In this video, healthcare marketing consultant Ron Harman King, JD, MS, discusses the growing controversy over large healthcare systems constantly coming up short on what they advertise themselves on — compassion.
Following is a transcript of his remarks:
If you were to conduct an online ethics poll of healthcare providers, my guess would be that lying to patients about their health would rank among the top three worst offenses. In fact, it can be against the law, for which doctors can go to jail for years or even decades, as can a provider who lies about research data.
So, if healthcare providers can be so severely punished for fibbing, how can healthcare systems get away with it openly?
I’m talking, of course, about how American hospitals and healthcare systems describe themselves in billions of dollars’ worth of advertising and promotions. Peruse their websites and advertisements and you’ll see the same messages ad nauseam. They promise that “patients come first,” “we listen to you,” “patients are our first priority,” “human kindness,” and “dedicated to caring for you,” among other flowery assurances.
The first problem to point out is that simply promising to be nice to patients does little to engender their loyalty or to recruit them. The golden rule of marketing is to stand out from competitors with what marketers call a strategic differentiator.
In healthcare, nice doesn’t cut it. Patients already expect nice. Promising them niceness is like a car maker guaranteeing that every model comes with four tires and a steering wheel. It’s anything but a differentiator.
Much, much worse, however, is how often the failed differentiator is an outright lie. Or should I say, perhaps overly charitably in some cases, a half-lie.
Not long ago the New York Times uncovered a notable example. Two of the newspaper’s investigative journalists reported that the Washington state attorney general had accused Providence Health of violating state law by pursuing 55,000 patient accounts for an alleged $73 million in wrongful healthcare charges.
Providence is one of the largest health systems in the country, with more than 50 hospitals and 900 clinics. The system’s revenues exceeded $27 billion in 2021. Its nonprofit status allows Providence to avoid more than $1 billion in taxes, according to the Times.
The attorney general sued Providence and three other health systems, plus two collection agencies, for allegedly mishandling hundreds of millions of dollars in medical debt affecting tens of thousands of patients.
According to the Times, the overpayments were a result of a program known as Rev-Up designed by Providence management with the help of the consulting firm McKinsey & Company. The Rev-Up program allegedly included instructing employees that their obligation to solicit money from patients “is part of your role. It is not an option.”
Let’s not overlook the fact that Providence was founded by nuns in the 1850s and proclaims its mission as “steadfast in serving all, especially those who are poor and vulnerable.” In addition, the system boasts on its website of a dedication to “compassion and humanity at the heart of every interaction.”
In its defense, Providence cooperated with the Times‘ investigation and said it was reaching out to 760 low-income patients to refund their payments. The system also reported a combined operating loss of more than $1 billion in 2020 and 2021. A spokeswoman especially noted that Providence had halted some of its debt-collection practices months earlier and that Providence was the biggest provider of charity care in Washington state.
The spokeswoman further told the Times that an “unintended error” caused misidentifications of those eligible for charity care. That explanation, however, does raise questions about how much an error might be a larger contributor to wrongful charges than the Rev-Up program.
If Providence runs its own venture capital fund as the Times reports, I also would like to note the rate of unintended errors in management of its reported $10 billion of investments, which the Times says generated $1.2 billion in 2021 profits.
But most of all, I leave it to you to decide whether the totality of alleged treatment of low-income patients by the New York Times and the Washington state attorney general paints the picture of a health system dedicated to “compassion and humanity” particularly to the “poor and vulnerable.”
Even if so, each of us no doubt has ample anecdotal evidence of healthcare’s biggest half-lie. For example, a friend of mine has suffered a multi-year urinary condition that led her to her state’s largest healthcare system. This system has flooded roads with billboards and the airwaves with broadcast ads promising the ultimate in compassionate care tailored to each patient.
My friend’s first visit to a clinic in the system was to provide a urine sample. She wound up driving around a sprawling medical campus with a full bladder for more than an hour in search of a parking space. In tearful desperation, she avoided a liquid disaster only when a security guard moved his vehicle for her. From then on, she paid an Uber $50 a pop to deliver her to appointments.
Next came encounters with phlegmatic physician assistants who challenged her diagnosis and physician orders. “Who told you you had a urinary infection?” one asked. Answer: her primary care physician, based on lab results. Turns out the PA hadn’t scrolled down far enough on her EMR screen to view the relevant entry.
Another curt PA described an order from a physician in the same system for a PAP smear as “an unnecessary medical procedure, but we can waste everyone’s time and money if you want.”
Ultimately, my friend switched to a solo specialist in private practice, where a weekly treatment cost $310 each. Cost of the same plan at the previous health system was $800 each. She has since experienced no parking problems, no long waits for the doctors, and unsurpassed kindness from the doc and staff.
In another example, a professional associate of mine has suffered a life-threatening condition since childhood and has spent decades seeing specialists. For her, hospitals and health systems suffer rampant internal miscommunication among providers, labs, and other ancillary services, sometimes forcing her to repeat tests at her own expense.
Although insured, whenever she inquires about unintelligible bills, the response is often a demand just to pay her bill immediately or risk being taken to collections.
My firm’s research validates her complaints, even among healthcare’s biggest brand names. Online data shows that nearly nine out of 10 online criticisms of the nation’s 20 top-rated hospitals cited nonclinical, service issues as the main source of dissatisfaction.
So, what can providers do about the half-lie? First, fight the urge to scapegoat. Yes, practicing medicine is becoming ever more frustratingly bureaucratic and controlled by bean counters. But that’s no reason to take it out on the customers who ultimately pay your salary and who are rarely to blame for systemic chaos.
Second, for the dwindling numbers of doctors still in private practice, resist the temptation to sell out to hospitals and health systems. Sure, that temptation to delegate the headaches of practice management is huge. But the tradeoff is often harm to quality of care and increasingly unhappy patients.
Third, for employed providers, push to establish or serve on patient-experience committees with real responsibility and power. Speak and act out for improvements in logistics, communications, and billing.
Fourth, never forget that big organizations need you as much or more than you need them. My firm’s research has found that two-thirds of online reviewers give four- and five-star reviews on rate-your-doctor websites. You’ve got clout. Use it to press for ending the biggest half-lie.
Tell your employer that if you can be imprisoned for falsehoods, the least the boss should do is to can the big half-lie.
Ron Harman King, JD, MS, is CEO of Vanguard Communications, a healthcare marketing and practice management consulting firm, and the author of The Totally Wired Doctor: Social Media, the Internet & Marketing Technology for Medical Practices. He blogs for MedPage Today on the topics of technology, the law, and the patient experience.