a statement today that Cassel's decision to sever ties was voluntary.

“Although serving on these boards provided her with direct knowledge of many current issues in health care, as well as practices of good governance, the issue of her board involvement had become a distraction,” the organization said in a prepared statement.

Cassel was hired in late 2012 to lead the nonprofit Quality Forum, which gets the bulk of its money from a contract with the Centers for Medicare & Medicaid Services (CMS).

ProPublica reported that Cassel was paid about $235,000 in compensation and stock last year as a director for Premier, Inc., a North Carolina purchasing and consulting company. She has been a longtime director for Kaiser Foundation Health Plans and Hospitals. Kaiser officials said she was paid $203,500 in 2012, the most recent year available.

Ethics experts said Cassel’s outside involvement presented clear conflicts of interest that were best eliminated if she resigned from the directorships. The Quality Forum said that Cassel's ties had been disclosed and were approved after a legal review when she was hired.

“Chris Cassel has shown tremendous leadership in voluntarily stepping down from these important board seats. Her generous act demonstrates her strong and continued commitment to NQF and its mission,” Helen Darling, chairwoman of the NQF board, said in the statement.

The Quality Forum's more than 700 endorsed measures cover everything from tracking hospital readmissions to setting information technology standards. Some are recommended to Medicare for use as “pay for performance” measures that tie reimbursements to quality.

A Quality Forum endorsement is considered the gold standard for health care practices. But questions arose in January when it became public that the co-chair of a committee endorsing patient safety measures accepted $11.6 million in undisclosed contracts from a drug company.

The Justice Department, which disclosed the payments in settling a whistleblower lawsuit, said the contracts were meant to win the Quality Forum’s endorsement for one of the company’s antiseptic products.

The Quality Forum said its 2010 Safe Practices guidelines did not include an endorsement of the product, called ChloraPrep. But a review by ProPublica showed that, in fact, they did endorse ChloraPrep’s formula. Afterward, the Quality Forum announced a review the Safe Practices endorsements and its conflict-of-interest policies.

The findings from that review are expected to be announced Friday.

Cassel has declined interview requests. Earlier this month, Darling said she believed it was an asset to have Cassel aligned with such prominent organizations like Kaiser and Premier. "It’s like saying you’ve got a Ph.D. from Harvard," Darling said. "This is something you’d be proud of."

Darling added that Cassel is well-compensated by Quality Forum, where her annual salary is $561,000, and said it was unreasonable to suggest she would be influenced by money.

“She is a strong person, and she has very strong principles,” Darling said.

Eric Campbell, an expert in conflicts-of-interest at the Harvard School of Medicine, called Cassel’s decision to step down from the outside boards a good one that shouldn’t be perceived as an admission of wrongdoing.

Lisa McGiffert, executive director of Consumer Union’s Safe Patient Project, is a Quality Forum member who questioned Cassel’s outside board roles with Kaiser and Premier. She also said resigning was the right thing to do.

“If she was going to continue at the National Quality Forum, she needed to separate herself from those other responsibilities,” McGiffert said.

ProPublica is investigating health care quality and welcomes your input. Medical providers – help us by completing a brief Provider Questionnaire. Patients can complete ProPublica’s Patient Harm Questionnaire.