A foundation funded by America's second-biggest health insurer has struck a nerve with a provocative national advertising campaign that tackles one of the healthcare industry's most sensitive subjects: medical errors.
Tucked between celebrity profiles and television previews in the July 2 issue of People magazine, the attention-grabbing, two-page advertisement features a big, bold pie chart under this "Major causes of death in the United States."
Breast cancer, vehicular accidents and AIDS all take a backseat to a category labeled only as "Oops!"-referring to medical errors, which cost almost as many lives each year as the other three causes combined. "Oops!" dominates the page, taking up nearly half the pie chart to highlight the disproportionate share of deaths that result from medical mistakes by all types of healthcare providers.
Already, the campaign has raised the ire of providers.
The ad is "an elephantine piece of hypocrisy," said Richard Wade, the American Hospital Association's senior vice president of communications. "The notion of an HMO or managed-care company giving this advice, at the expense of doctors and hospitals, is thin at best. I think it's an anemic effort to boost an image with the public that's almost beyond repair."
"It's a dramatization-with literary license," scoffed Donald Palmisano, M.D., a member of the American Medical Association's board of trustees.
The advertising campaign, launched earlier this month by UnitedHealth Foundation, rubs the industry's collective nose in one of its most unpleasant piles of dirt-the Institute of Medicine's 2-year-old estimate that as many as 98,000 people die each year from medical errors. A follow-up report by the IOM declared that the entire healthcare industry essentially should be rebuilt from the ground up.
"No one wants to hear that their appendix operation was a success when it was their gallbladder that needed to be removed," reads the copy accompanying the "Oops!" pie chart.
The foundation, a nonprofit association created in 1999 through funding by industry giant UnitedHealth Group, will spend about $8 million on a national "educational campaign" that already has antagonized or alienated many providers.
"We wanted to get attention," said Reed Tuckson, M.D., a senior vice president with Minneapolis-based UnitedHealth Group and a vice president of the foundation. "A lot of people are startled when they see these commonly known major causes of death, such as motor vehicle accidents, and then see the relationship between medical errors. It is startling. And that was our goal."
Tuckson, a former senior vice president for professional standards with the Chicago-based AMA, was hired last September to help the insurer improve relations with consumers and physicians. His stated goal to develop or maintain good relationships with doctors may be undermined by the foundation's campaign.
Even though some providers might take offense, Tuckson said, the intent of the ad was not to place blame or cast doctors or hospitals in a negative light. He stressed that the message in the ad is that medical errors result from a failure of the "system"-not from individual doctors, nurses or hospitals.
Indeed, the ad lists eight common-sense suggestions to help prevent errors, everything from ensuring that patients understand their prescriptions and treatment plans to determining without a doubt that doctors know "what will be done to exactly which part of your body."
"Having the surgeon mark the site to be operated on is a good idea," the ad copy advises.
Said Tuckson: "We think people need to be given information so they can make the best possible choices. This information is presented in a context to help improve the health system. It is never associated with blame to a doctor or any other sector. We're never going to get to the corrections if we're going to be pointing fingers."
But the AHA's Wade, incensed by the ads, doesn't see it that way. He said he believes that the campaign, created by a foundation underwritten by a huge managed-care company, is a thinly veiled public relations campaign that is doomed to failure. Though the foundation is independent of UnitedHealth Group, the financial connection is clear and irrefutable, Wade said.
UnitedHealth Group, the nation's second-biggest for-profit insurer after Aetna, has about 16 million members, a spokesman said.
"This is coming during the patients' bill of rights debate, when these companies are under fire for their behavior around denying care," Wade said. "It's a shame they take a serious issue like this and use it (in an ad). I think the advice is pretty good. But I don't think the public is going to buy the messenger."
If the foundation and HMOs are truly committed to patient safety, Wade said, "Why don't they sit down with hospitals and doctors and shape a campaign that really (has an impact) rather than trying to boost their image?"
"We're all in this together," he said.
Reaching a vast audience, the foundation's ad campaign could revive interest in federal laws that dictate mandatory reporting of medical errors-a requirement the AMA, the AHA and other provider organizations opposed last year. Health plans also oppose that provision, preferring a system of voluntary reporting. So far this year, the only movement in that direction has been through discussions about legislation to create a national database to track medical errors using voluntary reporting by providers.
Susan Pisano, a spokeswoman for the American Association of Health Plans, said it was far-fetched to suggest that managed-care companies could possibly have timed a national advertising campaign to coincide so perfectly with the debate in Congress over the patients' bill of rights.
"Not unless they had a crystal ball," said Pisano, whose trade organization, the largest of its kind in the U.S., represents about 1,000 managed-care organizations, which provide coverage to more than 170 million Americans.
"It's boggling to me," she said, "that this kind of simple, direct, straightforward advice to patients would be construed in any other light than as helpful to patients by arming them with some very good, real-world advice."
The "Oops!" advertising campaign, which debuted in the July 2 issue of People (circulation 3.5 million), will be reprised in some of the most widely read magazines in America-Parents, Ebony, Better Homes & Gardens, Good Housekeeping and Family Circle. The combined circulation of the five magazines is about 24.6 million.
"A good ad gets people to think, and we definitely wanted people to think about this subject," said Kent Simon, account director for GSD&M, the Austin, Texas-based ad agency that created the concept. "It's more to get people to think, `Wow, these are preventable situations.' "
Sara Bordo, the firm's account manager, added, "We sure weren't trying to alienate anyone."
The four categories of deaths included in the pie chart are "representative," Tuckson said, but do tend to highlight the disparity of medical errors in contrast to deaths from breast cancer (42,000 annually), motor-vehicle accidents (43,400) and AIDS.
The pie chart provides an incorrect proportion of AIDS deaths compared with the other three causes; because AIDS killed about 16,000 last year, it should have occupied a far smaller portion of the pie than any of the other three categories. The foundation's ad agency acknowledged the mistake, saying the categories were incorrectly transposed during production. The error "doesn't affect the overall intent of the message," said Roger Cruzen, a spokesman for UnitedHealth Group.
For his part, Tuckson acknowledged that some might argue with the decision to contrast the estimated number of deaths from medical errors with those from breast cancer, car accidents and AIDS. The impact would have been greatly reduced, for instance, if Tuckson had chosen to compare those estimated 98,000 fatal medical errors with deaths from heart disease, which kills about 725,000 people every year and is the nation's leading cause of death.
"You always go through (debate in) how to tell the story," he said. "The reality speaks for itself."
Not all physicians interpret the ad's message as a slam to the profession. Ronald Ruecker, an internist from Decatur, Ill., and the president of the Illinois State Medical Society, said, "I think the provider community comes out looking pretty good."
"I think it'll help open up a very constructive dialogue between patients and their physicians, with the ultimate outcome being the development of a partnership. Patients need to ask more questions, and physicians sometimes need to take more time to explain."