Hospital Ads, The Media, and Hospital Hype

Did you ever wonder why hospitals run those radio ads?  In the U.S., hospitals are always trawling for well-heeled, well-insured patients—and the doctors who bring those patients through the door.  And now, the Columbia Journalism Review reveals, some TV stations and newspapers have taken the hype one step further, by forming “Unhealthy Alliances” with individual hospitals.

But first consider the larger picture.

In the U.S. hospital advertising began in the 1970s, when the money really began streaming into the health care industry.  Meanwhile, other countries did not allow medical centers to peddle their services to the public. 

Indeed, in the U.K. the National Health Service decreed that hospitals could promote  themselves “direct-to-consumers” just a few months ago, bringing an end to what had been a fairly acrimonious debate.  Dr Laurence Buckman, a leading member of the British Medical Association’s (BMA’s) General Practitioners’ committee, was an early critic of the idea: "Patients want money to be spent on their healthcare, not spent on advertising to doctors so the hospital makes more money. The health service is not about making money, it is about delivering care for patients."

Dr Jonathan Fielden, chairman of the BMA's consultants' committee, told the BBC: "It is a sad indictment of government policy to consider spending public money on advertising NHS services when hospitals are having to make cutbacks in patient care…in order to save money."

Karen Jennings, head of health at Unison, added: "The very idea that hospitals should spend taxpayers' money on advertising for patients instead of on treating patients is simply ridiculous. It is the government's obsession with competition and choice that is forcing hospitals to set aside common sense and waste money in this way."

When you think about it, how much can a patient learn from a hospital ad? Would you consider telling your doctor that you wanted to have your by-pass surgery at Hospital Y because you had heard a radio spot assuring you that it “Put Excellence First?”  What if a magazine ad displayed a picture of a sunlit atrium? 

A Hospital CEO Explains

Over at “Running a Hospital,” Paul Levy, President and CEO of Beth Israel Deaconess Medical Center in Boston explains that one purpose of hospital advertising “is to respond from pressure from your doctors and show them that you support their programs. Before I took this job, I talked with the head of a major Boston hospital who gave that as the primary reason for ads.

“‘There is no evidence that ads work in creating business,’ he said, ‘but we need to keep our doctors happy.’ I have certainly felt that pressure in my place, and so I understand the desire to send a signal to your doctors – who, after all, are essentially free agents who can easily change hospital affiliation –that you support their practices.”

He adds that “another purpose might be to educate the public about certain diseases and treatments. I think academic medical centers like to rationalize that they are offering this general benefit to the public in their ads, but, really, who would consider these one-page blurbs an effective means for such education?”

Levy is honest:  “I think the ads are posted mainly as a component of creating a broader brand identity…it helps create a mindset that the hospital has standing and stature and permanence in the community.” This helps to attract high-profile doctors—who, in turn, want hospitals to advertise even more.

The Cost of Advertising

Is this a good use of a hospital’s capital? Just how much do hospitals spend gilding their image?

The Boston Globe reports that in that medical Mecca, media spending by hospitals jumped to $18.4 million in the first 11 months of 2005, nearly four times the $4.8 million they spent in 2001. (The Globe cited TNS Media Intelligence, a New York firm that tracks advertising by industry .)

A recent nationwide study shows major teaching hospitals laying out an average of $3,323,228 annually for marketing, public relations, and planning departments, while small community hospitals spend $420,205 a year.

And even the most prestigious academic medical centers feel the need to beat the drum. Indeed, as I reported in Money-Driven Medicine, only the Mayo Clinic in Rochester, Minnesota feels that it can get along on word-of-mouth alone.

Could this money be better spent on programs that might reduce infections and improve patient safety?  Perhaps, rather than advertising, hospitals could be a little more generous in providing discounts for middle-class patients who find that their insurance policy doesn’t cover what they need. Oh, but wait—that would attract more middle-class patients.  From a business point of view, it makes more sense to advertise the whirlpool baths and private suites to draw the affluent patient who can ante up for the extras.

