Hospital and Medical Practice Governance: The Role of Medical Executive Committees
The by-laws of hospitals, legal corporations, and practice groups outline the governance rules for these entities. However, hospitals typically cannot self-govern entirely. They have structures in place to prevent the corporate practice of medicine. Key among these structures are the physicians themselves, who organize and largely self-govern through a Medical Executive Committee (MEC).
For a detailed analysis of MEC rules, click here. Stanford Medical Staff ByLaws
One effective strategy used by good law firms is to align their work with existing frameworks used by large organizations. Generally, courts favor large entities (such as county organizations) and uphold their rules, enforcing them in a balanced manner. If your attorney is setting up by-laws for a smaller group, mirroring the practices of larger entities can provide an additional layer of protection.
What Does a Medical Executive Committee (MEC) Do?
A Medical Executive Committee (MEC) is responsible for making important medical and clinical decisions, overseeing medical staff, and addressing various healthcare-related issues within the organization.
A good webpage for seeing the structure of the MEC as it oversees operations is the Stanford Website. The site shows how the MEC structurally works with the other physician led entities.
The specific roles and responsibilities of a Medical Executive Committee may vary depending on the healthcare organization’s structure and policies as well as state law but some common functions include:
Governance and Leadership
The MEC plays a key role in setting the strategic direction and policies related to patient care, medical staff, and clinical services.
Credentialing and Privileging
The committee evaluates and approves the credentials and privileges of physicians and other healthcare providers who seek to practice within the organization. This ensures that only qualified and competent professionals are granted the authority to provide patient care.
Peer Review
The MEC oversees a peer review process to evaluate the quality of medical care provided by the medical staff. This may involve reviewing adverse events, complications, and patient outcomes to identify areas for improvement.
Compliance and Ethics
The committee may have a role in ensuring that medical staff members adhere to ethical standards and comply with relevant laws, regulations, and organizational policies.
Quality Improvement
MEC members often collaborate with other hospital committees to implement quality improvement initiatives, enhance patient safety, and promote evidence-based practices.
Liaison with Administration
The MEC serves as a bridge between the medical staff and the hospital administration, fostering communication and cooperation between the two groups.
Policy Development
The committee may participate in developing medical policies and protocols, ensuring that the medical staff follows best practices and evidence-based guidelines.
Composition of the Medical Executive Committee
Members of the Medical Executive Committee (MEC) are typically elected or appointed based on their professional qualifications and experience. The committee often includes key figures such as the Chief Medical Officer (CMO), the Medical Director, department chairs, and representatives from various medical specialties. The Chief of Staff, usually the highest-ranking physician in the organization, often presides over the committee. This diverse composition ensures comprehensive oversight and governance of medical practices within the organization.
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What Laws Require a Medical Executive Committee (MEC) to Exist?
The Medical Executive Committee (MEC) plays a crucial role in ensuring the delivery of high-quality medical care and promoting effective collaboration among medical staff, administration, and other stakeholders within the healthcare organization.
In California, the MEC is defined and regulated under Cal. Code Regs. title 22 § 71503. This section states:
(a) Each hospital shall have an organized medical staff responsible to the governing body for the fitness, adequacy, and quality of the care rendered to patients.
(b) Medical staff membership: (1) The medical staff shall be composed of physicians and, where dental or podiatric services are provided, dentists or podiatrists. (2) As required by section 1316.5 of the Health and Safety Code: (A) Where clinical psychological services are provided by clinical psychologists in a health facility owned and operated by the state, the facility shall establish rules and medical staff bylaws that include provisions for medical staff membership and clinical privileges for clinical psychologists within the scope of their licensure as psychologists. (B) Where clinical psychological services are provided by clinical psychologists in a health facility not owned or operated by the state, the facility may enable the appointment of clinical psychologists to the medical staff.
