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Special Report: Rising Above Health Misinformation

Cartoon image of an overflowing laundry bin full of hospital uniforms and nametags in a room where someone is departing through an open door

Introduction

“No go, unfortunately.”

That was the text from a friend saying her spouse, a physician, wouldn’t talk to us for this piece.

As a critical care physician who spent the last 18 months treating COVID-19 patients, he’s now taking an extended sabbatical to recover. He had the perfect perspective for an article looking at the current state of the healthcare workforce – the accelerated burnout, the frustration, the fear and the sheer exhaustion.

We had questions lined up: What do doctors and nurses need today? How much does monetary compensation play into the equation versus other types of support? Do the rumblings about an exodus from healthcare represent a real threat? Where do you hope to be after your time away?

But no, we would not be asking those questions. And maybe, that makes the story more powerful.

That this elite physician couldn’t talk to us wasn’t a matter of scheduling. It was because he has given everything to save as many people from COVID-19 as possible and has nothing left.

“He just shuts down when we talk about COVID,” the spouse said. That exhaustion encapsulates the problem our entire healthcare system is facing today. It clarifies both the human cost and the operational challenges facing provider organizations.

As an industry, we’ve been talking about the burnout of our nurses and physicians for years, to the point of cliché and numbness. Then: COVID. And now? The headlines are everywhere:

On top of that, President Biden’s new mandate for large employers will force even more people to make a choice – including some healthcare workers who may join peers who have already decided their career isn’t worth the vaccine.

All told, addressing the exhaustion and resignation of our clinicians has become an urgent business imperative for every organization who employs physicians and nurses. The issue’s been building for years. Maybe you can momentarily stanch the bleeding with pay raises and travel nurses, but that won’t heal the wound.

What to do now? This report, based on interviews throughout the Jarrard Inc. network of clients and experts, triangulates the trends, draws conclusions about the future and offers thinking on how to manage an issue that’s gone past the boiling point.

BY THE NUMBERS

6,800

Employees lost by Southern hospitals

49

Healthcare workers experiencing burnout

29

Healthcare workers considering leaving the industry

38

Healthcare workers self-reporting anxiety or depression

Back to the Beginning

Graepel

Burnout and the growing shortage of healthcare workers are well-documented. National surveys from a couple of years ago revealed burnout rates approaching 50 percent for a variety of reasons, per Kirk Brower, MD, chief wellness officer at Michigan Medicine. Long hours, burdensome administrative requirements, mediocre technology all contributed. Kevin Graepel, MD, PhD, a pediatric resident at St. Louis Children’s Hospital, observed that the buildup starts early. “A lot of the challenges my colleagues and I are facing in terms of burnout are driven in large part by the way resident training occurs in the U.S.,” he said.

Those stressors intensified over the past year and a half, evolving somewhat differently for physicians and nurses, according to Dean Browell, a digital ethnographer and principal at Feedback, who has been tracking the issue of burnout online for years.

Browell

Throughout the pandemic, we’ve seen clinicians of all stripes joining the conversation online. That’s not new, but it has taken on a different flavor, per Browell. Nurses, he said, have long used digital platforms to discuss work-related issues amongst themselves. Early in the pandemic, those conversations expressed frustration with somewhat amorphous ideas of “hospital administration,” and the virus. Exhausted nurses were checking around for jobs that might give a bit of relief.

More recently, the anger has moved towards a more direct target in “the patients,” specifically the unvaccinated. That shift has led to more public activity among nurses, and the persona of long-suffering, patient caregiver is being replaced by that of the exasperated professional fed up with the parade of patients making dangerous choices.

Screenshot of a Twitter thread highlighting several points on COVID-19
Screenshot of a Reddit post from an exhausted hospital worker during the pandemic
Screenshot of a Facebook post from a displeased nurse during the pandemic

Trauma is Changing the Equation (Permanently?)

Essentially, healthcare is facing a potential and troubling shift in the way caregivers see their roles.

Clinicians and their families have shared with us this refrain about their calling: “I’m putting those around me at risk to care for countless people who made choices that are creating the danger.” Dedicated nurses and physicians are having to decide how far that mission goes. And that tension is creating moral injury – possibly even recalibrating the moral and psychological standard.

An example one person offered: An ED team can treat the single gunman who’s harmed others, successfully managing their emotions and maintaining their oaths to care for every patient. Yet when a notable percentage of the population – healthcare worker and public alike – refuse to get vaccinated, it becomes like an accumulation of mini active shooters coming through the ED doors every day. And with that, a mental shift could happen that unconsciously allows the level of care slip.

Others maintain that the levels of care won’t suffer, but that there will be greater distance between clinician and patient. Those who make it through will become more aloof.

Holding on to “Heroes”

It’s time to stop using the language of “healthcare heroes.” It rings hollow and feels discordant with what’s happening inside ICUs today and the way a big chunk of the public is acting towards healthcare workers.

“About a year ago, this larger burnout effect started being stoked by the hero messaging that was finally starting to get a little stale. It was this idea that, ‘Hey, I’m tired of being a hero right now.”
– Dean Browell, Feedback

“Healthcare workers got at least an emotional boost by being the ‘healthcare heroes.’ That’s just not happening anymore. They are back out in their communities, and they see people walking around without masks. It’s disheartening. Same thing with treating anti-vax patients – it’s creating a lot of anger.”
– Lisa Bielamowicz, MD, Gist Healthcare

“The core issue today is staffing. It’s time to point out the problem, which goes beyond healthcare. It’s also a problem in any type of service job where society pays low wages to people who we call heroes on a daily basis.”
– Erika Matallana, Jarrard Inc.

Leaking from Both Sides of the Pipeline

Roades

The result of all this could be an exodus. It may play out in lower enrollment in nursing schools, as more early retirements or leaving healthcare mid-career. (While the American Association of Colleges and Nursing noted an increase in enrollment last year, Browell said he’s hearing from top-tier schools that are struggling to fill seats.)

“People have changed their calculus about where they want to be spending their time. Younger people have alternatives,” said Chas Roades, CEO and co-founder of strategic advisory firm Gist Healthcare. He pointed out, only somewhat tongue-in-cheek, that given the level of pay at entry levels in healthcare, some people may view warehouse or gig economy jobs as viable, safer alternatives. Lisa Bielamowicz, MD, president and co-founder at Gist, brought up the education debt issue for clinicians. “It’s hard to talk about aligning compensation and incentives if people have to take out a second mortgage for 20 years to pay for student loans,” she said.

Bielamowicz

Clinicians Have Options

Between the rise of telehealth and the resurgence of concierge care, there are lots of career options today enabling clinicians to practice without having to deal with some of the mess. Physicians in particular have the financial resources to look around and find other revenue streams. For nurses, travel jobs have always paid well. Now, privately owned groups are offering massive pay jumps and impressive per diems for those inclined to take contracts – sometimes not far down the street from their current employer.

“They’re understaffed and their people feel at risk because the ratios are so high,” said Aaron Campbell, a Jarrard Inc. associate vice president keenly focused on patient and employee engagement work. “There’s a sense, too that the short-term solution – ‘I’m going to bring in people who’ll be paid far more than you and aren’t invested in our culture and will be gone in 12 weeks,’ – is going to create even more strife.”

Mississippi nursing ad with a red background containing job description

Browell explained it by positioning traditional providers at the center of the industry and new models of care on the outer rings. It’s about how many people leave the center of it for “a nice, quiet CVS somewhere,” he said. There was already attrition for hospitals because of the rise of those new models. In the next 18 months the threat to traditional providers may increase because people don’t want to stand in the center of the storm.

