It must be spring, as sweethearts abound. This being a business magazine, I am of course referring to the kind of sweethearts who favor dark suits and seal the deal with a wink and a handshake, not necessarily a kiss.
We have all read of the lovebirds named Halliburton and Bechtel. These firms have won the right to reconstruct and run oil production facilities and rebuild public infrastructure in Iraq without regard to a public competitive bidding process. Our healthcare lovebirds aren't as famous, but they are singing the same song.
In New York state, officials of a quasi-public provider were alleged to have taken illegal gifts from competing information technology vendors that included free limousine and plane rides, hotel stays, meals and hockey tickets (May 5, p. 18). There was the special exemption to the Florida certificate-of-need law granted to Villages Regional Medical Center, developed by a wealthy contributor to the Republican Party, which controls the state government (May 5, p. 6). And, as always, there is the chummy relationship between pharmaceutical companies and physicians and health plans, which often involves freebies from lavish meals to crates of products to vacation trips and even direct payoffs.
The gifting in New York occurred at Nassau Health Care Corp., East Meadow, which operates one hospital and seven community health clinics. I was quite taken with the comments of Nassau's chief executive, Richard Turan, that he and six other executives who accepted more than $10,000 in freebies in the process of selecting a multimillion-dollar information technology vendor were merely following "standard business practice in the real world."
The New York State Ethics Commission, which can back up its finding with a $10,000 fine for each of 87 alleged infractions, begs to disagree.
I don't wish to single out Turan or Nassau. In fact, Turan is correct in his belief that corporate gifting in the contract process is standard business practice in our country, and the gifts in the Nassau case were small potatoes. Free trips, free meals, golf clubs, cash incentives, just about anything is available to win business in the private sector. Whole conventions and seminars are arranged for the business of giving gifts and cutting exclusive deals.
Yes, it is standard operating procedure. No, it isn't ethical. Often, it's illegal. And it's really pretty simple. If you take something of value, you are beholden to the giver. It's just human nature. The result is that you are far more likely to favor the company that helps you the most, not necessarily the company that has the best product. The American College of Healthcare Executives' Code of Ethics is quite clear on this issue: "Accept no gifts or benefits offered with the express or implied expectation of influencing a management decision."
Healthcare must abide by a different standard of conduct than private businesses. Money wasted in the healthcare system is money that can't be used to provide care to patients. Anticompetitive deals stifle innovation and quality of care.
The Medicare and Medicaid programs offer another way of controlling unethical behavior. Outgoing HHS Inspector General Janet Rehnquist has issued a needed guidance spelling out that drugmakers' incentives to doctors, hospitals or health plans to encourage them to switch patients to their drugs or to influence which drugs appear on drug formularies violate federal antikickback laws.
Strict enforcement of the law and better self-policing by the industry are needed. Sweetheart deals need to become as distant a memory as a first date.
What do you think?
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