Misinformation in Healthcare: It's a Big Deal

Last week, Dictionary.com named “misinformation” its word of the year. The definition: “false information that is spread, regardless of whether there is intent to mislead.” In its press release, Dictionary.com CEO Liz McMillan said they chose the word amid the growing role of technology platforms in spreading “fakery online a la recent admissions by Facebook, WhatsApp and others.  In 2016, Dictionary.com’s word of the year was “post-truth.” In 2017, it was “fake news.”

No industry is more susceptible to misinformation than healthcare. Whether intended to mislead or not, healthcare misinformation is never harmless. That’s why it needs attention, especially considering its prominence in our economy and politics. Misinformation about healthcare is systemic for four reasons:

1). The public’s understanding of healthcare is deeply rooted in their personal experiences. These experiences vary widely by income, health status and social determinants of their health.
Firsthand experiences with the hospitals, clinicians, insurance drugs, remedies they use and what they cost are the basis for a viewpoint about the healthcare system. Views about how it operates, its structure, regulation and funding do not change unless or until prompted by a medical event or change of circumstances.

Gallup’s surveys have shown no major changes in the public’s opinions about the healthcare system since 2000: two in three remain dissatisfied with healthcare costs and access to insurance and three in four are satisfied with its quality of care. Kaiser Family Foundation’s polling about the Affordable Care Act since 2009 shows a similar pattern, four in ten Americans continue to associate it with “government run healthcare” and six in ten think it’s primarily a law about expanded insurance coverage.

A recent survey by the Bipartisan Policy Center’s National Survey on Health Care Reform (July 2018) concluded “there is little support for either a fully government, or fully market-based system, once they consider the necessary trade-offs of increased taxes, limiting choice, or reducing benefits for the elderly, infirm, or low-income. Ultimately, although there was not a significant majority on any approach, the approach that garnered the most support was building on our current system of health care.”

What makes this all the more intriguing is the entry of Amazon, Alphabet, CVS, Walgreens, Apple, Privia, OneMed and other disruptors who promise a better experience for consumers. Might that change the public’s expectations? We’ll soon know.

Bottom line: misinformation in healthcare about our health system is filtered through firsthand experiences; if consistent with an individual’s circumstance, it is accepted as fact, if not, it is discarded.

2). The industry lacks a single source of truth. 
Each sector in the industry has its own messaging strategy and often these are incompatible or inconsistent. Polls by Deloitte and others indicate consumers trust physicians for information about their clinical options, insurers for information about their costs, and hospitals for safe, effective local care. In the mid-term election, each sector spent heavily to lobby elected officials for their legislative priorities: the American Medical Association spent $15,010,000, the American Hospital Association spent $14,470,000, the Blue Cross Blue Shield Association spent $8,290,126, the America’s Health Insurance Plans spent $5,190,000 and the Association of Medical Colleges spent $3,370,000 (Center for Responsive Politics).

Traditionally, the sources of “truth” about the health system were national broadcast media, especially the major networks. But trust in media has declined (Gallup) and more adults are getting their news through social media and mobile apps. In these newer channels, consumers are the ultimate news editors, and their appetite for health system insight appears quite minimal.

Bottom line: lacking a single source of truth about the healthcare system—the good and the not-so-good—the public is left to fend for itself. 

3). Media attention to healthcare issues and trends is inadequate and often lacks objectivity.
In 2008, Pew Research found healthcare news was the 8th most covered topic area consuming 3.6% of print and electronic content. By 2012, it had increased to 18% primarily related to coverage about health reform and the Affordable Care Act. At the same time, researchers observed a shift in how healthcare issues were covered, noting that media targeted to liberal or Democratic audiences carried twice as much information about healthcare than others. That pattern remains unchanged as media coverage about issues like Medicare for All, the Affordable Care Act and others are slanted toward liberal or Democratic-leaning audiences (Fair.org). Local news has become more important in covering healthcare as national news coverage has spent more time on stories about President Trump, Russia and domestic politics. (MIT Media Lab, Wesleyan Media Project).