Of course, the flip side of that is significant opportunity for health services organizations. Referring to an orthopedic group client, Browell observed, “Their story is going to be a fantastic one they can ride for a while because they can recruit a nurse who is desperate to get out of an ER by showing them what it’s like in an ortho urgent care by comparison.”

What’s the Answer to Burnout?

In our interviews, a near-universal sentiment is that this won’t be quickly fixed, only managed. We can only do so much to help clinicians and other employees who are at the end of their rope. The days of quick fixes ended years ago (though we do offer a few ideas for immediate intervention in the sidebar.)

Operationally, providers need to look ahead to long-term transformation. That could mean evaluating technology across your enterprise. Or creating a Wellness Office, which Michigan Medicine did before the pandemic. Or even going truly massive – how about HCA owning a nursing school? In contrast, some Communications strategies can be brought to bear immediately.

Glenn
We don’t want to wait until people are in a crisis. We’re trying to understand the factors that are contributing and do something before it gets to that point.

Rose Glenn, Senior Vice President, Chief Marketing Officer, Michigan Medicine
Glenn

Operations

PURSUE STRUCTURAL CHANGE

First and foremost, don’t expect to paper over the shifts in healthcare.  “Change can’t just be a rebranding exercise,” said Jarrard’s Campbell. He pointed to K-Mart’s promise to evolve several decades ago. They asked their employees to stick around and buy-in to that vision. Many did, literally. The company used pension funds to buy company stock, leading to huge losses and a lawsuit in the early 2000s. “People are trusting you,” said Campbell. “You have to pursue deep change to follow through on that.” We all know what happens to organizations that try to skip past the hard work and fail to adapt. (There are 33 K-Marts left, in case you were wondering.)

OFFER SHELTER FROM THE STORM

Clinicians are considering their career options. Many who want to stay in healthcare may look to move away from the center of the storm. When possible, Bowell says, providers should offer that.

Admittedly, this is easier for larger systems with opportunities for lateral moves within the enterprise, and frequently, larger coffers for salary increase and other investments. Health services companies like the orthopedic group mentioned above often can provide calmer environments. The challenge is greatest for smaller systems and independent hospitals. “For smaller hospitals, it may be about investment in telehealth and generally finding ways to be less reliant on ER/trauma,” said Browell.

OPEN YOUR WALLET

Which brings us to financial compensation for physicians and nurses. Money can’t solve all the problems for a mission-driven workforce, but financial incentives do need to better reflect the realities both nurses and doctors are dealing with. Some thinking:

  • Imagine the tension in organizations where staff ICU nurses are working alongside travel nurses hired with huge stipends. Dollars should be wisely allocated for retention as well.
  • Surprisingly, hazard pay hasn’t really hit the healthcare industry in a major way, but could be a solution as this plays out, noted Browell.
  • Graepel, the early-career physician-scientist, put it bluntly: “Financial issues are a huge strain for many of my colleagues. Increased financial compensation would go a long way to lifting some of these major stresses. People are looking at a quarter million dollars in debt while getting paid $60,000 a year… It can be hard to imagine what that future looks like.”

So where does the money come from to fund this? After all, labor is already the largest cost for hospitals and health systems. Gist’s Roades suggested “looking at trade-offs with other expenditures like capital projects.”

Making Appreciation Apparent

Some of these can kick off tomorrow, others require a bit more time and investment. But all will give your team small yet meaningful doses of hope. As always, ask your team what they need – and what they don’t want to see. They’ll tell you.

Visual reminders of mission and appreciation

Hand-written letters to employees’ loved ones to express appreciation

Local media coverage highlighting employee service

Discounts/gifts from local businesses

Free subscriptions to wellness/mental health apps

Membership to services connecting people to daycare, pet care, handyman, etc.

Cover meal/grocery delivery service fees

Subsidized gym memberships or, better…

…Build/update a top tier on-site gym

Revised PTO to offer extra time off or create “PTO banks” for specific situations.

SUBSTITUTE, STRATEGICALLY

Technology can also help free up money for better compensation – along with saving time and reducing stress. First, more user-friendly EHRs are directly correlated with lower workload and, by extension, burnout. Second, is “strategic substitution” and job design – finally realizing the long-promised revolution where technology can augment the human touch and allow clinicians to practice at the top of their license. Bielamowicz and Roades were adamant that strategic substitution and streamlining operations from back office to clinical decision-making will reduce stress on the healthcare workforce and make more efficient use of limited dollars. Leaders should be asking if there are places to reduce dependence on labor by using AI or restructuring their teams so patients can do more self-service.

It’s always critical, our experts maintained, to evaluate human capital, asking if the right people are doing the right things and identifying gaps that need to be filled. “Everyone wants more data-driven, personalized care,” Bielamowicz said. “Every health system wants to take data from devices and use it for remote monitoring. But right now, we don’t have people to take that information and turn it into actionable information. We need medical technologists trained to do that work.”

Lastly, finding ways to accomplish back-office work related to revenue cycle and HR is not a new discussion. Those tasks are prime candidates for automation and AI to free up resources.

In High Stakes, Issue Navigation, Quick Think, Strategic Positioning

Non-Profit Health Systems Fighting in an InHospitable Environment

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Note: This piece was originally published over the weekend in our Sunday newsletter. Want content like this delivered to your inbox before it hits our blog? Subscribe here.

The Big Story: InHospitable Documentary to Launch November 13

InHospitable, according to its website, “is a documentary feature film that exposes American hospitals’ significant role in our broken healthcare system by documenting patients and activists as they band together” to go up against a large non-profit health system. We’ve only seen the trailers, but the film appears to be a full-throated attack on non-profit health systems, featuring patients allegedly harmed by the featured organizations, activists and academics known to be critical of hospitals.

What it Means for Your Health System

We consider InHospitable the latest warning shot at how our screwed-up industry delivers and funds care, and hospitals and health systems are in the crosshairs. If you’re not ready, get ready.

We’ve known for a while the film is coming, and now we have an official date for a premiere. It may not be Michael Moore or Werner Herzog, but the film is real and the trailers include compelling imagery. In one regard it’s not that big of a deal – an indie documentary with 159 Twitter followers and not a lot of traction on Google. But health system leaders should pay close attention.

InHospitable is a recent example of emotional, sharp-tongued critiques of hospitals and health systems that have gained momentum over the last few years. Some of it well deserved, we must say.

You know the issues: The crazy and inconsistent cost of care, “profits over patients,” incomprehensible financial and billing practices, strong-arming payers, insufficient and inequitable access to care, suing poor patients for a nickel, and more. In addition, we’ve written here about the increased scrutiny by the feds of health system consolidation and the chatter of whether not-for-profit providers deserve their tax-exempt status.

By focusing its fire primarily on a single organization exhibiting bad behavior (it appears to focus on UPMC), the film will be all the more effective at elevating those questions for the broader industry.

The screening at DOC NYC is likely intended to generate enough buzz to get the film a slot on a streaming service sometime next year – when the pandemic will theoretically be behind us, and it’ll be easier to ramp up attacks on providers. Even if it isn’t a major success in itself (and, who knows, it could be), it will become part of the self-referential cannon used by hospital critics in their campaign.

So whatever your gut reaction to the film, you need to be ready to push back on the pushback. Here’s how:

Inform Your Board. They may not know any of this is coming. While providers were focused on keeping COVID-19 patients alive, the critics were honing their anti-consolidation arguments and putting the final touches on illustrations portraying hospitals as assembly (or disassembly?) lines.

Make sure your board knows about the growing storm, including the existence of this documentary and where it fits into the larger conversation. Last thing you want is for them to be caught flat-footed next summer when InHospitable appears on Netflix.

