Last week U.S. News
and World Report released its annual list of “Best Hospitals.” Web sites are being updates to celebrate
victories. (Johns Hopkins ranks No. 1!) Magazines will be plump with
advertisements. (New York-Presbyterian
is first in New York and tied for seventh nationally!)
But what does this
annual exercise mean for patients? And
what does it say about American health care?
After all, Harvard and
Princeton, which tied for No. 1 in the magazine’s 2013 Top 10 national
universities list, didn’t take out ads to proclaim their triumph; they will
fill their classrooms no matter. And as
in the college ratings, there are no big surprises in the top hospital group:
they are the big academic medical centers – the Mayo Clinic, Massachusetts
General Hospital, the Cleveland Clinic.
More to the point, even though you might well fly across the country for
four years of schooling, you are far more likely to stay near your home for
medical care. No one’s flying to Mayo in
Minnesota to get inhalers for asthma, even though it ranks No. 1 for pulmonary
medicine.
But American hospitals
are a bit like restaurants, competing for your business (and donations). As such they will go all out to promote their
brand, even though hospitals and doctors are permitted to advertise on many
other countries.
For American hospitals
large and small, it clearly pays to advertise, particularly in these tough
economic times and with the Affordable Care Act poised to throw tens of
millions of newly insured patients in the market. But for patients the rankings and,
especially, the subsequent promotions generally have limited benefit, experts
say.
“Nearly every hospital
has a banner out front saying they’re a ‘top hospital’ for something in some
rating system,” said Dr. Nicholas Osborne, a Robert Wood Johnson Clinical
Scholar at the University of Michigan.
“Those ratings have become more important for hospital marketing than
for actually helping patients find the best care.”
What’s more, Dr.
Osborne compared the outcomes of two ranking programs – one by U.S. News and
World Report and the other by Healthgrades – and found a “large discordance” in
their reports. “The two biggest rating
systems come up with completely different lists,” he said. “What does that tell you?”
If such advertising
often adds little in the way of useful information, it certainly adds ro health
care costs. Hospitals with more than 400
beds spent an average of $2.18 million on advertising in 2010, surveys have
found.
“We’re pushing $3
billion in health expenditures, and one-third of that is waste,” said Dr. Eric
Topol, chief academic officer at Scripps Health in California. “Those TV commercials saying ‘I got my cancer
care at X hospital’ are a shame, definitely wasteful.”
To be fair, U.S. News
cautions that its national ratings reflect ho hospitals perform in treating
“technically challenging” cases and that the list is merely a starting point
after which “patients have to do their own research.”
But those caveats are
lost in the subsequent barrage of advertising.
And the magazine encourages hospitals to post its seal of approval. In return, the U.S. News Web site is bursting
with hospital advertising.
Some critics decry the
glut of hospital self-promotion as not just wasteful and costly, but also
potentially dangerous.
“There are general
fraud laws, but there is no law specific to hospital advertising, and there
should be,” said Robert Steinbuch, a professor of law at the University of
Arkansas at Little Rock, who studies the topic.
“I can’t tell you how many hospitals say, ‘We have state-of-the-art CAT
scanners – there is no such thing! It’s
an old technology.”
In a country where
numerous organizations – including Yelp – accredit, rate, and rank hospital
care, some accolades many indicate excellence and some don’t mean that much at
all, he added. And while teams of
academics and scores of for-profit companies are developing “quality” metrics
to guide health care reform and to help patients shop for their care, it turns
out that rating a hospital accurately is extremely complicated. For one thing, hospitals that take on sicker
patients might have more complications after surgery.
Yet even smaller
hospitals tend to advertise their profit-making departments, like cardiology,
even though they may not offer the full range of heart services.
“If they advertise
cardiac care and doesn’t have angioplasty, that’s essentially fraud,” Mr.
Steinbuch said, adding that if a patient dies, “that could be considered
criminally negligent homicide.”
But health care
advertising is probably here to stay.
“Hospital advertising sets up an arms war, so that hospitals feel they can’t
survive without aggressive marketing,” said Dr. Topol of Scripps Health.
And even skeptics
concede that health care ratings, when properly developed and employed, may
health hospitals improve their performance and provide patients with valuable
information.
If you have a rare
lung condition that has flummoxed local doctors, for example, you may want to
fly to Mayo since U.S. News has ranked it No. 1 in pulmonary medicine. And if a dozen hospitals in your area offer
hip replacements, a search for regional rankings on the magazine’s Web site
will yield some useful statistics. But
take all those hospital advertisements with a grain of salt.
Indeed, with thousands
of good hospitals across the nation, the best selling point for routine medical
care many simply be convenience: some studies show that patients prefer nearby
hospitals with worse results over ones with better outcomes farther away.
“The Hype Over
Hospital Rankings” by Elizabeth Rosenthal, The
New York Times, July 28, 2013
No comments:
Post a Comment