For-profit hospitals are lobbying the Joint Commission for their own seat on the group's 28-member board.
The American Hospital Association controls seven of those seats, but none is held by an executive from the for-profit side of the industry.
Thomas Scully, president of the Federation of American Health Systems, said for-profits should have their own seat, which would enable their specific concerns to be heard.
That's especially true, Scully said, when other seats are controlled by special-interest groups that go toe-to-toe with for-profit hospitals in the field, namely organized labor.
Unionized workers have been a frequent irritant to for-profit hospitals, which workers have accused of cutting staff and shortcutting patient care to reduce their operating costs. In some cases, unionized workers have brought their complaints to the Joint Commission on Accreditation of Healthcare Organizations.
One of the Joint Commission's six public board seats is filled by a representative from the AFL-CIO. Gerald Shea, who joined the Joint Commission's board in January 1997, is assistant to the president for government affairs at the labor federation.
In January, Scully led a delegation of for-profit hospital executives to the Joint Commission's Oakbrook Terrace, Ill., headquarters to push for a for-profit hospital board seat.
Scully said Joint Commission President Dennis O'Leary, M.D., told him that his complaint should be addressed to the AHA and the American Medical Association, which also controls seven JCAHO board seats.
Scully said he has asked such for-profit hospital chains as Columbia/HCA Healthcare Corp., Tenet Healthcare Corp. and Quorum Health Group to take up the issue with the AHA.
Jonathan Lord, M.D., the AHA's chief operating officer, said: "The AHA has a nomination process (to the board) that considers a whole host of factors. I'm sure as we look at nominations in the future, that will be a factor that's considered."
The Joint Commission's official policy is that it really shouldn't matter who represents which organizations on the board. There is no policy that all commissioners must come from not-for-profits. Indeed, for-profit or not-for-profit is not a criterion.
"Those members are sitting in that boardroom as commissioners of the Joint Commission and to act in the best interest of the Joint Commission to serve the public," said Janet McIntyre, JCAHO spokeswoman.
The last group to lobby the Joint Commission for its own board seat was the American Nurses Association, which threatened to sue the JCAHO if it didn't concede.
The Joint Commission refused to designate a seat for the ANA but added an at-large nursing seat on the board in March 1992.