But as a paid lobbyist and the head of the trade association that represents almost all the state’s hospitals, Walsh’s service on the commission presents a massive conflict of interest — or at least, an appearance of one.
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The state law establishing the commission tries to avoid conflicts by prohibiting commission members from being affiliated with, having a financial stake in, or being a representative of a health care entity. A “health care entity” is defined as a provider or an insurance carrier.
Healey’s office says the trade association isn’t a provider, so Walsh is eligible. That view isn’t universal. Attorney James Roosevelt prepared a memo for the Massachusetts Association of Health Plans arguing that because the hospital association president is the chief representative of an association comprised entirely of health entities, Walsh should be barred from serving.
Legal interpretation aside, it’s undisputed that the Massachusetts Health and Hospital Association is funded by dues paid by hospitals and health systems, and Walsh is paid by the association. The association’s 2022 tax forms reported paying Walsh $984,646 in reportable compensation, plus $146,126 in “other” compensation, which can include things like retirement or health benefits.
In an ethics disclosure, Walsh committed to recusing himself from any matter that comes before the commission that relates to the hospital association, and from considering filings by association members related to acquisitions or mergers, expansions, or performance improvement plans. He wrote that he will work with commission attorneys on an ongoing basis to determine if additional recusals are warranted.
In an interview with the editorial board, Walsh said he will have a “bright-line firewall” between his day job and his commission work. Walsh said he believes he can bring perspective from his work with the hospital association and from prior jobs in the Legislature and a council representing community hospitals to be part of the conversation “to make sure we have an affordable system that stays best in class.”
Healey spokesperson Karissa Hand called Walsh “uniquely qualified,” noting “his deep understanding of the current challenges facing hospitals, his work with 70 community hospitals across the state, and his experience as a legislator and policymaker.”
The problem with relying on Walsh to recuse himself, however, is almost all the policies discussed by the Health Policy Commission could affect hospitals. Could Walsh truly be an honest broker in conversations about provider price caps, site-neutral payments, or other policies that would affect how much hospitals get paid?
Paul Hattis, a health policy expert and senior fellow at the Lown Institute, was part of a Greater Boston Interfaith Organization group that wrote to Healey expressing concern about Walsh’s conflict of interest. Hattis said virtually every significant transaction that comes before the Health Policy Commission involves a dues-paying member of the hospital association, and if Walsh must recuse himself, “We’re putting someone on the board who effectively won’t be able to function as a board member at the time we need them.”
There are similar concerns about another new appointee, Chris Leibman, who is senior vice president and chief access head at Biogen at a time when the Health Policy Commission has new authority to oversee pharmaceutical company spending.
State Senator Cindy Friedman, who cochairs the Committee on Health Care Financing, said having two appointees representing health care entities that fall under the Health Policy Commission’s purview “raises legitimate and deep concerns about potential conflicts of interest.” Restrictions imposed on them to avoid conflicts of interest “will significantly limit their involvement in critical recommendations and decisions that the Health Policy Commission is statutorily required to make,” Friedman told the editorial board.
The reason Walsh and Leibman were appointed now is because of a law passed by the Legislature and signed by Healey in January that reserves one commission seat for someone with “demonstrated expertise in representing hospitals or hospital health systems” and another for someone with “demonstrated expertise in health care innovation, including pharmaceuticals, biotechnology or medical devices.” The goal was to add more people with on-the-ground experience in the health care industry to a board primarily composed of policy experts and retirees. House Speaker Ron Mariano said lawmakers wanted to ensure every sector of the health care industry was represented.
But there are presumably people in Massachusetts who fit those requirements without the same conflicts of interest: a retired chief executive; someone who moved from health care into consulting, policy, or academia; or someone with experience in another state.
As the new commissioners begin work, they will have to prove they are capable of looking out for the interests of the state’s residents and the health care system overall — not just one segment of the industry.
Editorials represent the views of the Boston Globe Editorial Board. Follow us @GlobeOpinion.