Transparency, Shield Law, and more …

INSIDE THE ISSUE
> Hospital/Health System Transparency
> Codifying Shield Law
> The Static Cost Growth Benchmark
> UHG Insurer Penalized
> Limiting Insurer Use of AI
> An Insightful Globe Story
> Transitions
MONDAY REPORT
A Transparent Look at Healthcare Transparency
As 2025 begins, the issue of “transparency” in healthcare is once again generating great attention even though volumes of healthcare data – from finances to disease rates, to staffing, outcomes, mortality, and more – have been submitted by hospitals in a timely manner and reported regularly for years.
The new healthcare oversight bill that Governor Maura Healey signed last Wednesday is especially focused on bringing more transparency to private equity investments in the health sector, brought on by the bankruptcy of Steward Health Care. Steward repeatedly failed to file with the state the mandated financial data that all others Massachusetts hospitals are required to submit. That made the system an outlier from every other hospital in the state, all of which have reported their financial information to the Center of Health Information and Analysis (CHIA) over the past decade-plus with only a few exceptions. A recent report from the state auditor was critical of CHIA for not getting the Steward data, even though CHIA and the state had sued Steward for its failure to file.
Because the rogue Steward system has roiled the entire healthcare system, as well as the regulators overseeing it, it’s important to step back to take a transparent look at what already is being filed by every Massachusetts hospital.
Five times a year (once quarterly and once for the state’s final report), CHIA reports on more than 80 elements relating to hospital finances and temporary staffing based on information that hospitals and health systems submit to the agency. These range from core financial statistics such as operating margins, long-term debt, and salary and benefit expenses, to more specific details such as short-term investments; gross value of property, plant and equipment; amounts expected to be received from third parties; revenue received from alternative payment methods; and amounts paid for outside medical and pharmacy services, among many, many other items.
Once a year, hospitals also participate in a massive “cost report” data dump with the state consisting of more than 12,000 data points, of which approximately 3,900 are reported by hospitals, as well as another 2,000 imported from a separate report that hospitals contribute to.

“The financial underpinnings of Massachusetts hospitals, including the physician practices and other entities under a hospital health system’s control, are exhaustively reported on and made public,” said Mike Sroczynski, MHA’s executive vice president and general counsel. “Our member hospitals take pride in completing each and every one of these reporting obligations on time; their track record speaks for itself. While it is unfortunate that Steward was an outlier in not complying with the law, the reality remains that Massachusetts has the most robust reporting requirements and most transparent hospital sector in the nation; we have served as an example for other states to follow.”
The hospitals in the Heywood Healthcare system – Heywood and Athol hospitals – were also singled out in the auditor’s criticism of CHIA. But that system was an outlier in that its one-time reporting lapse was due largely to the failure of its electronic medical record (EMR) system that was integrated with the system’s revenue cycle. The EMR snafu was one of the contributing factors that led to the system entering Chapter 11. Following a year of restructuring efforts under the leadership of new CEO Rozanna Penney, the system independently exited Chapter 11 on September 30, 2024.
“Though the system was unable to provide audited financials, we made unaudited internal financial reports and any other obtainable operational data available to state officials and regulatory agencies prior to the filing of Chapter 11, and the organization maintained transparency throughout the bankruptcy process,” Penney said last week.
Hospitals also file price transparency data under federal law. Since January 1, 2021, each hospital operating in the United States has been required to provide clear, accessible pricing information online about the items and services they provide in both a comprehensive machine-readable file with all items and services, as well as through a consumer-friendly format.
Anyone interested in COVID-19 rates or the incidence of flu or RSV can get it through state websites fueled by hospital reporting. Since the COVID pandemic, hospitals file reports on daily occupancy, staffed beds, and other elements to both Massachusetts and the federal government. Under the historic Medicaid waiver, Massachusetts hospitals are leading the nation in collecting enhanced patient data to better identify disparities across race, ethnicity, language, and disability (RELD), and sexual orientation and gender identity (SOGI). Hospitals submit data to track behavioral health boarding (see below) and hospital throughput, in addition to a host of quality measures that drive funding under value-based care agreements with commercial payers.
