Medical Staffs and Conflicts of Interest
Medical staffs are increasingly frustrated with the financial relationships their medical executive committee (MEC) members have with the hospitals where they work. These financial relationships can be the cause of troubling conflicts of interest (COI). Medical staffs need to be proactive about the issue.
A hospital based physician’s livelihood (and the economic welfare of his/her family) depends in part on having a good relationship with the administration of the hospital where he or she works. It is easy, therefore, to see how the physician would be hard pressed to go against the hospital on controversial matters. The same goes for a full time employed physician of a hospital and even a medical director who may derive significant compensation from his or her relationship with the hospital.
Looked at another way, what about a physician who staffs a hospital based department at hospital #1 who wants to get on staff of competing hospital #2? What about the physician who is employed by hospital #1 becoming a member of hospital #2 and who wants to become president of hospital 2’s medical staff?
Intertwined financial relationships between hospitals and physician are on the rise. The complexity of an ever evolving business model brings hospitals and physicians closer and closer, which creates significant COIs. MECs must take a good look at what circumstances constitute a COI and develop methods to counteract them.
A COI basically exists for an MEC member when the member has a relationship with a party which causes the member to place his or her personal interests before those interests of the medical staff as a whole. A classic COI is a financial relationship with the hospital. If an MEC member receives money from a hospital for providing a service to or on behalf of a hospital, a COI exists. But the inquiry does not stop there. Simply having a COI is not dispositive. The question is what to do about it.
There is essentially a two step process involved for an MEC member with a COI. First, the COI must be disclosed. This ought to be done annually and at each MEC meeting. Second, on any matter where the COI is implicated, the MEC member ought to recuse himself or herself from a vote on the matter. They can participate in the MEC consideration, but should leave the room when the vote is taken.
There is a third option, a poison pill of sorts. If an MEC member find that the COI has him or her bouncing in and out of the MEC meeting room regularly, there ought to be consideration given to the person’s resignation.
At the very least, medical staffs must develop policies and procedures regarding COIs. COIs ought to be defined and handled on a predetermined basis. Moreover, medical staffs should give serious consideration to ensuring that at least a majority of the MEC members do not have a COI that would prevent them from doing their job, which is to ensure the integrity and proper functioning of the medical staff.
