The hospital already had made it clear it means what it says: It fired the director of corporate risk – Bob Nevens – and another manager in April when they did not meet the earlier deadline for bosses. In recent weeks, a few other major hospitals have followed Houston Methodist's lead, including the University of Pennsylvania, University of Louisville, New York Presbyterian and several major hospitals in the Washington, D.C. area. Houston Methodist's CEO Marc Boom predicts more hospitals soon will join the effort. Many hospitals and employers were waiting for legal clarification before acting. “We can now put this behind us and continue our focus on unparalleled safety, quality, service and innovation," Boom said after the ruling. "Our employees and physicians made their decisions for our patients, who are always at the center of everything we do."