And then there's enforcement. The law calls for the formation of a commission to track healthcare costs and all healthcare entities must comply with the performance targets or face fines of as much as $500,000. The commission will use a total system metric to assess performance, and health plans must also meet the reduction targets.
Those hospitals or health systems that don't hit the targets would be publicly exposed. But, these sums are just drops in the bucket for large health systems with millions and in some cases billions in annual revenue, especially considering these organizations could potentially lose millions once insurer contracts are renegotiated.
Unfortunately, four of the state's largest hospitals, Beth Israel Deaconess Medical Center, Massachusetts General Hospital, Brigham and Women's Hospital, and Hallmark Health declined requests for comment. They may be still parsing through the details and working on their compliance strategies.
As perhaps they should. "When the state's Attorney General [Martha Coakley] says she feels there's plenty of enforcement authority associated with the bill, I take that as a signal that the AG intends to be active, not passive, when it comes to insuring the implementation and execution of the legislation," says Sadowski.
And it was Coakley's office that helped spark the state legislature's interest in this issue to begin with. The AG's office released reports in 2010 and 2011 indicating that costs were, to paraphrase, unequivocally uncontained.