The education should include specifics about the attacks. We’re seeing more and more portrayals of healthcare providers as Big Business, with all the loaded connotations that idea carries. Big Business is predatory. Big Business cares more about profits than mission. Knowing that’s the representation should help inform the response. Equip your board with messages that explain why growth is beneficial for patients and communities and employees. It’s not enough to say, “That’s not us.” You have to say, “Here’s who we really are.”

Review Your Practices. Or, Know Thyself. Don’t sue patients. Don’t do the things that would lead an entrepreneurial filmmaker to paint you as predatory. Getting bigger doesn’t just make it easier to be accused of bad behavior; it makes it easier for things to slip through the cracks. Always make sure you’re operating in the most patient-friendly way possible.

Activate Your Board. Once they know what’s going on and everyone feels confident there aren’t any dark secrets, your board needs to get out there and engage. Healthcare board members have strong networks. Use them. Push them to reach out to the influential leaders in their orbit and humanize the organization’s work – to connect back to the mission, talk about the benefits of growth, show how they’re supporting the community and employees and either get ahead of or counter the attacks. Also, push them to connect with lawmakers and build or use the relationships necessary to ensure providers have a voice in whatever happens next. This is why you have board members. Time to get them organized.

Build Your Defenses. Now. We know InHospitable will premier in November and could easily get picked up for streaming sometime next year. It focuses on one health system but may name drop others as it looks to connect the dots to the industry at large. Whatever national context is created could lead to regional and local attention, so expect calls from the media. Look through the damaging coverage hospitals have received over the past couple of years (including 2019) and develop responses to those sorts of issues. Make sure your leadership team and board have a copy, as well. Whether or not you see any likelihood that your organization will get pulled into the conversation, prepare as if you will.

This piece was originally published over the weekend in our Sunday Quick Think newsletter. Fill out the form to get that in your inbox every week.

In High Stakes, Issue Navigation, Quick Think

Tired of Being Your Hero

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Note: This piece was originally published over the weekend in our Sunday newsletter. Want content like this delivered to your inbox before it hits our blog? Subscribe here.

Healthcare workers are leaving.

They’re citing burnout, stress, safety, moral harm – and in some cases a desire for “personal freedom” over all else. They’re answering the question, “Is it worth it?” with a decisive, “No.”

Many are leaving because they cannot spend another day watching patient after patient die unnecessarily. Others have decided their career isn’t worth the vaccine. Logs on that particular fire? President Biden’s new mandate for large employers that will force even more people to make a choice. All told, the consequences for healthcare are severe – moral injury for healthcare workers, frightening staff shortages for providers and the public and long-term questions that will likely affect how all of us receive care.

Our latest Special Report homes in on the massively complex problem of clinician burnout. It’s a big read with some strong takeaways – definitely worth taking 15 minutes to digest.

Meanwhile, for a fascinating behind-the-curtain look at how doctors and nurses are expressing their burnout online, check out our Q&A below with Dean Browell. He’s a digital ethnographer and principal at Feedback, a social listening firm that digs into how what we say in the digital realm translates into how we behave in the physical world. And, he’s been tracking the issue of burnout among the healthcare workforce for years.

The Genie’s Out of the Bottle: What Clinicians Are Really Saying Online

(Five-minute read)

Jarrard Inc.: You’ve been tracking burnout in the healthcare workforce for years. Give us a bit of the back story.

Dean Browell: There’s been two different arcs with nurses and physicians, which have developed a little differently over the past 18 months.

Browell

Starting with nurses, about this time last year there was a larger burnout effect that in some ways was getting stoked by the heroes messaging that was finally starting to get a little stale. The pushback started with nurses, who are the most vocal group in healthcare, maybe even more than patients. They have their own message boards and have for years. They had some of the first Facebook groups because they all had .edu email addresses.

This time last year there was this perception that all of healthcare was being treated the same publicly, but in those groups, nurses were asking whether it really was the same to work in one organization or the other. For providers this meant that nurses considering a move represented an opportunity to attract and retain or a threat that the grass might be greener somewhere else.

Jarrard: What are the nurses expressing today?

DB: There’s more outright discussion that, “Maybe this entire industry isn’t for me.” What was first anger towards a larger or more nebulous idea – like administrators or how people are handling things on a macro level – is now towards the patient. Before, it was being angry at the virus and potentially how your hospital handled something. Today people are wondering if they can continue and serve a public that is, in their mind, willingly putting themselves at risk and creating this situation. It’s a very different burnout. And it’s a much harder equation from a retention and a recruitment standpoint for providers.

Jarrard: How are nurses talking about those concerns?

DB: In the beginning, nurses often had two distinct online personalities. There’s the online personality of “capital N” Nurse in front of everyone on Facebook versus on the American Nurses Association message board where they’re talking amongst themselves. Last year, those two faces began to collide. What we saw for the first time last fall was nurses on Facebook talking about union meetings. Typically, that would be relegated to the nurse message boards or discreet groups. We saw nurses not just take the platitudes about heroes and say, “Thank you. It’s been a lot. We have to push through this” like they did last summer. Instead, suddenly, you had them openly criticizing things they normally never would have discussed with their public-facing persona.

Jarrard: What’s the background on physicians?

DB: Usually what we saw is that physicians would pop up every now and then during a career change asking about the schools or nightlife in a particular city they were considering. “Hey, I’m thinking about moving to the city, what’s the orthopedic scene like?”

In August of last year, though, we saw physicians poking their heads up for the first time with the general public. They were offering their own statements and being a bit more forward with their own name at stake. That was different. And we saw this happening in some unusual places like threads of Reddit – that almost never happened before.

Jarrard: Same question – where are physicians today?

DB: They stepped out last August and they’ve stayed out in the public square since then. Now, like nurses, we’re seeing that they’re not just saying, “Hey, I have a stake in this, and I’m trying to help you navigate misinformation.” It’s not just a benign educational leadership approach like it would have been a year ago. Now it’s taken on an angrier or more exasperated tone that we haven’t heard out loud.

Jarrard: Nurses and doctors are coming from different professional and financial statuses. Does that affect how they’re able to respond?

DB: It manifests in the freedom to talk in a certain way. The physician discussion we’ve seen has still been very high level. “Here’s my take on what’s happening” as if they’re giving a comprehensive analysis of the moment. Contrast that with the nurse that says, “I just took my first break in eight hours.” Physicians take more of a punditry angle, whereas the nurses’ perspective is more in the moment.

Jarrard: Is this shift in tone and the level of engagement permanent or will it recede?

DB: For the most part I expect the physicians-as-pundits to eventually fade. Their level of connection online may stay, they may reappear when there’s something big they want to speak their mind about. But from a day-to-day perspective I’d expect that genie to go back into the bottle.

On the nurse side, I doubt the genie that will go back in the bottle – because of how open nurses are being today – is this idea of the two personas. There’s the happy-go-lucky, “I love that I’m in healthcare!” and “Here’s why I’m a nurse,” that is presented to family and friends, versus what they were saying in private among peers. You can’t unwind that clock now that they’ve been this exasperated publicly.

Jarrard: What does it all mean for the healthcare workforce going forward?

DB: This will have a freezing effect of some sort. It’ll be fascinating to watch enrollment in nursing programs. It was on a fast track for the last three years in order to meet the demands. We do a lot in higher education and there are some robust nursing programs having trouble meeting their enrollment numbers.

The question is turning into, “Who do you want to do this for?” And the feelings of betrayal and burnout change that conversation. I think it’ll have a freezing effect on the creation of a new nurse population.

