Excellence achieved," declared a newspaper ad run in January by 168-bed Doctors Hospital of Sarasota (Fla.). The ad claimed Doctors ranked among the top 50 hospitals in the nation.
In smaller print, the ad explained the logic behind the claim: Doctors was among 50 accredited hospitals out of 5,000 to receive a perfect score from the Joint Commission on Accreditation of Healthcare Organizations. The JCAHO doesn't rank hospitals, so Doctors created its own ranking.
Not surprisingly, administrators and staff at rival Sarasota Memorial Hospital were miffed. They had never seen such a bold advertising claim from any competitor, particularly a small community hospital.
The ad reflects a controversial and somewhat risky trend toward aggressive advertising tactics in markets where competition is intensifying.
"I had phone calls from doctors saying, `What are we going to do?'*" said Donna Burtanger, Sarasota Memorial's director of communications and public affairs.
Burtanger said the ads were misleading, particularly because Doctors, owned by for-profit Columbia/HCA Healthcare Corp., doesn't perform open-heart surgery or care for very sick infants, as does 807-bed Sarasota Memorial, which is a public hospital.
"It's not that what they're saying is (technically) wrong," Burtanger said. "It's a semantics game."
Doctors made no apologies. "We want people to know we got 100 out of a possible 100 score on our Joint Commission survey....That's a tremendous feat," said Pat Driscoll, Doctors' marketing director.
Doctors doesn't believe the ad directly generated any new business, but Burtanger thinks it had an impact because consumers readily mentioned Doctors' top 50 status in focus groups.
In response, Sarasota Memorial launched an image campaign centered on its mission as a not-for-profit and its status as "the only full-service hospital in Sarasota County." Its fiscal 1996 promotional budget increased 30% to $750,000, and another increase is expected in 1997.
The Doctors ad "certainly changed our way of thinking," Burtanger said. "It's forced us to act a little more aggressively."
Contrary to some expectations that managed care would negate consumer advertising, it has instead increased competition in many markets, forcing providers to market themselves more aggressively. Hospital systems now are trying to influence consumer choice of hospitals, physicians and health plans.
Hospital and hospital system advertising grew a whopping 40% in 1995 to a record $1.2 billion from $856 million in 1994, according to Princeton, N.J.-based Opinion Research Corp.
The good news is hospitals are doing more consumer research and issuing more substantive messages about their quality and service. The bad news is some hospitals, under pressure to market themselves, are testing the established bounds of taste and fair play.
Some tactics, such as negative and comparative ads, could backfire, experts warn.
In March, not-for-profit Community Memorial Hospital of San Buenaventura in Ventura, Calif., came away with a black eye for an ad that falsely listed dozens of community leaders as opponents of a proposed $56 million outpatient construction project at crosstown rival Ventura County Medical Center.
Community Memorial believed the project would lure away its patients, so it contributed nearly $1.2 million to a group called Taxpayers for Quality Health Care, which ran the ad. The hospital issued an apology for the mistake, but the episode left a negative impression.
"It's like your mom and dad fighting-you don't expect that. You expect them to be warm and cuddly," said John Masterson, Community Memorial marketing director.
Greenville, S.C.-based St. Francis Health System, annoyed at long being excluded as a preferred provider by Blue Cross and Blue Shield of South Carolina, last spring unleashed ads urging consumers to complain to the insurer. The ads included coupons consumers could fill out and send to the Blues.
What set the ads apart were startling images. One pictured a baby in handcuffs. Another showed a pregnant woman tied with rope; the copy accused the "men" who manage the Blues of "trying to keep you away from St. Francis Women's Hospital."
"We saw it as a way to make a point about our dealings with Blue Cross, but we also saw it as an opportunity to educate consumers," said Carolyn Bobo, public relations director at St. Francis.
The ads drew attention in the local media but apparently haven't affected the insurer's contracting strategy. The Blues said it received 1,025 responses, many from consumers who weren't even part of the plan at issue. That wasn't enough to make it end its long-term relationship with competing Greenville (S.C.) Memorial Hospital, which offers more services and has a larger market share than St. Francis, a Blues official said. Moreover, the responses stopped abruptly when St. Francis quit running the ads, the official said.
Dick McDonald, management officer at Milwaukee-based BVK/McDonald, a marketing and communications firm, said consumers are turned off by negative messages, particularly in healthcare. In his view, hospitals have a responsibility to be sensitive.
"Research shows over and over again that what people want in their life is security," he said. "I think negative advertising generates insecurity. You are raising issues that people don't want, especially in healthcare."
He commends the approach taken by West Allis (Wis.) Memorial Hospital, which in June lost a managed-care contract that provided 27% of its admissions.
West Allis was forced to lay off workers on short notice, and remaining employees were angry.
Milwaukee-based Aurora Health Care, of which West Allis is a member, considered blasting the health plan but took a softer approach. It ran ads informing consumers of the change and giving them pointers on how to select a new health plan, if they decide to switch.
"It wasn't in the hospital's interest to create an impression of a high-profile dispute between (entities) that should be putting their (patients') interests first," said Diane De La Santos, vice president of public affairs at Aurora.
Another potential minefield for healthcare marketers is rankings. One controversial practice is touting a hospital's listing in "America's Best Hospitals," published by U.S. News and World Report, or "100 Top Hospitals-Benchmarks for Success," an analysis by HCIA, a Baltimore-based healthcare information company, and New York-based William M. Mercer, a human resources management consulting firm (Dec. 4, 1995, p. 54).
Critics of such practices point out that the surveys aren't flawless. For example, the HCIA-Mercer analysis benchmarks financial and operational success as well as clinical quality and is not designed to help consumers pick hospitals.
Moreover, consumers tend to be skeptical of rankings, said Richard Wade, senior vice president of communications for the American Hospital Association.
"Any ranking of an institution is a snapshot in time," Wade said. "Our view is that one institution that tries to portray itself as superior to another could well find itself embarrassed."
The AHA and 10 state hospital associations have been studying consumer responses to various advertising approaches as part of a public opinion study, due to be released to its members in October.
Wade said consumers in focus groups were skeptical of an ad by an academic medical center that emphasized its prize-winning researchers; viewers questioned whether such high-end organizations would care for them. Likewise, they were turned off by another hospital's lighthearted, cartoonish approach.
The ad that registered best was the least provocative, Wade said. It showed real healthcare providers going into the community to care for patients.
More than anything, Wade said, today's skeptical consumers "seem to want to know about the commitment and the values of the institution."