Medical Politics/Policy/Healthcare Reform

Hospital Governing Boards

Re: 1. Rensimer Report on Oct 4^th Physician Leadership/CI Event

2. Proposal for Task Force on Governing Boards

1. I sent out a report to many Houston-area physicians on our Oct 4^th speaking event by Alice Gosfield is a call to action and lays the foundation for a quality-driven payor environment; ACOs being one type of that. Would you think that document as is (with a brief preface explaining the circumstances that generated it) or somewhat edited to a piece directed at a more general, less local audience, would be worth submitting to the TMA or AMA for publication? My skin is thick, so be direct about whether there is value for the profession to hear this message as ACO-type reform is imminent.
2. Texas Medical Association Task Force (TF) on Governing Boards: Per my comments earlier this year and at the Oct 21 Physician-Patient Advocacy Committee, would it be of benefit for the TMA (and possibly the AMA) to take this issue on with an intent to?,
   1. Study GB characteristics in for-profit v. non-profit hospitals.
      1. How members are qualified to be seated on a GB
      2. How transparency for conflicts of interest between GB members is established and monitored and reported.
      3. How individual GB members should and do participate in GB agenda formation and voting on issues.
   2. Research the way that Organized Medical Staff (OMS) actually and should interact with and effectively influence (I doubt the latter is true at all) GBs by,
   1. Their voting representation
   2. Accessibility to individual GB members
   3. Study GB accountability,
   1. How qualified are members to vote on the issues brought before them?
   2. What is the responsibility of GB to be informed on crucial issues before exercising a vote and how is it validated that they are duly prepared?
3. If a GB shows a pattern of behavior inconsistent with the interests of the community, how is that confronted?

There are other issues that could be tackled by a GB TF. But, the point would be to make the case that without substantive accountability by GB’s to the public and to the OMSs, then OMS self-governance is a sham and the OMS cannot uphold its obligation as advocate for patients effectively. The goals of such a TF would be,

1. Codify guidelines and rules for proper GB performance per the medical profession.
2. Define operational GB mechanisms for,
   1. Accountability
   2. Transparency
   3. Communication
   4. Competency
3. Propose a watch-dog mechanism outside the OMS, hospital Administration, and GB to oversee and enforce the above, with the power to,
   1. Disqualify GB officers/members
   2. Disband GBs
   3. Take legal action, as needed, against GBs or individual member for wrongdoing.
4. Define and implement a lobbying/legislative agenda to achieve the above.

My experience as Chief of Staff and my entire political path has led me to conclude that without this type of reform, there is no hope for this profession effectively standing for patients and quality care.

Edward R. Rensimer, MD