Jarrard: We’re also seeing indications that people at the other end of their career are getting out. What does the situation you’ve described mean for them?

DB: It’s how many people leave the industry completely and how many leave the center of the industry. It’s people saying, “I’m going to find a nice, quiet CVS somewhere.” There’s this idea of decentralization of demand for healthcare services where it’s coming out of the hospitals and moving to those outer rings. It’s dangerous for hospitals because there was already attrition due to these alternative models. But now and over the next 18 months the threat is greater with people looking to leave completely or say, “How about I just not stand in the center of the storm?”

Jarrard: How can healthcare providers respond to this shift?

DB: Health systems have an opportunity to do better because of their sheer size. They can talk about what it’s like to work for the system in different roles. People will gripe about robbing Peter to pay Paul, but showcasing lateral movements that improve quality of life is one way that systems can cope.

Jarrard: What about smaller hospitals?

DB: Community hospitals will be the hardest hit because there’s almost no lateral movement available. For them, it will be about improving the situation. Maybe it’s investment in telehealth or to try and not be so ER-focused to remove some of that constant pressure. But it’s not an easy solution.

Jarrard: Last category: What’s the approach for those non-traditional or health services providers that aren’t in the center of the storm?

DB: We just finished a study for an orthopedic group that’s branching out towards a major metro area where they’ll be competing with some big systems. They’re going to have a fantastic story because they can recruit nurses who are desperate to get out of the ER by showing them what it’s like in an ortho urgent care by comparison. For these specialty practices it’s saying, “Hey, stay in nursing but come out of the storm.”

Jarrard: One of the consistent themes in our interviews is that it’s not about the money, but money is a major factor. Where does compensation come into all of this?

DB: Something that hasn’t come to healthcare is the concept of hazard pay. Of all industries you’d think it would be there for healthcare. That may start to happen, especially in systems that can only offer so much lateral movement. Maybe it comes into play between telehealth and in-person care in the ER or trauma.

Jarrard: Anything else? What are we missing?

DB: We may see an effect on M&A, too. If a system is looking at three different hospitals with similar profiles but one is an absolute powder keg in terms of its workforce, that would probably make it very easy to choose a different acquisition. It’s a different metric than most systems have looked at in the past. The focus has been on heads in beds. But looking at the distressed asset from the workforce standpoint will change the game a bit. The question will be, “What can our system sustain in terms of volatility, whether it’s attitude or behavior? Can we repair the culture or, even though it makes sense on paper, should we walk away because it will never fit?”

In High Stakes, Issue Navigation, Strategic Positioning

Special Report: Clinician Burnout and Managing the Unsolvable

“No go, unfortunately.”

That was the text from a contact saying her spouse wouldn’t be able to talk to us for this piece. As a critical care physician who’s spent the last year and a half treating COVID-19 patients and is now taking an extended sabbatical to recover, he was the perfect source for an article looking at the current state of the healthcare workforce – the accelerated burnout, the frustration, the fear and the sheer exhaustion. We had questions lined up: What do doctors and nurses need today? How much does monetary compensation play into the equation versus other types of support? Do the rumblings about an exodus from healthcare represent a real threat? Where do you hope to be after your time away?

But no, we would not be asking those questions. And maybe, that makes the story more powerful. Because the reason that this elite physician couldn’t talk to us wasn’t a matter of practicalities and scheduling. It was because he has given everything to save as many people from COVID-19 as possible and has nothing left. “He just shuts down when we talk about COVID,” the spouse said.

That absolute exhaustion encapsulates the problem our entire healthcare system is facing today. It clarifies both the human cost and the operational challenges facing provider organizations.

This report, based on interviews throughout the Jarrard Inc. network of clients and experts, triangulates the trends, draws conclusions about the future and offers thinking on how to manage an issue that’s gone past the boiling point.

That’s the public side, though. How much do the headlines reflect what’s happening behind closed doors? And, how much of an impact are we seeing from the visible PR battle combined with the results of closed-door negotiations? What’s the public perception of providers and payers? Does it even matter?

To determine whether payer-provider relationships are under more strain than usual, we spoke to experts in our network, checked in with our team and polled the public.

What we summarized: The cold war is heating up. There’s pressure on and from both sides, and a growing feeling of “Us” vs “Them.” Publicly, the balance of the PR is weighted towards payers, thanks to the campaigns mentioned above. But the insurance industry has a way to go to convince the public of its good intentions.

What We’re Hearing

Overall, payers and providers are getting more aggressive. Historically, negotiations tend to follow a set arc, with long, tense conversations bumping up against the expiration date only for a deal to be struck at the eleventh-and-a-half hour. While that remains largely true, the tone of more negotiations is getting hotter, the demands bigger. And in some cases, according to sources, the conversations nastier and more personal – with some individuals pointing fingers at the people across the table, not the organizations represented. That’s a problem.

As both providers and payers get bigger, it makes sense that the stakes would get higher. Each side is looking for leverage, and size is leverage. There are many reasons why hospitals pursue mergers and partnerships. Strength to push back against payers is certainly one of them.

An Elephant in the Room

Or, ahem, at the negotiating table.

Last year, as the CMS price transparency rule loomed, a big question was how the posted data would be used. Providers were concerned the data would  be of marginal value to consumers – but a gold mine to competitors and other industry stakeholders. Eight months on, that’s looking more likely.

Sources tell us those numbers are beginning to come into the national discussions around price. While the data are far from perfect – in some cases they’re not even that great – they could begin to affect payer-provider negotiations.

M&A skeptics (including the White House) like to note that “The top 10 health systems now control 24 percent market share,” according to Deloitte. Yes, and, the five biggest health insurance companies control 44 percent of the market. Half as many players controlling almost twice as much relative territory. So, joining forces with a larger system that can help balance the weight makes a lot of sense for a smaller provider.

Document with the White House signet with text that reads "FACT SHEET: Executive Order on Promoting Competition in the American Economy"

Still, it’s not all brass knuckles. “I’m seeing more candid discussions and true attempts to find middle ground,” said James Kennedy, a Tampa-based shareholder and chair of the healthcare practice at Carlton Fields. Greg Maddrey, director at Chartis and president of Chartis Consulting, said he’s seeing a mix of discussions:

“We see very collaborative discussions in some parts of the country and contentious discussions in other regions. It depends on the payer and market. One system just negotiated a significant value-based program, and they are exploring additional opportunities for JVs/collaborations. In other areas, the negotiations seem like traditional zero-sum game models.”

Things Usually Work Out, But…

We’ve also seen recent examples of things falling apart, eleventh hour or not. As the players get bigger, so do the numbers of patients who will suddenly find themselves walking into an out-of-network facility. Then comes the finger pointing as both sides try to pin the blame on the other. “They’re too expensive!” says the payer. “They’re raking in profits and want us to take less!” says the provider. “We’re trying to find a solution for our patients,” both exclaim. Meanwhile, patients are left scrambling, confused and footing the out-of-network bill.

Fortunately* for providers, the public is on their side. Or at least, more on their side than on the side of payers. We recently fielded a survey of American adults to get past the noisy headlines and figure out what the public actually thinks.

Do You Think Healthcare in the US Costs too Much?

Pie chart showing 85% "Yes" and 15% "No"

Who is Primarily Responsible for the Cost of Care?

Pie chart showing 12% "The System," 15% "Doctors," 13% "Hospitals," 30% "Insurance Companies," 16% "Government," and 10% "My Choices"

Most everyone (85 percent) agrees that healthcare is too expensive, and 30 percent of consumers believe the insurance industry is to blame. Only 13 percent blame hospitals for the high cost of care. Makes sense, then, that insurance would want to reposition itself in softer, friendlier light. It also follows that health insurance advocates would want to shift some of the blame to hospitals.

