SC Consumer Perceptions of Hospitals

1. SC Consumer Perceptions of Hospitals July 2014

2. Assumption: a hostile environment • chargemaster • medical errors • The Bitter Pill • transparency • profits • executive salaries • Medicaid expansion • CON • ObamaCare

3. Value of market research “Some use research as a drunkard uses a lamp post . . . for support, rather than for illumination.” David Ogilvy

4. Our research was illuminating

5. Utah’s campaign The Utah Hospital Association developed a campaign to increase trust and confidence in hospitals. That campaign included paid advertising. Its theme was Utah Hospital Association: The trusted voice of health care We were considering modeling a SC campaign based on Utah’s. Excellent messaging, but not the right one for SC hospitals because . . . .

6. South Carolinians trust their hospitals • Hospitals are highly regarded compared to other institutions, ranking in top 4 among firefighters, military and doctors. • South Carolinians gave lowest rankings to health insurers, state government, and federal government. • 68% of respondents believe hospitals are a credible source of health care information.

7. Our investment in quality is paying dividends Nearly 80% of respondents believe the quality of hospital care in SC is excellent/good. About half say quality has improved over the last 4 years. 80% consider quality “extremely important” in choosing a hospital. Just 1 in 5 say they are “extremely concerned” about a serious medical mistake while being treated in a SC hospital. Most consumers perceive quality in SC hospitals as similar to quality in other states. Responses do not differ by political affiliation.

8. But we do have areas of weakness • Hospital costs are too high. (61%) • Cost is a national problem. • 40% are “extremely concerned” about paying hospital bills and 32% have the same level of concern over dealing with the billing office after a hospital visit. • Public doesn’t blame hospitals, yet. • Consumers need more information to make decisions. • Nearly 70% would make health decisions differently if they knew the true costs of treatment. • Only 23% are very or extremely aware of range of services at local hospital • Hospitals are not perceived as efficient. • 38% believe hospitals are efficient. • 34% believe hospitals are working hard to control costs.

9. By far, most rely on personal experience, personal physician, and word of mouth (friends, family and colleagues) for health-related information. • A second tier of sources includes hospitals, media stories, websites, and insurers. • Advertisements (9%) and social media (10%) are lowest ranked sources. • However, persons under 35 tend to use websites and social media much more than older persons. Where do consumers go for info?

10. What info are they looking for? VALUE QUALITY PRICE Hospital ratings/ reviews (79%) Physicians on medical staff (72%) Special services provided (71%) = Average charges for procedures (65%) Out of pocket estimates (64%) Insurers with which hospital contracts (63%) Itemized list of all fees (63%)

11. What else would they like to know? • Health coverage options (60%) • How many times procedure has been performed (55%) • Average payment (50%) • How to choose a doctor (37%) • How to choose a hospital (35%) • Hospital policy on financial assistance (35%) • Charity care provided (29%) • Hospital profit/loss (21%)

12. Public expectations of hospitals emphasize quality of care • Care for the sick • Bring good physicians into the community • Provide emergency care • Focus on prevention as much as treatment (90%)

13. Public policy views More than half of respondents agree it is just as important for government to fund hospitals as it is to fund other public institutions. Public funding of hospitals is money well spent. The majority (75%) believe Medicaid funding should either increase or stay the same. The majority believe the ACA will lead to higher costs and lower quality of care. Less than half know that SC is not participating in Medicaid expansion.

14. Public policy views Less than a third know that the federal government is paying most of the expansion costs. 60% of respondents overestimate the number of South Carolinians on Medicaid. 24% said they didn’t know. Only 6% have communicated with an elected official regarding a health care issue. Only 20% believe that the public, the media and/or elected officials have negative attitudes regarding hospitals.

15. Regardless of credibility, politicians and media discuss your business for you with your stakeholders. www.schealthdata.org

16. A problem or an opportunity? Dear Hospital Communicator: If someone goes on the SC Health Data page posted by S.C. Department of Health and Human Services and checks out the numbers for your hospital, they might wonder about the future of the hospital. I know numbers don't always tell the full story. Do you think it might be good for somebody from the hospital to sit down and talk with me about the financial health and future of the hospital? So many small hospitals in the state are struggling, and I've written about several others. But I haven't done much on your hospital. Thanks, Joey Holleman Staff Writer, The State

17. What are our options? • Do nothing and keep quiet. • Do nothing, whine and criticize without an alternative to displace the contrary view. • Create a relevant, accurate, meaningful alternative and actively communicate it to stakeholders. 

18. Conversations are taking place beyond SC, and hospitals are taking action. “…been 'studied' for 6 years in a row by the AG's office and availability of pricing is a topic discussed each time. Our hospitals have voluntarily placed common charges on their web pages, and made their charity policies and documents available.” Bob Olsen, Montana Hospital Association

19. CHA adopts “modern pricing” effort “CHA has been working over the last two years on a solution to the current hospital pricing/charging system . . . CHA undertook this work in an effort to proactively mitigate efforts by others to mandate unreasonable and unsustainable pricing policies on hospitals and to improve the public’s perception about hospital bills and pricing.. . . CHA Board adopted “Modern Pricing”, a voluntary effort by hospitals to adjust their prices (i.e. charges) to a level that is explainable, understandable and reflects the unique cost structure of the hospital’s mission and patient population.   Hospitals across the state are taking steps to adopt modern pricing . . . Throughout the development, staff worked closely with top officials at the Centers for Medicare & Medicaid Services, the Office of the Inspector General, expert legal counsel and others.. . . modern pricing is one of the steps hospitals can take to make information more meaningful and user friendly to patients  and purchasers.. every stakeholder – providers, health plans, employers and purchasers – has a role in making meaningful price information available to patients.” Duane Dauner, CEO, California Hospital Association

20. Summary • 1. South Carolinians trust their hospitals. • 2. Quality is king. • 3. Public and stakeholder concerns over price and efficiency are increasing. • Lack of information is as damaging as bad information. • Others are discussing hospitals with key audiences. • 4. All patient interactions affect a hospital’s image and financial health. • 5. The public (voters) has little voice regarding “hospital business” and policy.

21. Going forward 1. Proactively get involved in the discussion on cost. 2. Promote hospital efforts to improve population health. 3. Continue to focus on quality. It’s working! 4. Use internal assets (SCHA training programs and digital media) to help address customer service/culture change in hospitals. 5. Consider activating a highly supportive public to address key policy issues after ground is gained on cost/efficiency perception.