Competition Boosts Our National Health Care Bill

In the past, I have written about how competition among hospitals increases hospital costs. When every hospital in a 3 mile radius buys the same cutting-edge equipment, the only way to pay for it is to use it—whether the patient really needs  another diagnostic test or not. Studies show that when there are more hospitals in a single area, competition doesn’t bring prices down.  Instead, they climb. Finally, and perhaps more importantly, when hospitals see each others as blood rivals they are far less likely to collaborate.

The Media’s Role

Below, a story from the Columbia Journalism Review, illustrating how some unscrupulous members of the media have experimented with using hospital hype to raise their own profile.

“Unhealthy Alliances Between Hospitals and TV Stations”, by Trudy Lieberman, begins by congratulating Glen Mabie, the former news director at WEAU TV-13 in Eau Claire, Wisconsin. Mabie, it seems, won an ethics award from the Society of Professional Journalists after he resigned last January,  “in protest, after the station agreed to run medical stories suggested by Sacred Heart Hospital, featuring employees and services the hospital wanted to promote. The partnership also meant that the station could not talk to any rival hospitals in the area. So much for getting all points of view! Mabie quit, saying that his conscience would not allow him to defend the deal to his employees. The TV station later canceled the arrangement with the hospital.

“It takes balls to do what Mabie did,” CJR continued, “ and he has become something of a cause celebre in journalistic circles. The deal that WEAU struck with Sacred Heart is just the proverbial tip of the iceberg. Similar arrangements exist all over the country, and the public is unaware that the five o’clock news story on the latest imaging device used on patients at a local hospital—perhaps reported by the TV anchor—is really an ad in disguise.

“We at CJR know a lot about ‘news’ that crosses the line into advertising and misleads viewers and readers. We reported on the practice in the magazine’s March/April 2007 issue. Our investigation showed that, although these deals vary, they are usually the ‘product of a marriage of the hospitals’ desperate need to compete for lucrative lines of business in our current health system and of TV’s hunger for cheap and easy stories.

“Last March, a new variety surfaced in Maryland when The Capital, a 47,000 circulation daily paper in Annapolis, sold its weekly health page to the Anne Arundel Medical Center, relinquishing all control of stories, pictures, layout, the works. The paper did run a disclaimer, and, in a column, the publisher said the paper was “experimenting with a new concept that could alarm some readers.” Some were so alarmed the day the hospital page debuted that the paper scotched the agreement.

“What to do about all this? The Association of Health Care Journalists and SPJ have issued a joint statement urging local broadcast stations and newspapers to avoid arrangements that improperly influence health coverage. The statement said that, even if such deals are disclosed to the readers and viewers, handing over editorial decision-making to hospitals violates the principles of ethical journalism and betrays the public trust. ‘Content produced by hospitals does not fulfill the duty of news organizations to provide the public with independent medical reporting,’ the organizations said. (Full disclosure here: I am president of the board of the Association of Health Care Journalists.)

“The statement is not only a plea to news outlets to stop doing phony journalism, but also an invitation for reporters to start exploring these deals in their own backyards. Steph Gregor, a reporter at The Other Paper in Columbus, Ohio, found some unsavory deals at Ohio State University Medical Center,which was paying local TV stations $100,000 or more to air “medical breakthrough” segments that, of course, benefited the hospital. One station vice president maintained that the segments were not ads but ‘vignettes,’ and that he did not see anything wrong with them, ethically speaking.

“But aside from the ethics, there’s a lot wrong with them. They mirror the crazy health payment structure that directs gobs of money toward high tech, expensive procedures. Hospitals compete for that kind of lucrative, high end business, and an easy way to do it is to make deals with TV stations willing to discard the ethics of good journalism. For journalists, there’s plenty to look at here, as candidates talk more about the marketplace reforms in the coming months. The take-away for journalists: The next time you hear some candidate for high office push the principles of the marketplace, think about competition in the hospital business and what it really means for the public. Has any of this competition lowered hospital bills? Has it better informed patients about x or y treatments—especially when a news outlet is barred from bringing in other points of view? Who has it really served? Those should be questions enough to get some serious reporting started on this topic. “

A good story.  Online subscriptions to the Columbia Journalism Review (www.cjr.org) are available at a very reasonable price. (That was an unpaid, unsolicited advertisement.)

