The Big Story: Hospitals taking fire from all sides in Washington
“Hospital advocates argue that the intense focus on hospital prices ignores the drivers of those costs, such as inflation, an aging population, soaring labor expenses and regulatory burdens, in addition to other players in the healthcare sector seeking to maximize their own profits.”
Critics are making their case. Are you?
By Tim Stewart and Isaac Squyres
4-minute read
Hospital executives absorbing the news can be forgiven if they find themselves returning to a dog-eared copy of “Catch-22” or cueing up an old Nirvana track and murmuring, “Just because you’re paranoid doesn’t mean they aren’t after you,” as a mantra.
Let’s take a quick spin through the headlines, studies and speculation keeping hospital leaders up at night:
- In March, a Congressional Research Service (CRS) released the report “Nonprofit Hospitals, Tax Benefits, and Charity Care.” The report cited Congress’s continued interest in “whether nonprofit hospitals offer sufficient community benefits, with a specific interest in providing charity care, to justify their tax-exempt status.”
- A recent spate of white papers describes hospitals as the culprit of high health care costs, leveraging consolidation, the absence of site neutral payments and tax-exempt status to take advantage of a “costly, distorted market that burdens patients, employers, and taxpayers with high and unpredictable prices.”
- Over the first week of May, three major editorial pages took swings at hospitals from different angles: The Wall Street Journal editorial board hit the 340B prescription drug program, which they said “hospitals use to raid drug makers.” The Washington Post published an op-ed from a tax think tanker focused on (you guessed it) hospitals’ tax-exempt status and the New York Times did the same, blaming hospitals for the “320 percent increase in insurance premiums that Americans have experienced over the last 25 years.”
Sheesh.
Now here’s where we point out something that can be difficult to hear when you are in the bullseye, or when you see every major newspaper in the country coming for you over the course of a couple days: Just because these attacks seem coordinated does not make them nefarious.
Is there a shadowy cabal of figures from the media, academia, think tanks and politics who are meeting regularly to coordinate on the anti-hospital agenda? While a fun visual and a fever dream theory consistent with these fever dream times – for the sake of everyone’s sanity, let’s operate under the assumption there isn’t a healthcare Illuminati plotting to make hospital leaders’ lives miserable.
Health spending accounts for roughly 18% of GDP in the United States, so there’s no shortage of interested parties who want to interrogate how those dollars are allocated. Or perhaps pocket more of them for themselves. So whether these attacks are tightly coordinated or totally decentralized is immaterial, because the compounded effect is an information campaign that hospitals are losing. Badly.
You don’t have to tell us that some of these perspectives distort the facts, are funded by special interest groups or cherry-pick data points to make hospitals look as bad as possible. That may be true but it’s working, and our own research consistently finds that Americans have very little trust in hospitals’ motives. But blaming the refs ignores this fact: The reason these attacks have gained and held traction is that hospitals have not done a very good job of counterprogramming. If we recognize that this is politics, too often hospitals have ceded their time.
Interest groups, think tanks and politicians are making their case and using all the tools at their disposal. The question for hospital executives: Are you?
Hospitals have demonstrated a commitment to traditional lobbying and influence campaigns, but it’s hard to ignore that all of that institutional will and financial commitment isn’t producing noticeable results in D.C. or state capitols. So how do you break through the noise? Or put differently, how do you create enough of your own noise to draw some attention away from the bullhorns trained on you?
Treat it like a campaign. Strategize, organize, coordinate and stay focused. Part of what makes this moment challenging is the deluge of negative coverage that is leaving hospitals defensive and sputtering. You’re not going to win on their turf, at least not immediately. Instead, pick a narrow issue within the larger line of attack and build a campaign around that.
Go small to go big. People – and decision-makers – respond to the specific and the local. The national narrative we’ve described certainly sets a tone, but that’s not what people will feel when they think about their healthcare and their local hospital. It’s up to you to show and tell how you’re addressing community needs and fulfilling the imperative of community partnership and impact in, well, your community. That starts with knowing exactly what your community wants and expects, and what will move the needle with which audiences. Market level research to figure this out, followed by thoughtful microtargeting, lays the foundation for a strong campaign.
Make it tangible. And speaking of how you show up in the community, the more you can show the more trust you will earn. Jarrard’s recent Community Impact survey found that the public has a high expectation for their local hospitals to be out there, contributing in ways that go beyond medical care. And, when they see hospitals doing that and have a strong sense that their local provider is a good community partner, their support for that hospital jumps dramatically. People are more willing to trust, speak up for and contribute to a hospital they see as civic-minded. So, having a clear plan for helping people see and experience and understand all the ways you’re making a difference helps strengthen reputation while also demonstrating “enough” community benefit.
Another option would be to turn off all your news notifications, cross your fingers and hope that maybe things will just work themselves out. Based on the trajectory of public opinion and legislative losses, we wouldn’t bet on that happening until hospitals pull themselves up off the mat and get in the fight.
Contributors: David Shifrin, David Jarrard, Emme Nelson Baxter
Image Credit: Shannon Threadgill