“Data collection for the past decade-plus has been essential in informing the direction of our commonwealth’s healthcare system,” MHA’s Sroczynski said. “It’s important to recognize the enormous efforts the healthcare community has made in providing this data as well as the work of regulators to put it to good use.”
Registration Boards Line Up to Codify Shield Law in Regulations
Massachusetts is clarifying the legal shielding it provides caregivers in the state that provide reproductive and gender-affirming healthcare services. Last week, the licensing boards under the Department of Public Health each met to issue emergency regulatory amendments to codify the so-called “Shield Law” or An Act Expanding Protections for Reproductive and Gender Affirming Care that Governor Healey signed into law in 2022.
That law, passed in reaction to the U.S. Supreme Court’s Dobbs decision that ended federal legal protection for abortion, protects Massachusetts-based providers from civil and criminal actions in other states that restrict or criminalize reproductive and gender-affirming care. The Massachusetts shield law provides protections against out-of-state investigations and prosecutions, professional discipline, civil liability, and adverse actions that threaten providers’ professional liability insurance. It also prohibits Massachusetts law enforcement entities from helping other states investigate or prosecute legally protected healthcare activity.
While the law has been in effect since 2022, and although DPH issued policy guidance, many in the provider community were still uncertain about the protections the law affords them.
So last week the Boards of Registration in nursing, medicine, pharmacy, physician assistants, and psychologists met to issue emergency regulatory amendments that codify aspects of the Shield Law into the boards’ regulations. The emergency regulations are in effect for three months, during which the state will gather comments and hold hearings before finalizing the rules.
Following the vote last Wednesday by the nursing registration board, Governor Healey issued a statement, saying, “When Roe was overturned, we worked with the Legislature to take immediate action to protect providers and patients from liability for providing or receiving an abortion. Today, with attacks on reproductive healthcare and providers escalating across the country, we’re proud to take action to further strengthen those protections. In Massachusetts, we’re always going to protect people’s rights and freedoms, and we’re going to make sure that everyone can access the high-quality healthcare they need.”
Default Healthcare Cost Benchmark Once Again Set at 3.6%
Last week, Secretary of Administration and Finance Matthew J. Gorzkowicz, House Ways and Means Chair Aaron Michlewitz (D-Boston), and Senate Ways and Means Chair Michael Rodrigues (D-Westport) agreed on a consensus state revenue forecast for Fiscal Year 2026 of $43.614 billion, including the income surtax. This revenue basis sets the foundation for proposed state government spending proposals from the governor and legislature for the next fiscal year. Later this month, Governor Healey will propose her FY2026 spending plan and the House and Senate will take up their budget proposals in the spring.
As part of this consensus revenue process, the Executive Office for Administration and Finance and the House and Senate Committees on Ways and Means also determined the “potential gross state product” (PGSP) growth benchmark for calendar year 2025, as required by state law. The PGSP growth benchmark is the commonwealth’s default healthcare cost growth benchmark that the Health Policy Commission (HPC) establishes each year. While the HPC has the ability to set a different amount, it has always defaulted to the PGSP as the basis, including a period where state law mandated a 0.5% discount to the PGSP amount.
For more than a decade since the benchmark’s creation in 2012, state policymakers have always determined the PGSP to be 3.6% despite varying future and past measures of the state’s gross domestic product. Specifically, since the PGSP and healthcare cost benchmark process was established in 2012, the average growth rate in Massachusetts gross state product has been 4.8%, according to the U.S. Bureau of Economic Analysis. Therefore, the potential gross state product growth rate and commensurate healthcare cost benchmark has been set at a much lower rate than actual Massachusetts economic growth. Financial firms also update their predictions for state economic growth each year. MHA has frequently advocated for an updated benchmark process that takes into account actual inflationary pressures as well as other factors that inform economic growth forecasts.
UnitedHealth Group-Affiliated Insurers Penalized
Suffolk Superior Court has ordered three UnitedHealth insurance companies operating in Massachusetts – HealthMarkets, The Chesapeake Life Insurance Company, and HealthMarkets Insurance Agency – to pay more than $50 million in restitution to Massachusetts consumers and more than $115 million in civil penalties to the commonwealth for misleading consumers.
The UnitedHealth Group subsidiaries were sued by Attorney General Andrea Joy Campbell’s office under the Massachusetts Consumer Protection Act.