Bottom line: misinformation about healthcare is exacerbated by lack of adequate attention by journalists.

4). The politics of healthcare amplifies misinformation. 
In the mid-term elections last month, healthcare was the focus of 45% of all campaign ads (Kantar Media/CMAG). Bloomberg analyzed 3 million TV ads run in Nielsen’s 210 local markets finding 1.2 million addressed a healthcare issue. 75% of these were run by Democratic campaigns featuring pre-existing conditions, drug pricing and Affordable Care Act protections. Kaiser Family Foundation polling concluded healthcare was the number one issue that drew   Democrats and Independents, but ranked low for Republicans. But campaign strategists on both sides routinely discourage their candidates to depart from focus-group tested talking points about healthcare – the risks for the campaigns are too high. The solutions in healthcare rarely fall into Blue or Red buckets. They default political rhetoric and campaign ads where the most egregious misinformation about healthcare is on full display.

Solutions to our rising suicide and drug addiction mortality rates, decreased life expectancy, increased prevalence of obesity and depression, a 9% decrease in children’s insurance coverage, escalating drug costs and a litany of other issues are more easily managed by characterizing the opposing party’s position as right wing or socialistic. Healthcare issues are often complicated: that’s why candidates avoid in-depth discussion about them.

Bottom Line: much of the misinformation in healthcare is a by-product of partisan efforts to overtly simplify a solution that’s complicated for political advantage. 

The U.S. health system in its modern era has evolved over 70 years. It is complicated, expensive, and prone to misinformation as each stakeholder seeks advantage. The implications are these:

  • Every healthcare organization must be proactive in making its case fully transparent in assembling facts for public scrutiny on which their case is based.

  • Every healthcare organization’s board must be fully accountable for the information and misinformation its organization provides.

  • Every employer, school and workplace must invest in educating their constituents about how the health system operates and performs today and its likely changes tomorrow. 

  • Every journalist who covers healthcare must probe beyond soundbites and talking points to protect readers/viewers from misinformation.

  • Every elected official must be willing to set aside party politics for the greater goal of having an informed electorate on healthcare issues.

  • Every citizen must take responsibility to understand the system beyond personal circumstances, biases and partisan leanings.

It’s often said that ‘you are entitled to your opinion, but you’re not entitled to your own facts.’ A meaningful national discussion about the future of our healthcare system is needed. But pervasive misinformation must be addressed first.

Paul

P.S. Last week, my post about hospital price transparency sparked widespread reader reaction. Many offered their own experiences with hospital sticker shock. Some challenged its relevance since hospitals are increasingly at risk for value-based payments. And all acknowledged that hospital charges bear no resemblance to what’s actually paid.

This from Joe Fifer, President and CEO of the Healthcare Financial Management Association (and long-time friend), “I had mixed emotions reading your November 26, 2018 blog post about price transparency. On one hand, you were writing about a topic that we at HFMA have been talking about for over 10 years, and about which we have great passion and content. On the other hand, I was surprised that someone so well connected to our industry, spending an entire professional career in healthcare, would be so confused about the topic of hospital charges, prices and transparency. It tells me how far we have to go in terms of having understandable patient financial communications: if Paul Keckley is confused, then how in the world would we expect someone that does not work in the healthcare industry to understand their healthcare financial picture? While I could quibble with parts of your blog post, such as the comparison of hospital billing process to that of a lawyer, or the necessity of understanding underlying costs of production, your three part call for easily accessible prices, encouragement of consumers to use transparency tools, and doubting whether transparency is the golden ticket to cost containment, were all right on. The reality is that the posting of hospital charges is not only not helpful, but often times hinders what really matters. What we really need to do is eliminate charges from the transparency conversation (maybe get rid of grossed up charges in their entirety?) and focus transparency efforts on what really matters: reasonably understandable price (expected payment) and individual out-of-pocket responsibility. That is what HFMA has been talking about since 2006.  And yes, Paul, you really should drink more water, and stay out of the ER.”

Note: Price Transparency in Health Care: Report from the HFMA Price Transparency Task Force 2014 www.hfm.org/transparency