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Hospitals mounting public advertising campaigns in recent years tended to be those in the best financial shape, yet their objective quality measures were no different than for facilities with no ad spending, researchers found.

Mortality and readmission rates, as well as CMS composite quality ratings, were nearly identical in 2016 between hospitals that advertised and those that didn't, according to Chima Ndumele, MPH, PhD, of Yale School of Medicine in New Haven, Connecticut, and colleagues.

Patient satisfaction, as measured with the Consumer Assessment of Healthcare Providers & Systems' Overall Patient Experience Rating, also didn't differ between advertising and non-advertising hospitals (mean 3.2 vs 3.3, P=0.92), the group reported in .

But they did differ markedly in size and financial health. Hospitals that advertised -- about half of the more than 4,500 included each year in the analysis -- were nearly three times bigger on average in terms of bed count (234 vs 85). More importantly, mean net income for hospitals that advertised was $17.8 million, whereas the average for those with no ad spending was barely above the break-even level at just $134,000.

Although hospitals typically claim their advertising helps to inform consumers, Ndumele and colleagues said their findings make that unlikely. "[I]f the most financially stable hospitals advertise (rather than the highest-performing hospitals) and if consumers cannot distinguish between the competing claims, it is unclear how the substantial resources devoted to DTC [direct-to-consumer] hospital advertising could improve consumer choices."

Indeed, the more likely effect is that such advertising pushes patients to choose hospitals with resources to spare, "potentially limiting revenue for community or safety net hospitals responsible for treating the most vulnerable patient populations," the researchers argued.

"Unlocking the potential of competitive health care markets," they added, "will require greater concordance between what is communicated to patients and what occurs in practice."

At the same time, and perhaps surprisingly, advertising wasn't mainly the province of investor-owned hospitals. Among hospitals in the highest third for ad spending, 45% were nominally nonprofit -- and 42% were major teaching hospitals -- whereas 37% were for-profit.

In addition, a few metrics did appear to favor the hospitals with substantial advertising budgets. Ndumele and colleagues identified a statistically significant trend in which increased ad spending was associated with lower mortality rates. Numerically, the mean adjusted 30-day mortality rate for those in the lowest tercile of spending was 12.7%, compared with 11.2% for hospitals in the highest tercile (P=0.003 for trend).

The study's data on ad spending came from a database maintained by market research firm Kantar Media. Ndumele and colleagues drew on CMS's Hospital Compare website for quality measures. CMS also supplied the data on hospital size, for-profit status, and finances.

Overall, the researchers analyzed an average of 4,569 hospitals each year during the full 2008-2016 study period to identify links between advertising and general hospital characteristics. However, associations between quality measures and advertising were for 2016 only, because that was the first year in which CMS recorded data for all the domains of interest.

Limitations cited by Ndumele and colleagues included that it relied on CMS's data for care quality, which are imperfect, controversial, and less than fully comprehensive. Moreover, the ad data didn't indicate or describe the content, such that "some hospitals may have advertised in targeted areas of specialization that may not have been captured in our analysis," the researchers noted.

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