*About that asterisk: Hospitals should be pleased that they retain more of the public trust than other healthcare stakeholders. But they shouldn’t take that trust for granted. While the headline-grabbing ongoing campaign against hospitals doesn’t seem to have taken hold in the public’s mind yet, nothing says that it won’t.

What Happens Next

On paper it looks like providers are facing a multi-front battle, with skirmishes breaking out in places and tensions rising in others. How do you, as a provider, prepare for the impending charge? By going on the offensive.

Publicly

Explain your value. Repeatedly. Specificity is the antidote to speculation. Be aggressive in presenting data that shows how your organization contributes to the community it serves. Patient visits, lives saved, babies delivered, cancers caught early, people employed, economic impact. If your hospital reflects the local demographics, if you have a career development program to help improve diversity at the upper ranks, if you have a unique recruiting program to bring in more diverse physicians – talk about it. (If you don’t, start working in that direction). Talk about what you do with the revenue that comes in. Explain where that four percent margin you make is reinvested.

But don’t get mired in the data. Personalize it. Use stories to illustrate the numbers. Need a sign that stories are effective? Look no further than the “other side” of this debate. Hospital critics have been far more effective using stories to illustrate purported patient harm. They’re masters at personalizing the numbers they’re attacking. The public can see and hear patients and the pain they’re suffering. In contrast, providers, so far, tend to speak in numbers and vague platitudes. It’s no contest.

Explain how healthcare finance works. Did you cringe? Fair. Explaining the complexities of healthcare is brutal and daunting. But it’s on you to simplify the complex (or call in the experts to help you with that). Clear is kind, right? The more absurdly dense something is, the harder you need to work to explain it clearly, and dispel any sense of covering up, hiding facts and being opaque. Your patients and the public will appreciate you for that.

More Smart Strategies

Keep these tips in mind to navigate public disputes with payers

Advance preparation is key

Strike first to frame the issue

Clear, patient-centric messaging is most powerful

The messenger matters most: Clinical spokesperson is key

Establish a single source of truth online early on

Tactics & tone must match culture

Marcom obviously plays a lead role here. It’s time to develop educational materials to explain how insurance and billing works, and what patients’ options are. Not the inscrutable, low-quality papers that look like they came off a 90s copier, but attractive resources that explain in simple language what the terminology means, where people should look for information and how to interpret what they find. Video is helpful, or even social media posts to talk through the basics. Finally, work with your rev cycle team to ensure that anyone who might interact with patients on billing is trained to answer questions…in a friendly way.

One more thing here. While you’re translating the basics healthcare finance to your patients, think about going public. Seek out opportunities to talk in public forums. Use the media. Be a resource for reporters who are covering these issues. Don’t wait until they call you with tough questions. Position yourself proactively as the one offering information.

Privately

Get networking – now. Weak or nonexistent relationships sit at the center of problems around the negotiating table, according to experts who provided insight for this article. As noted above, some negotiations include personal attacks – an odd, dispiriting development. Without relationships, there’s no built-in trust, no ability to read the other side’s actions or words – typical buffers that prevent conversations from turning nasty. In the legal world we hear of plaintiff and defense attorneys having lunch together, meeting for drinks after court. On the surface, it feels strange to be dining with the enemy. But the outcome is often far more amicable and productive in legal proceedings. Healthcare could use the same approach. It’s time to network and meet with counterparts regularly so that the personal relationships can help soften the rough edges of negotiation.

The need for better relationships extends to employers and brokers, as well. As providers struggle to match up with payers, the employers who are effectively paying for care and whose employees make up the patient base can be strong allies. In our experience, this doesn’t happen nearly enough. Same thing for insurance brokers, who are often so key to connecting the various pieces of the how-do-we-pay-for-care puzzle.

In all of these networking conversations, providers must always take the high road. Everything should be about improving the health, access, experience and comfort for those receiving care. It’s all too easy for patients to get lost in the skirmish, but providers must intentionally make them the focal point.

Profanely

This is a no brainer. Just @%!# do it.

Providers save lives. They drive innovation. They employ millions. The provider side of the industry is not without its faults, and we should not hesitate to call out problems and bad actors. Ultimately, though, it is the providers who deliver care. Make that point in public and in private. Step up efforts to ensure every aspect of your organization is aligned with its mission. Make the case with data and stories, and don’t behave in ways that could give critics fresh ammunition.

As insurance companies increase the pressure, consolidate and integrate with providers of their own, delivering on their mission and showcasing how they’re doing it is the best way for hospitals and health systems to maintain trust take the financial steps necessary to keep the doors open.

In High Stakes, Issue Navigation, Quick Think

Now’s a Good Time to Not Say Dumb Stuff

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Note: This piece was originally published over the weekend in our Sunday newsletter. Want content like this delivered to your inbox before it hits our blog? Subscribe here.

The Big Story: The Science of Masking Kids at School Remains Uncertain

Inconclusive doesn’t mean invaluable. True, inconclusive results from scientific studies often get put on the back shelf and don’t make their way into published results. But last week when the CDC skipped over results from studies casting doubt on how much masks really do benefit young kids – it was a flat-out communications snafu.

What it Means for Your Health System

(3-minute read, 22-minute podcast)

Brilliant, experienced people across the country keep forgetting this basic lesson: Pause. Consider the consequences. Speak.

Examples? There are plenty:

  • The CDC is “file drawering” data that shows the science of masking kids in schools might not be as settled as they’ve maintained.
  • Hospital advocacy groups are responding to specific, reasonable questions about price transparency with, “It’s really hard.”
  • The FDA gave accelerated approval to a “blockbuster” Alzheimer’s drug against its own committee’s recommendation and then responded by doubling down.
  • Last year, public health leaders told everyone to hunker down at home in all circumstances – with a sudden carveout for social justice protests.
  • Local officials reopened bars and restaurants before many other businesses with convoluted explanations why drinking on a Saturday night was totally fine as long as it concluded by 10 PM. Cheers? Maybe not.

Each of these decisions was made with good intent. Some on compressed timelines with uncertainty swirling. Others were crafted in the heat of the moment – but here’s the problem: Often, those moments were either avoidable or could have been at least somewhat predicted.

On top of that, these conversations are happening at a time where people are inured to bad news. We’re sapped emotionally to the point we aren’t responding normally to tragedy  – in fact, we’re not responding to tragedy. We’re out of empathy. That means getting a critical message across may be harder than ever because people either won’t respond or will respond with skepticism.