“For years, the defendants preyed on financially vulnerable individuals, deceiving them into buying products they didn’t need or couldn’t afford,” Campbell said.
The court found that the companies’ sales agents deceived consumers when they claimed they represented all insurers operating in Massachusetts and when they claimed objectivity when offering products. The court also found, according to the AG’s office, “that the defendants engaged in widespread misrepresentations of supplemental health insurance that they sold in Massachusetts, including intentionally engaging in bundling of major medical and supplemental insurance to deceive consumers into unknowingly buying supplemental polices.”
The civil penalty is believed to be the largest deriving from an action brought by the Attorney General’s Office under the Massachusetts Consumer Protection Act.
California Limits Insurers’ Use of AI
California’s The Physicians Make Decisions Act (SB1120) went into effect on January 1, cracking down on the use of artificial intelligence (AI) by insurance companies to deny claims routinely and automatically.
The law requires that a denial, delay, or modification of healthcare services based on medical necessity be made by a licensed physician or other healthcare provider competent to evaluate the specific clinical issues of the case. That means that insurers can’t rely on an AI algorithm to make the final decision. The law also creates new guidelines for companies that choose to use AI in their utilization review process.
A widely cited article in ProPublica drew attention to the issue as it detailed how Cigna doctors rejected claims every 1.2 seconds using an algorithm that bundled denials, allowing the MDs to “click and submit” rejections “50 at a time.”
MHA supported legislation in the last session that would have curbed insurers’ use of AI in making claims denials.
Globe Story Provides an Inside Look at Healthcare Dynamics
“It’s a broken system, and we’re doing our best to fix it.”
That was the gist of a thoughtful Boston Globe story posted last Friday, which spelled out many of the dynamics now defining Massachusetts’ provider community, while also following the experiences of MHA President & CEO Steve Walsh.
The piece, written by veteran Globe reporter Robert Weisman, touched upon the major capacity and labor constraints that are challenging hospitals’ ability to deliver care. South Shore Hospital is one such organization that has operated over its capacity for many months.
“You’re doing something right,” Walsh said at a recent meeting of the South Shore Health Board of Trustees, which the Globe attended. “You’re 200 people over census, and there’s no chaos. That’s remarkable.”
The hot-button issue of healthcare costs was also covered, with Walsh explaining that arguments around affordability too often devolve into a “blame game.” “We have to push back on this ridiculousness,” he was quoted as telling the South Shore leaders.
And in perhaps the most resonant point for local providers, the piece shared Walsh’s view that the worsening healthcare crisis is still flying under the radar. “The fragility of the healthcare system right now is beyond what anybody outside the walls of healthcare understands,” he said.
Transitions
Tom Sands, the president of Beverly, Addison Gilbert, and BayRidge hospitals, will now also serve as the president of Anna Jaques Hospital following the January 8 departure of Dr. Glenn Focht. The hospitals are part of the Beth Israel Lahey Health system of which Sands serves as Market President – North Shore.
Southcoast Health’s President & CEO David McCready has been elected as an at-large delegate to the American Hospital Association’s (AHA’s) Regional Policy Board 1. There are nine such policy boards across the U.S. that meet throughout the year to help shape the advocacy of the AHA while fostering communication between it, state hospital associations, and member hospitals. McCready, a member of the MHA Board of Trustees, has led Southcoast Health since October 2023. The system consists of Charlton Memorial in Fall River, St. Luke’s in New Bedford, and Tobey in Wareham, as well as a physician network and numerous ancillary healthcare services.
Doug Brown, the well-known Massachusetts healthcare executive who most recently was president of community hospitals and chief administrative and legal officer for UMass Memorial Health, has become a partner of Manatt, Phelps & Phillips’ Health Care industry group in Boston. In his new role, Brown will provide legal counsel and strategic consulting to a range of healthcare organizations throughout New England and nationally across transactions, litigation, governance, health policy and regulatory matters. Brown is a former member of the MHA and American Hospital Association Board of Trustees.
U.S. Rep. Jake Auchincloss has been added to the House Energy and Commerce Committee, which has jurisdiction over Medicaid, Medicare Part B, and numerous other health-related issues. He joins delegation member Rep. Lori Trahan, who has been a member of the committee since 2021.