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Ballot-averting deal on hospital payment disparity is hardly a cure

A commission will soon convene to study how Massachusetts hospitals are reimbursed for the care they provide. Yes, yet another study.

It has long been established that some of the state’s biggest medical systems — especially Boston-based Partners HealthCare — wield their market power to negotiate better payment rates from insurers than what community hospitals receive for many of the same tests and procedures, driving up health care costs. That was the finding of a study released earlier this year by the Health Policy Commission, a state watchdog agency. That was the finding of a 2015 study by Attorney General Maura Healey. That was the finding of a 2010 study by Healey’s predecessor, Martha Coakley. And that was one of the findings of an exhaustive 2008 investigation by the Globe Spotlight Team.

So much studying, so little action.

Fast-forward to this spring. Partners executives were holed up in secret meetings with representatives of the Service Employees International Union, Local 1199, in an attempt to scuttle the union’s proposed — and utterly draconian — fix for the disparity in health care pricing. The union was championing a ballot initiative that would have asked Massachusetts voters in November to take about $450 million a year from Partners and dole it out to lower-paid hospitals, many of which have high numbers of patients on public insurance. Some hospital industry insiders believe SEIU’s underlying motivation had little to do with waging a righteous battle for equitable hospital reimbursements — the ballot question was more about gaining leverage to push for more union jobs at Partners facilities. But that’s a matter for another editorial.

Late last month, the parties struck a deal that averted a ballot showdown. The multifaceted backroom agreement won overnight approval from Governor Charlie Baker and State House leadership. It was almost miraculous — nonpartisan consensus on an issue that has generated decades of debate. The problem is, the deal isn’t anything close to a real fix.

First, the pact adds $15 million more to a $250 million tax on hospitals that already is part of the 2017 fiscal year budget being sorted out on Beacon Hill. The modest amount of additional funding will be returned to hospitals in the form of Medicaid payments, based on their reliance on MassHealth dollars. It’s like applying a bandage to a gaping wound.

Second, the agreement establishes a five-year $45 million Community Hospital Reinvestment Trust Fund, which will benefit lower-priced hospitals based on their size. The fund, however, will draw its cash from the budget of the state Center for Health Information and Analysis, or CHIA. That’s unfortunate — the state agency plays a valuable role by monitoring financial performance and trends in the hospital industry. This move effectively renders it superfluous.

Finally, the Partners-SEIU deal that was so swiftly agreed to by elected officials revives a dormant entity called the Special Commission to Review Variation in Prices among Providers. It is this last component of the plan that is most worrisome. Based on the self-congratulatory statements made by Baker, Senate President Stanley C. Rosenberg, and House Speaker Robert A. DeLeo, you might think the study commission’s success is preordained; that the remedy for all that ails the state’s hospital industry is just a few congenial meetings away. If anything, the new board only delays action on pricing, increasing pressure on hospitals that have been struggling for so long that it’s become business as usual. Excuse the skepticism, but in this case, the announcement of a commission sounds too much like punting the ball in a football game.

The 23-member panel is required to meet monthly, starting by September 15. Its final report, “including drafts of proposed legislation if deemed necessary,’’ is due by March 15, 2017. Assuming legislative action is indeed part of the report, that will add months to the timeline. Best case scenario: Another full year passes before anything is done to address the root causes of hospital pricing disparities. That’s hardly the way to take on what just about everyone in the industry labels a “crisis.’’

The commission’s makeup also is reason for concern. Members are to include political appointments and state officials, as well as a representative of a “leading health care labor organization.’’ Hello, SEIU. Other slots will go to vested organizations such as the Massachusetts Association of Health Plans, Blue Cross Blue Shield of Massachusetts, the Massachusetts Council of Community Hospitals, the Massachusetts Hospital Association, a hospital with more than 800 beds (a requirement that only Partners’ Massachusetts General Hospital meets), and a hospital with 200 or fewer beds. It will be up to Attorney General Healey, who gets a seat at the table, alone to look out for consumers’ interests.

Politicians partial to process may be excited about the impending study, but it will take an unprecedented level of cooperation between parties that generally don’t get along if this is to be the one that yields true reform. Any proposed solution must provide adequate support to Medicaid-dependent hospitals while refraining from punishing Partners for offering some of the world’s best medical care. Considering the breadth of the challenge ahead, it is advisable for all involved to hold the applause for now.

Disclosure: Ellen Clegg, the editorial page editor, is married to Ellen J. Zucker, a Boston attorney who serves as counsel to Dr. Dennis Burke, an orthopedic surgeon who has been publicly critical of policies at Massachusetts General Hospital. In keeping with the Globe’s guidelines on ethics, Clegg recused herself in August 2015 from any role overseeing editorials, opinon columns, or letters pertaining to MGH. The Globe’s opinion pages are a separate operation from the Globe’s newsroom, which is run by Editor Brian McGrory; Clegg has no role in determining news coverage. Editorials involving MGH are overseen by Deputy Managing Editor Katie Kingsbury; opinion columns and letters involving MGH are overseen by Deputy Managing Editor Marjorie Pritchard. Kingsbury and Pritchard can be reached by email at: katie.kingsbury@globe.com and marjorie.pritchard@globe.com.