This bleak picture coupled with missteps by the groups mentioned above are a warning to communicators about the risk of being unclear. Here are five pointers that hold true whether dealing with the heat of a crisis or a thoughtful explanation of a long-running issue like pricing:

  • Get accustomed to overexplaining things. Don’t assume your audience knows everything. The CDC and FDA, should know by now that very few people deeply understand science; therefore, simplicity and repetition are key. Same goes for the rest of us. Hand waving and saying, “It’s complicated but trust us” doesn’t cut it. Use simple language and repeat the message with empathy toward your listeners.
  • Know your audience. Understand who you’re trying to reach, their concerns, barriers to communicating with them and whom they trust. Prepare to communicate with them on issues that matter to them through their preferred channels.
  • Slow down (a little). You know to “tell your story or someone else will.” That doesn’t mean “say anything just to fill the space.” You may feel like you don’t have time, but trust us, you’ll spend more time cleaning up the mess if you’re sloppy the first go around. Pause to give everyone at the table a moment to consider and make sure you’re addressing the real issue.
  • Consider the consequences. Having understood your audience and slowed down to consider what you’re doing, think through how the message you’ve crafted is likely to be perceived. Anticipate questions. What holes will people on the receiving end try to poke in your message? Responding to questions by saying something is “really hard,” or that “hospitals are trying but maybe we should scrap the whole system,” looks like you’re spinning. You’re certainly not addressing the concerns of actual patients whose lives and wallets are at stake. To be clear: Don’t shy away from offering the kind truth and standing up for what you think is right. Acknowledge concerns; don’t brush them off.
  • Don’t be just truthful. A favorite phrase around Jarrard is “responsible transparency.” It’s the idea that we should offer more information than we’d like to because it builds trust and gives our audiences a more complete picture. Even when the information might not be what we want it to be. When the CDC fell down with the masking story, they weren’t fudging the numbers or hiding data that showed masking has negative effects. It appears they were just trying not to muddy the water. But this is a national debate about the safety of our kids and, despite the insane heat of that debate, it’s crucial to show your work, warts and all.
  • Know that some people will misconstrue, misrepresent and mislead. There are trolls and click-bait artists who will come after you no matter what. You can’t reach them. Don’t let them stop you from doing the right thing.
  • Speak with kindness and empathy. We know, a lot of us are running out of empathy. Here’s good advice from a commentary in The Wall Street Journal: “Healthcare professionals have a challenging obligation to work to understand where people are coming from, build a relationship, address their fears to help them understand, gently correct information that is wrong, admit when medicine was wrong and medical authorities misled people, motivate them based on their needs, and develop networks of support in the community.” Amen to that.
In High Stakes, Issue Navigation, Quick Think, Strategic Positioning

Payers Singing from the Same Hymnal: A Q&A with Wendell Potter

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Note: This piece was originally published over the weekend in our Sunday newsletter. Want content like this delivered to your inbox before it hits our blog? Subscribe here.

Editor’s Note

Call it perfect timing. Last week, when the nation’s largest provider in California and Anthem Blue Cross finally inked a deal after months of escalating friction, we’d just dotted the final I and crossed the final T on our Special Report on payer-provider tension. Check it out and then chase it down with our Q&A with noted author, speaker, Congressional witness and consultant Wendell Potter. He spent years leading comms and PR at Humana and Cigna before leaving to advocate for healthcare reform and shine a light on how payers operate.

Jarrard Inc.: We talk a lot about the increased scrutiny on providers, and not just from insurance companies – also from media, advocacy groups, Congress and the White House. What are you seeing?

Wendell Potter: There’s a decline in favorability because of news coverage over the past several weeks, months and even years. Part of it is the result of an ongoing campaign by payers to point the finger of blame away from them. Insurance companies are quite adept at shaping the conversation. They’ve spent a lot of time trying to make the public think that they are largely blameless for any ills in our system.

Jarrard: What is it about providers that makes them a target?

WP: One thing is that they have brick-and-mortar facilities. They’re seen, they’re ever-present and we need them. Insurance companies are not that way. People can assume they have good coverage and pay little attention to the name on their insurance card. So it’s less visibility, less awareness, even on lawmakers’ minds. A decade ago, during the debate on the ACA, insurers were under more scrutiny than they had been in a while or have been since. But a lot of the attention has been shifted in subsequent years to rising healthcare costs. The insurance industry has been quite successful in getting everybody to focus on rising cost of hospital care and pharmaceuticals. It’s playing out in what Congress is paying attention to right now.

Jarrard: Why are health insurance companies so good at creating this public narrative?

WP: They’re able to get everyone to sing out of the same hymnal. It’s interesting because AHIP has a pretty diverse membership – non-profits and for-profits of different sizes. But they’ve been good at forcing message discipline and being perceived as the ones wearing the white hats.

For them it’s an absolutely necessary strategy where it might not have been for others in healthcare. I don’t think others have understood the vital importance of doing what the insurance industry does day in and day out. Essentially, insurance companies are not necessary. We’ve got evidence around the world that health systems can get along quite well without them, so they have to have an ongoing campaign to make people believe they offer a very good value proposition. And they’ve been hugely successful in doing that.

Jarrard: We recently asked the public who they blame for the high cost of healthcare. Insurers came in at 30 percent with providers at around 15 percent. People trust their doctors and are more likely to blame insurers than hospitals, but in our view, providers need to cultivate that trust, not rest on it.

WP: I think that’s absolutely right. If you were to do a comparison of what you’re finding now, versus what it was a decade or two ago, you’d see some changes in attitude. The losers have probably been on the delivery side. Insurance companies have always brought up the rear in terms of public opinion. We want insurance to pay our bills and get out of the way. There is a lot of work that needs to be done on the part of provider organizations to rebuild trust with the American public.

Jarrard: How do providers do that? What can they do to tell better stories?

WP: It goes back to value proposition. There needs to be renewed focus on crafting messages that resonate with the public about what the value proposition really is. It’s always useful to have individual stories and throw in data. But if you just lead with data, people’s eyes glaze over. So it has to be packaged in the right way.

Jarrard: What are two or three types of data that providers need to really build that message?

WP: Something along the lines of population health. Talk about what your system is doing to improve the quality of life in the communities that they serve. You can get into wonky topics like social determinants of health without using that term. It can be important for community leaders at every level to understand what you’re doing, how the work that you’re doing improves quality at the individual level and for people who live in the area that you serve.

Another thing is highlighting good work. When an insurance company is giving money to a group in whatever city, they’ll have a press release. They’re always out showcasing their charitable contributions and what they’re doing. You can’t overstate the importance of things like that.

In High Stakes, Issue Navigation, Quick Think

Delta Survey Says: People Are Angry, Patients Are Nervous

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New Jarrard Inc. Poll: Six Insights into What Healthcare Consumers Are Thinking

(4-minute read)

As the Delta variant raged hot this week and hospitals began to curtail services, we asked 1,200 US adults about their thoughts and feelings about the pandemic*. Here’s what stood out:

  • Nearly three in 10 people say the current COVID-19 situation has them less likely to seek in-person care.
  • Telehealth is sounding better to many, with more than four in 10 saying today’s environment makes them more likely to go that route.
  • About half of those who aren’t vaccinated are dug in to their position. In fact, they’re so dug in that many of them say they’d leave their jobs rather than comply with an employer mandate.
  • Sixty percent of the people who are vaccinated harbor some ill will towards those who aren’t.

Several questions continue threads we’ve been pulling in our various consumer surveys over the past 16 months. In each, we want to understand people’s feelings of safety in different settings. (See findings from last April, August and this January.)

Here’s the latest healthcare consumer intelligence:

In-person care has some people nervous. We asked consumers if the current COVID-19 situation has changed the way they’ll seek non-emergency care – in person and via telehealth. Twenty-eight percent said they’re less likely to pursue in-person care. A smaller proportion is actually more likely to seek in-person care. (Yeah, we don’t get that either. Maybe they think wait times will be shorter?) But, the largest shift is in the wrong direction – a tough situation for providers who had a taste of returning volumes this year and now may be facing the need to scale back services due to the latest surge.

Does the current COVID-19 situation affect the likelihood you’ll seek non-emergency medical care in person?

Bar chart representing individuals' levels of comfort in-person

On the other hand, it looks like providers can expect an uptick in patients seeking remote appointments, as 44 percent said the current situation makes them more likely to pursue the virtual route. It’s a great reminder that telehealth needs to stay front and center. Marcom teams should play a strategic and tactical role here, helping shape public perceptions of safety, comfort, convenience and different options for care. It pays to keep patients abreast of any changes along the entire care process – from scheduling to arrival to checkout and billing.

