Maybe it’s just me, but I remember back twenty five years ago when I was a fresh MBA right out of Northwestern’s JL Kellogg Graduate School of Management with my degree in marketing and hospital administration (a rare bird, indeed, in those days) and I had just landed my first hospital marketing job in the inner city of Chicago. At that time, the 200 bed general acute-care hospital I was going to work for was surrounded by 2-3 more hospitals of a similar size and service mix and literally in the shadow of giant Northwestern Memorial (actually walking distance). The hospital competed for physicians and their patients; growth was regulated heavily by the state; and, consumers went wherever/did whatever their doctor said. While some hospitals had marketing departments, their focus was really PR and fund raising. No one advertised services, awards, quality measures, service guarantees, etc. Occasionally, a hospital might advertise an event to raise money, announce a new physician to the community, or promote participation in a community event, like a health fair or screening. We restricted the bulk of our work in those days to brochure development, for distribution by the referring physician to the patient. We wrote annual reports and distributed the same to the donors.
Back then, hospital administrators and board members of these not for profit organizations were reluctant to act (read advertise) like a retail organization. When the marketing department was lucky enough or skilled enough to convince the above of the merits of an ad, every physician in that specialty, every administrator on the leadership team, and frequently even the board chairman had to approve every word in that ad.
Fast forward to 2008. Today, you cannot watch a television station, even cable, for more than 15 minutes without some type of healthcare advertising…and in most markets; you can’t go an hour without a hospital ad. Try reading a newspaper, any size, any town and count the number of healthcare related ad placements you see.
Couple this proliferation of advertising with the push by government, business and private insurers to transfer health care management from the primary care physician (the one most competent) to the patient/consumer (the one frequently least competent or prepared) and you find yourself (at least I do) asking yourself, has my role changed? Should it? Is it ok to abandon the advertising rules that apply to the food industry, the drug industry and the cosmetic industry? Is it permissible to ignore the rules relating to truth in advertising…avoiding deceptive and misleading advertising claims of superiority and achievement? I should think not. Should I be looking for avenues to position my clients in ways that accurately portray their capabilities and services that encourage patients to learn more, ask questions, and most importantly, engage in a relationship with their primary care physician to jointly manage their diseases, their family’s health needs and inform them of the options my clients represent? I would argue absolutely. That is exactly our professional responsibility and challenge. So what do you do when clearly your competitor has gone too far beyond truthful advertising? What options are open to you? How do you respond?
As professionals, we have a responsibility to partner with our organizations or clients to better educate and prepare the consumer for this important role. Instead, the bulk of ads I see today add to the confusion of the situation. Rather than accurately delineating what services are available, how to access them, and how to responsibly find the right care at the right time, they more often tout meaningless claims of advancements and immeasurable proclamations of superiority.
I have opportunities to travel all over the country, where I choose to watch TV, listen to local radio, and pick up local print, and I like to see where area hospitals are in their work. I have to say, it seems many have thrown out the rule book…FTC, AMA, AHA, the other AMA, CHA; you name it…there appears to be no rule book in sight. They appear to be not only abusing the airwaves with unsubstantiated superlative claims, many actually made false and/or deceptive claims, as evidenced by the very same claim by a competitor…they both can’t be first, best, and only.
If you face this in your market, start by understanding the rules (See sidebar on rules and regulators). Then, prepare and take action.
Unfortunately, unless your competitor is a national advertiser, you are unlikely to get the attention of the FTC. With limited federal resources, the staff of the FTC is busy with larger national abuses. However, if you reach the end of the rope of possible approaches to correct the situation, and you are lucky enough to have a powerful congressman or senator as a fan of your organization, he or she may be able to entice the FTC to open an investigation. As you can imagine, this may or may not bring immediate relief. It would seem that this type of investigation may finally get the attention of the abuser.
You can also attempt to invoke the Lanham act by filing suit in your district courts. The expense is now yours, and if you are unsuccessful, you will very likely be out your costs and theirs. It, too, may not bring immediate relief.
