Why high-tech devices are props in so many hospital marketing campaigns

Abbott Vascular won regulatory approval in July for its Absorb stent, a first-of-its kind artery device that dissolves into the bloodstream. Hospitals are already marketing the availability of the product with TV, radio and billboard ads.

Experts are still debating whether the device offers any additional medical benefit over traditional stents in exchange for its premium price. But the attribute that might be most compelling to patients is that they just don't want a foreign object left in their body.

“Nothing is like the love of family,” says a man narrating a Wellmont Health System video ad over images of elderly men spending quality time with young grandchildren. “Nothing is better than moments together. Nothing is more important than your heart. That's why Wellmont CVA Heart Institute has pioneered the region's only fully absorbable stent, which restores heart vessels to a natural state, leaving nothing between you and the life you want.”

Leaving nothing behind is a good enough reason to promote the product and give patients what they want, said Dr. Jerry Blackwell, president of the Wellmont CVA Heart Institute. “It's a perfectly logical way for people to think,” he said. “You can think about this in the same context of other purchases that might be a bit more expensive: It might be an advantage to one customer but not worth it to another.”

The Absorb stent is just one of many expensive devices that hospitals champion in pursuit of being known among consumers as offering the most advanced medical technology around. Providers are betting that consumers will walk in their door if they can offer procedures using technologies such as Absorb, proton therapy and robot-assisted surgery.

“I see greater pressure on not-for-profits to say, 'Well, how can we get our fair share of those patients who can afford to pay, who are insured?” said George Sillup, professor and chairman in the pharmaceutical and healthcare marketing department at St. Joseph's University in Philadelphia.

Advertising Wellmont's use of the dissolving stent and other technology at its hospitals and other facilities in Northeast Tennessee and Southwest Virginia is also a matter of maintaining its reputation. “It's less about patients actually calling up saying I want the stent,” said Tim Attebery, president of Wellmont's Holston Valley Medical Center in Kingsport, Tenn. “Most of it is about image: We continue to be regional leader, and here's further evidence about that.”

Some products draw substantial interest from consumers despite their relative newness and lack of clinical consensus that they offer significant improvement over less expensive treatments.

The verdict is still out on Absorb, for example. A number of interventional cardiologists dismiss it as a marketing gimmick that offers little or no benefit over traditional metal stents.

Proponents of the product, many of whom participated in Abbott's clinical trial, say it allows more natural blood flow once the stent dissolves, preventing inflammation that can occur in some patients with metallic stents and keeping the artery clear for a very small percentage of patients who might have operations in that area of the heart. Blackwell at Wellmont maintains there are clear advantages for certain patients.

Intuitive Surgical's da Vinci series of robotic-assisted surgery systems has become emblematic of high-tech healthcare in hospital markets even though some studies have concluded it doesn't yield better outcomes than are achieved by conventional or laparoscopic surgery.

The American Congress of Obstetricians and Gynecologists has even suggested its outcomes may be inferior when used for routine hysterectomies, one of the most common procedures performed using the surgery system. The brand was also battered by a flurry of bad press about liability lawsuits filed by patients who say they were harmed during da Vinci procedures.

But none of this has stopped hospitals from purchasing the robotic systems or patients from expressing interest in the procedures. Intuitive shipped more da Vinci systems in 2015 than the year before, and the number of surgeries performed with them continues to rise.

One of Intuitive's new customers is Casa Colina Hospital and Centers for Healthcare, a small stand-alone facility in Pomona, Calif., that until recently exclusively provided rehabilitation services. Casa Colina spent millions of dollars to acquire a da Vinci Xi system and a Stryker Mako Robotic-Arm system for its new 31-bed medical-surgical unit that opened in April.

It's likely to take several years for Casa Colina to recover the costs of the equipment given the hospital's low volumes. But when other hospitals in the Los Angeles area are blanketing the market with ads for the technology, Casa Colina can't afford not to have it, too.