People feel a bit safer in public places now vs. January and continue to feel safer in medical settings over other locations. We’ve been asking this question for the past year. Overall, people’s feelings of safety are up roughly one point from eight months ago, based on our 10-point scale with higher meaning safer. It’s something, but not a lot to bank on.

On a scale of one to 10, how safe do you feel going into…

Horizontal stacked bar graph representing individuals' feelings of safety

Vaccines and masks help allay fear. Many providers are already taking valuable safety approaches that their patients appreciate. But we wanted to dig deeper into respondents who are iffy about their feelings of safety in medical settings.

Asked what factors might help them feel better about in-person care (for non-emergencies), one of the top signals that cohort is looking for is a vaccine mandate.

We’re well-aware that many hospitals are struggling with the decision to implement mandates for employees. It’s a tough call. Still, in the public’s eye, mandates are vital to ensuring their comfort in your facility. Almost eight in 10 respondents in our January poll said that vaccinations should be required for healthcare workers – and this remains a consistent theme. So if you’ve got one in place, make sure you let the people know.

Other top factors in increasing feelings of safety were:

  • Isolation of infectious diseases in separate facilities
  • Masking requirements for everyone in the facility

Vaccine resistance is hard-baked for a small but notable percentage of respondents. Almost 70 percent of respondents said they were either fully or partially vaccinated, perfectly in line with CDC data out this week. We asked the remaining percentage about things that might help move them towards vaccination. For about four in 10 – or 13 percent of all respondents – the answer is, pretty much nothing. In fact, we asked if an employer mandate would increase their likelihood and phrased the options as “Yes – I’d do it to keep my job,” “No – I’d leave my job,” and “unsure.” Forty-six percent of the unvaccinated said they’d leave their job rather than comply with a mandate.

For providers, that unfortunate finding is a reminder to spend time and resources where you can make change happen, because there are corners of the community where you can’t.

Would you be more willing to receive a COVID-19 vaccine if…

Stacked bar graph representing what changed individuals' minds on getting the vaccine

Those who are vaccinated aren’t thrilled with those who didn’t get the jab. No surprise, our country is divided. Sixty percent of the vaccinated said they’ve become angrier at those who aren’t since news hit of the Delta variant surge. That anger extends to the medical community, including the doctors and nurses caring for those patients who made the choice – sometimes loudly – to avoid vaccination. Each day, these professionals see the accusations and misinformation. Then they come to work to deal with the avoidable consequences of it all.

Marcom leaders need to continue keeping open lines of communication with staff, keep support resources in place and simply be aware that it’s happening.

Have reports of the Delta variant changed your opinion of those who choose not to get vaccinated?

Bar graph with navy bar representing 51% "I'm more upset," orange bar representing 10% "Wasn't upset but am now," green bar representing 17% "I'm less upset," and light blue bar representing 23% "I'm not upset"

People think the worst is behind us…barely. On a brighter note, a slight plurality – 39 percent – said that they think we’re on the right side of this pandemic. Wishful thinking? TBD. Let’s hope they’re right.

Do you believe the worst of COVID-19 is behind or ahead of us?

Donut chart with green color representing 30% "unsure," orange color representing 39% "behind us," and navy color representing 31% "ahead of us"

*Online poll of US adults ages 25 and up, fielded Wednesday, August 4

Gender: 53% M / 47% F

Ethnicity: 67% white / 13% Black / 12% Latino/Hispanic / 4% Asian

This piece was originally published over the weekend in our Sunday newsletter. Fill out the form for full survey results.

In High Stakes, Issue Navigation, Quick Think

Death by Misinformation: Five Ways Providers Can Fight Back

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Note: This piece was originally published over the weekend in our Sunday newsletter. Want content like this delivered to your inbox before it hits our blog? Subscribe here.

Scroll to the bottom for a podcast and question of the week.

The Big Story: Surgeon general issues warning about sharing health information on social media

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The US Surgeon General urged social media companies to do more to combat rampant sharing of health misinformation. It was a slight walk-back from the President’s earlier comments that tech companies are “killing people” by allowing misinformation to be propagated on their sites. (Biden has also softened his statement.) Then, on Thursday, Senator Amy Klobuchar put forward a bill that would “strip online platforms such as Facebook Inc. and Twitter Inc. of their liability protections if their technologies spread misinformation related to public-health emergencies.”

What it Means for Your Hospital

(2-minute read; 18-minute podcast)

Can your clinicians go toe to toe with Dr. Facebook? Yes and no.

Yes, doctors and nurses remain highly trusted when it comes to health information. But both younger and lower-income demographics express less trust in their doctor. Fewer young adults have a primary care provider than do older generations. And the percentage of people who consider healthcare overall in the U.S. “good or better” has dropped below pre-pandemic levels.

There’s been a shift in the relationship between patients and the medical community. It’s less personal, more transactional. At the same time, people are forming strong online relationships, turning to Facebook and the like to find, validate and act on information.

The national buzz is heating up on how we should combat misinformation and the relative contribution of individuals, tech companies and government.

But closer to home, do local healthcare providers have a responsibility to step in and correct misinformation their patients may be receiving? And how can the marcom pro on the ground  help stem the tide of misinformation on vaccines or any other topic? This may help:

  • Get in the fight. After an exhausting year putting out hour-by-hour information, many marcom teams have refocused this year on other critical issues facing their organization. But you’re needed, spreading as much good information as possible.
  • Activate your existing supporters. You can’t do it alone. The good news is that you have an army of brilliant and enthusiastic people with credibility to help. Your clinicians and your patients themselves. Help them all to spread the word. Provide tip sheets with do’s and don’ts for talking to friends and family.
  • Similarly, use relationships where they exist. On the latest Touchpoint podcast, pediatric gastroenterologist and digital health expert Dr. Bryan Vartabedian said while he’s not normally involved in the vaccine conversation with patients, he has persuaded many skeptical teens to getting the COVID-19 jab just as part of the “one-on-one connection, the grassroots-level conversation” during a visit. So, yes, despite the trends we noted above, the doctor-patient relationship isn’t dead, yet. And that white coat can also exert significant influence outside of the exam room – with friends and neighbors.
  • Go where they are. You’ve got a well-designed Facebook page for your organization. But just how accessible, friendly and conversational is it? Review your online properties and make sure you’re not just using them as a bulletin board to highlight Heart Health Month. Then, see where you can expand – we’re looking at you, TikTok. Create engaging posts for the channels where your patients spend their time. Might feel weird at first, but it puts the information in the right spot – and your team might have some fun along the way. Be sure to tell your patients about these channels so they know to look for you and spread the word.
  • Partner up. Early in the pandemic we saw public collaboration between otherwise bitter rivals. Now might be a good time to bring that back. Think about how powerful it would be for the public to see two competing hospitals standing side-by-side. Then, call your peer down the street and invite them to join forces. Maybe even choreograph some TikToks together.

Want more? Check out the 18-minute conversation featuring Jarrard Inc.’s Kim Fox and Tim Stewart:

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In High Stakes, Issue Navigation, Quick Think

Six Critical Ways to Address Falling Short on Community Spending

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Note: This piece was originally published over the weekend in our Sunday newsletter. Want content like this delivered to your inbox before it hits our blog? Subscribe here.

The Big Story: Major nonprofit hospitals’ community spend falls millions short of tax break savings, report says

The Lown Institute last week released its naughty and nice list of hospitals based on their community benefits and found that 72 percent of not-for-profits spent less on the community than they received in tax breaks. The report ranks hospitals as community partners based on spending for charity care, community health initiatives and Medicaid revenue. In a first, it also assessed “fair share spending,” which compares private non-profit hospitals’ spending in those categories against the value of their tax exemptions.

