In Rush to Promote High-Tech Treatments, What About Patients?

Marketing done right is when hospitals successfully promote proven treatments to their communities. By and large, most marketing I come across follows this tactic.

Late ly, however, I've been seeing more instances of hospitals promoting unproven high-tech treatments and procedures in order to outpace their competitors.

Some call it an arms race. I call it the tail wagging the dog. Ultimately that dog can turn and bite you.

Controversial Proton Therapy in D.C.
In Washington D.C., two of the region's largest health systems, MedStar Georgetown University Hospital and Sibley Memorial Hospital, are vying to offer proton beam therapy, the Washington Post  reports. Proton beam therapy centers are large, expensive and unsupported by evidence of improved patient outcomes.

Proponents say the therapy is more precise in targeting tumors and safer for healthy tissue than conventional X-rays. It's thought that proton therapy's greatest potential is in treating children, especially those with brain and eye tumors. The therapy can be administered at higher doses than conventional radiation and causes fewer long-term side effects.

See Also: Hands-On Robotic Surgery Promo Connects with Shoppers

The ECRI Institute suggests that since comparative effectiveness research is lacking, hospital leaders considering a major proton center build-out might wait a bit.

Nevertheless, if approved by the government, Sibley plans to open a $130 million facility in 2017. MedStar Georgetown has proposed a $32 million center, which could begin operating next year out of its existing cancer center. Both projects are pending a decision by D.C. health planning officials.

Here's the thing—both organizations acknowledge that research has yet to demonstrate that the treatment is better than conventional therapy for other cancers, such as prostate, even though many hospitals want to use proton therapy to treat that disease. And they aren't the only ones moving ahead with the costly therapy before the verdict is in.

Even the venerable Mayo Clinic is building two proton beam facilities. Why? "Because it's competing against Massachusetts General Hospital, M.D. Anderson in Texas, the University of Pennsylvania, [and] Loma Linda in California —all of which have one," Ezekiel J. Emanuel, an oncologist and vice provost at the University of Pennsylvania, wrote in the New York Times last year.

And Scripps Health in San Diego will have one this fall. Until recently, Scripps and UC San Diego Medical Center were poised to move forward with competing proton beam centers within 5 miles of each other. UCSD, citing "a lot of simpler solutions" coming down the road, has since opted to pursue a smaller project involving a different technology.

Why aren't more hospitals being this cautious? You guessed it—money.

Hospitals using proton technology receive higher Medicare reimbursements than those using conventional radiation; for example, $32,000 per patient compared with less than $19,000 for prostate cancer treatment, according to a recent study in the Journal of the National Cancer Institute.

Questionable Robotic Surgery in MA
A similar technological arms race has been unfolding in Massachusetts, where the state has recently cautioned hospitals about robot-assisted surgeries. State health officials sent hospitals an advisory letter in March alerting them to safety concerns based on a rise of reports of complications from robot-assisted surgery.

"In some cases, it appears that doctors have used the aggressively marketed robots to perform hysterectomies and colorectal operations that were too complex for the technology, or for the surgeons' skill level in directing the robots' actions," The Boston Globe reports.

The popularity of robotic surgery has surged in recent years, largely because of heavy advertising by the manufacturers and hospitals, promoting the technology as a way to reduce complications and speed recovery.

"The marketing is not based on any data," Dr. Peter Dunn, director of perioperative services at Massachusetts General Hospital, told The Globe. "This tool was brought to us [by the manufacturer] solely as a marketing device. The medical community didn't do what it should have done—say, 'Wait a minute, hold on.'"

Several Massachusetts hospitals that have advertised robotic procedures, including Brigham and Women's, St. Luke's, and Beth Israel Deaconess, said they are reviewing their marketing activities.

And, based on reports of adverse events related to the da Vinci robotic surgery system, the FDA has launched a survey to assess the hardware based on physicians' opinions.

Hospitals need to be innovators and risk-takers in order to move healthcare forward, but the primary motivation must be to enhance patient care. It's when organizations make high-cost decisions chasing better reimbursements and increased service line volumes that priorities get muddled.

It's up to marketing leader to be a strong voice advocating for the former.