You can appeal to the AHA, your state association, or the AMA if the spot promotes an inappropriate MD representation, but the odds are very high that they’ll choose not to get involved. Or, you can do what we as professionals should have been doing all along, police each other, and begin by writing a clear, definitive, evidence based letter, peer to peer, marketing executive to marketing executive, with the specific references to all of the above “rules” of advertising, with clear and precise direction; namely stop the use of ABC superlative claim within seven days, unless they are prepared to substantiate it for the audience that is seeing/hearing it. If necessary, share data to substantiate that, in fact, your data (publicly reported) demonstrates that your performance and outcomes are superior to theirs, or that their claim is somehow false. You can also insist they stop using any unsubstantiated claims until such time as they have 3rd party comparative data to substantiate the claim and then include that reference or basis upon which they make such claims.
As a veteran of healthcare marketing and having worked my entire career with hospitals in highly competitive markets, I can assure you that I thrive on a good competitive situation. But, I never lose sight of our responsibility to not only promote our organizations, but to allow the audiences we target to have better and more information than they had without the advertising. We have a responsibility as stewards of not for profit resources to educate our consumers in a manner that enables them to make good choices, with excellent qualified information, in a manner that supports and fosters a great relationship with enhanced communication between doctor and patient. If my ads make un-true claims, exaggerated references to pedestrian awards and labels, or mislead the public in any way, I conspire to falsely deceive.
Putting aside the frustration and anger you may feel for these colleagues who would deceive and manipulate the communities we have both pledged to serve, what about the consumer? The unsophisticated consumer….does buyer beware hold true for healthcare? The FTC, the AHA, the AMA, and our own organizations have said NO! The buyer doesn’t have the knowledge to beware. We as professionals in our field are held to a higher standard. Are these deceptive claims harmful? YES! With truly low performing organizations, the consumer actually has a greater chance of complications and even death in these hospitals.
With the proliferation of awards, ratings, rankings, surveys out there, it is tempting to use these as basis points to compare your organization’s performance to another’s. But be very cautious. This information is at best confusing…with statistical practices, and terms and qualifications that make it all but impossible for the average consumer to decipher. Ask yourself if the reasonable person… you know, the people who live two and three doors to your N, S, E & W… can truly understand the difference between your organization and the ones the study, ranking or rating agency are comparing you to. Have you given them any valuable information upon which to make an informed decision?
How would I advise a client to respond in this case? I would attempt to continue to work behind the scenes, appealing to the ethics of the situation. I would keep the client hospital board informed of the ethical violations and hope that as they dine and meet with their colleagues who sit on the board of the offending organization (and you can bet in small towns around the country they do know each other) they begin to ask their friends some hard questions. And, in turn, these board members ask that hospital administrator and marketing director hard questions. I would also work hard with my client’s advertising to encourage consumers to understand ratings’, rankings’, and awards’ advertising claims. I would direct them to a call center and/or website, where I would place links to these same rating agencies. I would try to explain our scores, our data, and the rankings. I always encourage consumers to ask their physician about this data and the information they find.
Ultimately, if your letter is unsuccessful, you may have to call in the FTC if the continued pattern of deceptive advertising continues. One would hope that the abuser will come to appreciate the higher responsibility we have to the consumer. The greatest tragedy in this situation is that frequently, the offending hospital has engaged an advertising firm….staffed by professionals in our field who are probably members in good standing of our professional organizations and clearly professionals who should appreciate the responsibility inherent in our roles.
I encourage each of you in your local markets if you face a situation like this, or if you wonder if your administrator is pushing too hard in your messages and claims, to stand up for the consumer. Write a letter citing the work in this article. Work to help consumers in your area to have the information they need to make good choices. Let’s work within our organizations to police our membership and reestablish those important ethics before we are required to be policed by others. Let’s begin by holding ourselves and each other accountable.