Impact on Your Hospital

This failure to cover the tax exemption is red meat for critics of our industry…And where it’s true, it should be. Let’s address what you can do to safeguard your reputation if your organization is one with a deficit in “fair share” spending, at least as Lown figures it. A couple of points to set the stage before we do that:

First, this is real money we’re talking about.

  • The value of tax breaks for nonprofit providers is significant, with the national aggregate a whopping $24 billion in 2011; experts say it’s likely double that today – do the math, that’s something around $50 billion. 
  • Roughly $17 billion.That, per Lown, is the cumulative deficit from the almost three-quarters of the 2,400 nonprofit hospitals reviewed that spent less on overall community benefits than the value of their tax break (as they calculate it, at least).

Second, “community benefit” is notoriously difficult to define and is inconsistently calculated across the country.

Does it include charity care? Of course. Does charity care include just the cost of the care delivered or the margin lost as well? And that margin is based on what charge? If you’re an academic medical center, does it include the cost of research? (Lown says it does not). While we’re at it, how do you determine the potential tax relief you’re receiving as a not-for-profit? What’s included in that calculation?

The days are passing when providers can rely solely on the great, historic strength of their branded reputations to push aside pointed criticisms of our industry based on thoughtful research like we see in the Lown report.

The visibility of the study demonstrates again that if providers aren’t defining their value to the communities they serve, someone else will. And it won’t be to their benefit.

This story is the latest in a series of critical spotlights on the performance of providers, and it will not be the last. Indeed, there’s more data from Lown on the way – the institute said it will release its full hospital index later this year.

Providers need to do well, of course, and be true to their mission in every investment made and in service to the community.

They also need to know how well they do, how they can prove it and then tell that story. It’s not creating a conversation. It’s joining (and shaping) a conversation already in progress.

What Communication Must Happen Today

Shaping that conversation requires intentional focus on both the work of Community Benefit itself and how you talk about it. It means defining the terms and demonstrating how you’re applying them. Because, in our experience, the apparent discrepancies picked up by the Lown report often happen when individual decisions are made in near isolation, without enough connection to or consideration of the larger issue – in this case, Community Benefit.

Therefore, as you dig into the work and the message, consider the following:

  • Know your value. How do you calculate your community benefit? Work with your leadership team, including finance and clinical leaders, to create the formula that reflects your orgs true value.
  • Know your numbers and the story they tell. What does your formula tell you about your organization; what comprehensive narrative do the numbers reveal? Frame it.
  • Tell your story. Set the table so the value of your organization is clear and defined by you before others do it for you. Engage proactively and consistently with the community through your own channels and the media to show the incredible ways you’re meeting their needs and fulfilling your mission.

And then, as you move forward, keep these three tactical considerations in mind:

  • Plan ahead. Work with leadership to determine in advance your charity care and community benefits spending – and then plan for how you’re going to measure and publicize this. Marcom leaders, as connectors between community and hospital, should play a vital role in discerning what people want and need. Focus keenly on your community health needs assessments and prioritize spending to mirror needs. Then do it and get the word out.
  • Stay in the loop and keep others looped in. Your board will be asked about your organization’s policies and actions, especially for community hospitals. Report out regularly on this issue, involve them. After all, as board members they are accountable. Meanwhile, stay vigilant to ensure your organization isn’t engaging in predatory financial practices that are harmful to people and undermine your collective community benefit.
  • Document everything. If it wasn’t written down, it didn’t happen. There’s a decent chance your organization is doing a lot of community benefit work that’s slipping through the cracks and, therefore, you’re not getting credit for. Capture it all – every community meeting, screening event, health fair, hour donated by employees on the clock, etc. Use that documentation to share what’s being done and spent.
In High Stakes, Issue Navigation, M&A, Quick Think, Strategic Positioning

Cartels or Safe Havens?

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The Big Story: Biden executive order calls for action on hospital consolidation, price transparency

The President issued an executive order on Friday “telling the Federal Trade Commission to prioritize hospital consolidation in its enforcement efforts. The order will ‘underscore that hospital mergers can be harmful to patients and encourages the Justice Department and FTC to review and revise their merger guidelines to ensure patients are not harmed.’” The AHA and FAH weighed in with overviews and critiques shortly after.

Our Take

(2-minute read)

It’s a Catch-22: Scrutiny of hospital consolidation is increasing in direct proportion to the need for hospitals to find strong partners.

Biden’s executive order follows a cascade of criticism and Senate hearings directed at hospital consolidation – with one outlet going a step or three further and referring to it as “cartelization.”

Yes, the scale of deals is on the rise. A Kaufman Hall study found that the number of deals through Q2 of 2021 is down markedly from previous years, but the size of those deals is “the second highest in recent years.” And yes, some research shows such mergers can drive up prices.

What’s missing from the conversation is that consolidation is happening because the system is broken. It’s broken in myriad ways (seriously, it takes two presidents to let us buy hearing aids without a prescription!?), and we’re stuck until we create something new together.

The current version of the escalating-costs narrative critics are using pins the blame squarely on providers by suggesting – implicitly and sometimes explicitly –  that mergers are driven by greed. The White House fact sheet laying the foundation for the order says that “Hospital consolidation has left many areas, especially rural communities, without good options for convenient and affordable healthcare service.”

It’s a compelling narrative. Our question: Where’s the counter? Who’s telling the story of the real reasons a hospital might want – that is, need – to join a larger system? Or of what might happen if they don’t partner up? There’s a taste of that in the AHA and FAH statements, but more is necessary.

It’s time for hospitals and those who care deeply about access to healthcare to build that narrative. To speak up.

Hospitals can and do pursue mergers, acquisitions and partnerships for a variety of reasons. First among them is so they can continue to fulfill their missions. Over and over, we’ve seen hospitals stay open because of a deal.

Which brings up a related reason for deals. Rural providers often have no other option because the math isn’t working in their favor. The government pays as little as 50 cents on the dollar through Medicare and Medicaid. Plus, there’s a downward push by payers to reimburse at lower rates. That means standalone hospitals – particularly smaller community hospitals where relatively little revenue comes from private reimbursement – often must choose between closing or becoming part of a larger system.

Again, you can’t care for your community if you don’t exist.

So instead of the chatter depicting health systems as predatory, let’s share the stories of community providers seeking a partner for true shelter. To be able to survive. Providers and advocates for access can start engaging in that conversation this way:

  1. Articulate the actual value to consumers of a consolidation or merger. To be clear, this isn’t offering the same tired and vague messaging about “value,” “transformation” and “scale.” It’s a direct, honest story about what will happen if the deal goes forward…and the consequences if it doesn’t.
  2. Prepare for state attorneys general, health insurance companies and others to use the administration’s activity to ramp up opposition to consolidation (which challenges their market share). In other words, your government relations work and relationships with opinion leaders matter more than ever.
  3. Explain how you will deliver on promises made. And then do it.

This executive order appears to be a request for more action, not the action itself. That suggests there will be a waiting period, possibly even a comment period. Don’t let that time go to waste. The conversation has been underway for a while, and it’s being dominated by non-providers. Some are well-intentioned and want to improve the value and delivery of care. Others are market competitors (the self-proclaimed disruptors) and adversaries who view this as a zero-sum game and are campaigning to make providers the fall guy. Hospitals, health systems and others who are focused on access need to stand up. This is a new type of scrutiny. It’s time to respond in new ways.

How to do that? Coming soon.