(c) The medical staff, by vote of the members and with the approval of the governing body, shall adopt written bylaws which provide formal procedures for the evaluation of staff applications and credentials, appointments, reappointments, assignment of clinical privileges, appeals mechanisms, and other subjects or conditions deemed appropriate. The medical staff shall abide by and establish a means of enforcement of its bylaws. Medical staff bylaws, rules, and regulations shall not deny or restrict, within the scope of their licensure, the voting rights of staff members or assign staff members to any special class or category of staff membership based on whether such staff members hold an M.D., D.O., D.P.M. degree, or clinical psychology license.
(d) The medical staff shall meet regularly. Minutes of each meeting shall be retained and filed at the hospital.
(e) The medical staff bylaws, rules, and regulations shall include provisions for the performance of the following functions: executive review, credentialing, medical records, tissue review, utilization review, infection control, pharmacy and therapeutics, and assisting medical staff members impaired by chemical dependency and/or mental illness to obtain necessary rehabilitation services. These functions may be performed by individual committees, or when appropriate, all functions or more than one function may be performed by a single committee. Reports of activities and recommendations relating to these functions shall be made to the executive committee and the governing body as frequently as necessary and at least quarterly.
(f) The medical staff shall provide in its bylaws, rules, and regulations for appropriate practices and procedures to be observed in the various departments of the hospital. The practice of division of fees, under any guise whatsoever, shall be prohibited and any such division of fees shall be cause for exclusion from the staff.
(g) The medical staff shall provide for the availability of a staff physician or psychologist for emergencies among the in-hospital population in the event that the attending physician or psychologist or their alternate is not available.
(h) The medical staff shall participate in a continuing program of professional education. The results of retrospective medical care evaluation shall be used to determine the continuing education needs. Evidence of participation in such programs shall be available.
For more detailed information, you can refer to the California Code of Regulations and the Health and Safety Code.
Powers of the Medical Executive Committee (MEC)
When a physician seeks employment with a group or credentials with a hospital, the Medical Executive Committee (MEC) takes tremendous control over the MD’s life. A summary suspension over 14 days is state reportable to the medical board (in California) and 30 days is reported to the National Practitioner Data Bank1. These are removed if the physician later prevails, but the career-threatening power of the MEC should not be underestimated.
Before joining an organization, know who controls the MEC. Most MECs are controlled on paper by the medical staff but in reality by management. Power cliques can wrest control of the MEC from less political but more medically oriented physicians, changing the direction of the hospital and the conditions of your employment.
At times, the MEC can target a physician with unjustified suspensions, investigations, and reporting. (See our article titled Physicians Have Less Rights than Criminals). When a committee targets a physician with an unfair MEC investigation, legal representation is necessary.
Rarely do hostile actions resolve without the intervention of an attorney and in truth, even then the lack of physician rights makes the path difficult.
JOINT COMMISSION
The Joint Commission sets standards for the governance and operation of Medical Executive Committees (MECs) within healthcare organizations. While the Joint Commission does not have specific rules solely for MECs, it provides comprehensive guidelines that impact their functions. Here are some key points:
Governance and Leadership
The Joint Commission emphasizes the importance of effective governance and leadership within healthcare organizations. This includes ensuring that the MEC plays a crucial role in setting strategic directions and policies related to patient care, medical staff, and clinical services.
Credentialing and Privileging
The MEC is responsible for the credentialing and privileging of medical staff. The Joint Commission requires that healthcare organizations have a thorough process for evaluating and approving the credentials and privileges of physicians and other healthcare providers.
Peer Review
The MEC oversees the peer review process to ensure the quality of medical care provided by the medical staff. This involves reviewing adverse events, complications, and patient outcomes to identify areas for improvement.
Compliance and Ethics
Quality Improvement
Liaison with Administration
Remember that the hospital governing board is ultimately responsible for hospital safety and credentialing. The Medicare COP's make it very clear that the Board of Directors is above the MEC.
The Eight Unnamed Physicians Case (MEC Gone Haywire)
To understand how the Medical Executive Committee (MEC) can morph into a Frankenstein, consider the case of Eight Unnamed Physicians v. Medical Executive Committee. This case involves physicians who were eight of 11 members of a medical group that had, for years, arranged to provide all necessary anesthesia services at the hospital in return for a virtually exclusive opportunity to do so.