“If I as a patient wanted a partial knee replacement or my wife needed a (gynecological) procedure or a pelvic reconstruction, would I drive by a hospital that did not have the tech necessary for us to achieve our best outcomes? I'd probably drive by if it wasn't an option,” said Felice Loverso, the hospital's CEO.

Loverso acknowledged the studies questioning the clinical advantages of robotic surgery systems but said a hospital of Casa Colina's caliber must have the technology as an option to attract and retain physicians and patients, regardless of the return on investment.

“I want my physicians to have every tool available,” Loverso said. “It's my job to make sure they have those tools.”

Sillup, the healthcare marketing professor, says capital expenditures can create an incentive for providers to drum up demand. “Hospitals are beginning to look at this and say, “Well, we've invested in this equipment, we need to have it used.'”

Another name that hospital systems are eager to plaster on their billboards is CyberKnife. The equipment delivers targeted high-intensity radiation beams to cancerous tissue using a robotic arm.

The heavy advertising for CyberKnife means many cancer patients pursue treatment at hospitals in hopes of receiving a CyberKnife procedure even if it may not be right for their particular case. At WellStar Health System in Marietta, Ga., 20% to 30% of patients who ask about CyberKnife are self-referred, said Dr. Mark McLaughlin, the system's medical director of radiation oncology.

McLaughlin acknowledged that the self-referral rate for CyberKnife is unusually high, but he stressed that a multidisciplinary team, including a surgeon, carefully evaluates whether each interested patient is a good candidate for the procedure. For example, CyberKnife may be one of few options for patients with underlying health issues such as chronic obstructive pulmonary disease.

Some patients are a bad fit for CyberKnife. If a tumor is too large, for example, conventional surgery may be the only option, said Dr. Marie-Adele Kress, a radiation oncologist at Canton, Mich.-based St. Joseph Mercy Health System.

Denial can be frustrating for patients after an advertisement has dangled the opportunity, Kress said. That said, she doesn't believe patient research is counterproductive as long as patients consult a doctor about what they've read.

“I think when patients take a proactive role in medical decisionmaking, we usually get a better outcome,” Kress said. “Someone taking agency in medical decisionmaking is more likely to be satisfied with their care.”

Another technology that generates intense interest from cancer patients is proton therapy, which similarly offers narrowly targeted radiation to destroy tumors.

Only 23 proton facilities have been built in the U.S. since the first at Loma Linda (Calif.) University Medical Center in 1990. That's largely because the construction is a massive undertaking with capital costs that often exceed $100 million. As a result, the ability to perform the procedure—which often costs twice as much as traditional radiation treatment—can mean bragging points for health systems.

University Hospitals in Cleveland is now able to tout itself as the first in Ohio to offer the service. Its new proton therapy center cost only $30 million because it's a more compact version of the technology. Dr. Nathan Levitan, president of the University Hospitals Seidman Cancer Center, said UH wanted to create a proton therapy program that reflected the health system's population in northern Ohio.

UH is participating in research that's intended to increase the body of clinical evidence of the effectiveness of proton therapy, which was conceived to blast cancerous tumors with higher doses of radiation without damaging surrounding cells, particularly important with tumors that are close to vital organs.

“Research is ongoing to clarify what additional diseases could be treated with proton therapy where the cost could be justified by the outcome,” Levitan said, but right now the hospital is focused on treating patients whose indications clearly show that they would benefit from proton therapy, he said.

UH did a number of things to drum up already-high demand for the center. The system sent out a series of mailers to physicians throughout the region before and after the center opened, intended to educate them on what types of patients often qualify for the therapy, and also developed a video about the center directed at physicians.

UH also took journalists on tours to build up media attention and created a TV spot, brochures and fact sheets. The system also operates a hotline where patients can ask questions about the treatment and find out if they might be a candidate.

Like McLaughlin said of the CyberKnife at WellStar, Levitan said most patients treated at the UH proton therapy center found it on their own rather than through referring physicians.

“The trend in healthcare, and certainly the trend in cancer, is for patients to really understand their disease and understand their options,” Levitan said. “Patients really are highly educated about what's out there.”