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UMass Memorial Health’s unwavering decision to close the Leominster Hospital Maternity Ward sent a clear signal to Beacon Hill that the Department of Public Health needs more leverage to bear in these situations.
And that can only happen through the Legislature, which must provide the DPH with the authority to make shuttering a vital medical service a difficult, painstaking process.
If that were the case, UMass Memorial Health probably wouldn’t have gone forward with its September 2023 closure.
As we previously predicted at the time, as long as UMass Memorial Health followed the current protocol, the state was powerless to alter the closure’s course.
The announcement reaffirming its intention to close came only hours after the Worcester legislative delegation joined with North Central Mass. lawmakers to request a delay.
That, like previous petitions, fell on deaf ears, even over the DPH and lawmakers’ objections.
The Health Policy Commission, in its quest to control health-care costs, works under the same limitations.
Although it’s an independent state agency charged with monitoring cost trends, as with the DPH, the Health Policy Commission can only make recommendations, not issue binding mandates.
Since the HPC has no real enforcement powers, we shouldn’t be surprised that its health-care cost-containment goals have been routinely ignored.
In a competitive environment, marketplace forces control the pace of price increases and worker compensation.
Without those restraints, health-care costs find their own level – considerably higher than HPC guidelines.
That’s not how business works in the real world.
The HPC previously set the cost growth benchmark at 3.6% for 2026, despite the fact that total health-care expenditures grew by 8.6% from 2022 to 2023.
While hospitals and other medical facilities routinely blow through cost controls, private industry in this state somehow manages to toe the line HPC expects from its client base.
That’s reflected in the combined data for the Boston-Worcester-Providence, R.I., area for the statistical year that ended in September.
Compensation costs for private industry workers in the Boston metro area rose by 3.3% for that 12-month period.
Nationwide, total compensation and benefit costs for civilian workers increased by 3.5% over the same timeframe.
Undeterred, health-care oversight officials pledged last week to maintain their strategy of setting a cost-containment target, despite their ineffectiveness.
The HPC urged policymakers and health-care leaders to “recommit to the health care cost growth benchmark” in 2026, and “convene to develop consensus on a comprehensive set of reforms.”
The HPC board agreed on the topline recommendation as they voted to issue a new report in response to last month’s cost trends hearing.
As reported by the State House News Service, hours of testimony at the Dec. 11 hearing focused on mounting affordability issues, challenges accessing care, and the threat of massive insurance coverage losses due to federal policy changes.
Critics rightly pointed out the obvious – the benchmark established in 2012 does not represent a strong check on growing costs.
At a recent primary-care task force meeting, Retailers Association of Massachusetts President Jon Hurst said the benchmark “obviously has not been followed for the last decade or so.”
The new cost trends report offers four major and familiar themes for recommendations: administrative complexity, health-care prices, pharmaceutical spending, and low-value care, avoidable health-care visits.
Lora Pellegrini, CEO of the Massachusetts Association of Health Plans, said the HPC, for more than a decade, has identified the same factors driving health-care spending growth.
“The troubling reality is that, year after year, these cost drivers have gone largely unaddressed,” Pellegrini said in a statement.
“And we are now seeing the consequences in real time: premiums climbing faster than wages, cost sharing rising as employers struggle to manage those premiums, and patients facing increasing barriers to care. The affordability challenges we face today are the direct result of a failure to act on what the data has long made clear.”
The HPC says Massachusetts should take action to “dramatically” reduce the “significant administrative complexity” in the system, “prioritizing those that impede care for patients and burden primary-care clinicians and support staff (e.g., prior authorization).”
The HPC recommended Massachusetts tackle “excessive prices” for provider services, noting that other states rein in costs “above a fair, reasonable threshold or moderate price growth to a sustainable rate.”
With rising prescription drug spending, the HPC advises the state to consider forthcoming recommendations from the new Office of Pharmaceutical Policy and Analysis, as well as the Division of Insurance.
The HPC also recommends that Massachusetts should encourage payers and providers to reduce “low value care” and avoidable emergency department visits, ED boarding, and readmissions.
To accomplish that, the state must expand access to behavioral health-care and primary care, which is at the crux of the task force led by the HPC and the Executive Office of Health and Human Services.
“The HPC has outlined a comprehensive and evidence-based roadmap, not once, but repeatedly,” Pellegrini said. “The time to act is now.”
But there’s that word again, recommend.
As we’ve witnessed, words without teeth don’t produce the desired results.
Arm the DPH and HPC with actionable authority to make those recommendations stick.
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