On Saturday, November 20, 2004, the hospital was informed that the physicians would be transferring their practices to a different hospital on the upcoming Monday, November 22. The Medical Executive Committee (MEC) aimed to individually discipline the physicians for this abrupt cessation of services, which purportedly could have endangered patient safety and eroded public trust in the hospital. The physicians refuted the allegations, asserting that they had made arrangements for adequate coverage.
The rest of this published case outlines the battle. The key point is that a business dispute put a gun in the hand of the MEC, and the MEC used the discipline process as a litigation substitute. The case is too long and detailed to discuss here, but the spoiler is that the physicians had far fewer options than you would think.
The Structure of a Medical Executive Committee (MEC)
What is the Composition of a Medical Executive Committee (MEC)?
The composition and leadership of a Medical Executive Committee (MEC) can vary depending on the healthcare organization and its structure. The current trend in hospital ownership centralizes power and control at the executive level, often with executives who are not medical professionals. Technically, the MEC is responsible for overseeing medical staff affairs and clinical quality within a healthcare facility. In a tiered approach, the MEC is consulted by the executive level team, and ultimate authority rests with the board of directors. In practice, most boards are rubber stamps for corporate executives. The MEC is theoretically independent, but the overlap with management can call that independence into question.
The MEC represents the medical staff but acts primarily as an independent entity, much like Congress represents the public – or not. Common job titles for those involved in running a Medical Executive Committee include:
Composition of a Medical Executive Committee (MEC)
Chief Medical Officer (CMO): The CMO is often a high-ranking physician within the organization and typically serves as the chairperson of the MEC. They provide leadership and guidance to the committee and represent the medical staff to the hospital administration.
Medical Staff President: In some organizations, the president of the medical staff, who is typically elected by the medical staff members, may lead the MEC or serve as a key member. This role varies depending on the hospital’s bylaws.
Hospital CEO/Administrator: The hospital’s chief executive officer or administrator may be a member of the MEC or attend MEC meetings to provide input from the administrative perspective.
Other Medical Staff Leaders: The MEC may include other medical staff leaders, such as the Vice President of the Medical Staff or department chairs, who help coordinate and lead the committee’s activities.
Medical Staff Members: The MEC often includes elected representatives from various medical departments or specialties within the hospital. These representatives bring the concerns and perspectives of their respective departments to the committee.
Quality and Safety Officers: Individuals responsible for quality and patient safety within the organization may also be part of the MEC to ensure that clinical standards and patient care are closely monitored.
Legal and Compliance Advisors: Some MECs may have legal counsel and compliance officers to provide guidance on legal and regulatory matters related to medical staff affairs.
In a best-case scenario, the Medical Executive Committee and hospital administration have a level of tension, ensuring real checks and balances. In reality, the hospital administration drives customers, reimbursements, and advertising, so MEC committee members who represent and act on behalf of medical staff will have personal interests that are exploited by management to help control and drive their decisions.
Conclusion
The Medical Executive Committee (MEC) serves as the voice of the medical staff, providing a crucial check on corporate greed, the corporate practice of medicine, and the substandard practices of poor-quality physicians. It plays a vital role in maintaining the integrity and quality of healthcare services within an organization.
However, the effectiveness of the MEC can be compromised. There is often little oversight and few controls when an MEC is corrupted by hospital management or influenced by personal agendas and self-interested decisions. This lack of accountability can lead to unjustified actions against physicians, putting their careers at risk.
Expert Physician Lawyers
We represent many physicians whose careers are jeopardized by hostile and completely unjustified MEC practices. Our legal team is dedicated to defending the rights of medical professionals and ensuring that the MEC operates fairly and transparently. If you are facing challenges with your MEC, it is crucial to seek legal representation to protect your career and professional reputation.
See our MEC Webpage
Call our office at (925) 291-5388 to schedule an initial case review. (Our phones are answered by real people who physically work in our office.) Or fill out the confidential contact form below.