Comments

[hagi]

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[maggiemahar]

Lisa and Annie--

Thanks much for your comments.

Lisa--I like the idea of a "Failures Everyday" segment. People really need to realize that hosptials can be dangerous places-and to put pressure on their local hospitals to explain why they are putting money into cosmetics but don't have electronic medical records (which greatly reduce medication mix-ups); what their infection rates have been over the past few years, and why they haven't improved much (if they haven't).

Annie--

You're entirely right. "patient education" cannot be done with ads.
For one, most ads are not designed to stimulate thought; they are designed to close the mind by giving you one simplistic answer to a question like "what the best . . ."

And yes, patient education has to be done in the right setting, by professionals who are not selling anything.

We need hospitals to provide free classes for pregnant moms talking about nutrition and exercise during pregnancy,
preparing for childbirth, breast-feeding, etc.-- not ads showing you that the birthing center has whirlpool baths.

[Annie]

Excellent points, and finally out to a larger audience.

Two points:

The marketing is done under the guise of "patient education". However, patient education is solely appropriately accomplished by those licensed healthcare professionals qualified to provide it - to the right patients in the right setting and only after their specific learning needs have been addressed. Marketers have usurped dollars that need to be available to provide real and critical patient services in the way of education and counseling.

If one stripped all of the dollars spent on patient education from marketing budgets, the extent of this dishonest, wasteful and harmful practice would be astonishing to the public.

Secondly, many hospital and healthcare company CEOs are jumping on the blog bandwagon. But beware - their blogs are simply new media marketing tools with their personal warm and fuzzy touch. They are heavily moderated, are slanted and provide marketing and propaganda as policy and program.

[Lisa Lindell]

We have the same thing happening down here, our local CBS station has a regular feature called "Breakthroughs Everyday" featurning one healthcare network. I've written to the news director at this station requesting, in the interests of fair and impartial journalism, that they also have a regular feature entitled "Failures Everyday" and start reporting on the stories of patients from the same hospital. No reply.
Same healthcare chain does advertising and the crux of their campaign is "What if...?" Meaning everyday they ask themselves "What if..." so they can keep improving. Right. "What if..." they followed the NNOC suggested nurse staffing ratio's? "What if..." they participated with CMS hospital compare? "What if..." they disclosed their infection rates. I could go on all day. The hospital PR has disgusted me for years, I'm glad you wrote about this. I thought we were in a great hospital when my husband got hurt because they do so much advertising and hang their banner at every event around town.

[maggiemahar]

Mike C and Robert

Mike C--Thank you for
directing me to Royter's website. I've saved it to "Favorites" . And please feel free to e-mail me at mahar@tcf.org if soemthing comes up on the website that you think I would find of special interest. I can't read everything and really do appreciate it when readers steer me to pieces that they know I would find of interest.

Robert-- I hear those "NorthShore" ads on the radio all of the time here in N.Y.

I wouldn't be surpised if there is some quid-pro-quo there . . .

[Mike C]

Maggie, Dr. Tom Royer, the CEO of Christus Health I told you about last week, actually just wrote a new blog post I thought you might find interesting. The main theme is that competition among hospitals is often unhealthy and that hospitals in the same community would be better-served to collaborate and find ways to meet the community needs together rather that constantly try to one-up each other. His blog can be found at http://wiresidechatwithdrtom.blogspot.com/

I'm probably sound like a shill at this point, but seriously it is so refreshing to read his ideas about healthcare.

[robertdfeinman]

The advertising also leads to oneupmanship with regard to new fangled technology.

If hospital A starts advertising its new widget than B will feel obliged to get one also. This makes some slight sense with for-profit hospitals, but I'm at a loss to understand the behavior of the non-profits.

I live in the shadow of North Shore/LIJ and they run ads in the local papers every week. I wouldn't be surprised if there is a bit of quid pro quo. Those who give money to hospitals don't mind seeing a bit of it thrown their way in terms of the local services that the hospitals purchase.