When dentist Augustine Berge heard an ad on his car radio for an inexpensive heart scan, he almost dropped his teeth.

The 54-year-old Mariettan had been worried about his ticker because of high blood pressure and cholesterol levels, though not quite enough to see a specialist. But the Emory Healthcare ad touting a $150 CT scan caught him by surprise and spurred him to action.

LANCE M. SKELLY/Special (ENLARGE)

Emory technician Lucienne McKinney prepares to run patient Robert E. Brown through the CT scan machine. A scan is available for $150.

LANCE M. SKELLY/Special (ENLARGE)

Robert E. Brown, 81, of Marietta, is in great shape for a man of any age, according to a CT scan he received at Emory Clinic.

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"It was cheap, so I figured, why not?"

Good thing. He made the call, got the scan and was told within minutes to see a cardiologist.

"They said I had the heart of a 66-year-old man," Berge says. "I've got to get healthier."

He's one of 2,278 Atlantans who have responded to the Emory radio ad since February, 75 percent of whom made appointments. Like several hundred of them, Berge was told by doctors who analyzed his space-age X-ray that he needed to see a specialist, preferably, Emory concedes, one of its own.

Experts say nonprofit hospitals are advertising more now than ever.

Competition has become fierce for paying patients to keep the nonprofits afloat, said Dr. Greg Simone, chief executive of Marietta-based WellStar Health System.

"We have no choice but to advertise," he said. "To fund our mission, we have to be able to pay for everything from tongue depressors to salaries. We have to run a profitable business. Every dollar we make gets plowed back into community benefit."

But prices have to reflect that most hospitals' bottom lines have been weakened by the tens of thousands of patients who can't pay — but who, by law, can't be refused treatment.

Emory's ad campaign cost more money to run than it has brought in so far, but it raised awareness about its cardiology programs. And other big Atlanta hospitals have similar ideas.

They spend many thousands of dollars a year to tout everything from sleep, pain and eye clinics to cancer, allergy and obstetrics centers to possessing the newest technologies, ranging from scanning and imaging devices to robots with arms that help doctors perform surgery.

Northside Hospital, where more babies are born than at any other hospital in the nation, promotes obstetrics and gynecology. Saint Joseph's pushes "minimally invasive robotic procedures such as heart and partial knee replacements." Piedmont touts its new Piedmont Heart Institute with more than 50 cardiologists. And Gwinnett Medical Center promotes its proximity to 750,000 people. Promotion often comes in the form of ads, though how much a hospital spends is a competitive secret.

"The market is very cluttered with health care advertising," says Nina Montanaro of Piedmont. "Our competitors' billboards will show up at our location, Collier and Peachtree. It's a fragmented market."

Una Newman, Emory's chief marketing officer, said the heart ads are paying off by saving lives and drumming up future business for the cardiology practice. The hospital's heart doctors serve not only Emory, but also Grady Memorial Hospital and WellStar.

"We're trying to make sure that people who have heart disease receive proper care," Newman said. "We're not doing this for free, but we would hope people would remain in our system for follow-up care. We've seen some patients we've walked down to the ER because their scans [revealed serious illness]. When the ads started, a lot of people started coming in right away."

Lucienne McKinney, a 35-year-old CT technician at one of four Emory locations that offered the scans, said the campaign has kept her busier than usual, examining 25 to 30 patients per day. Scans take 10 minutes or so, but it takes longer for patients to be told their results — and whether they need to see a cardiologist.

"Normal patients are counseled by myself or one of the other technologists," she said. "Then, the results are examined by a radiologist, a doctor. A blood test is part of the exam."

And then patients are mailed an assessment of their blood pressure, cholesterol, calcium and glucose levels; their 10-year risk of cardiovascular problems; even their own personal "vascular" age.

Arthur Levin, director of the New York-based Center for Medical Consumers advocacy group, said hospital ads are exploding, though no one knows exactly how much is being spent because the figures are secret. Hospitals are spending on broadcast media, billboards, Web sites, and newspapers and magazines.

He said health prices are rising at double-digit rates, which make it critical for hospitals to "scrap for all they can get."

Kevin Mann, an adjunct professor of advertising at Syracuse University and owner of an ad firm called Camp Design, said most hospitals have customers "whose bills have to be paid by someone, so they have to raise prices for people who can pay. The feeling is, if ads can help businesses, then, why not hospitals?"

Karen King, head of advertising at the University of Georgia who does research on health communications, says hospitals "don't want to fall into financial troubles like Grady Memorial Hospital, so they try to get the word out about what they do, and where they are located" to attract paying patients.

"It's much easier to sell a product for which there's a need," King said. "If they are going after baby boomers, it's because that group of people now is more likely to need the procedures being advertised."

Some doctors, like Atlanta internist Sandra Fryhofer, worry about hospital ads, as do ethicists.

"Before having any type of test, especially one with radiation exposure, think out benefit/risk and talk to your doctor," Fryhofer said.

Arthur Caplan, director of the Center for Bioethics at the University of Pennsylvania, said some hospital ads have gotten "outrageous" because of "the lucrativeness" of certain types of treatment. "There's a tremendous amount of advertising to come in and get your stomach stapled," he said.

Bill Custer, director of the Center for Health Services Research at Georgia State University, said the ads are hospitals' reaction to their financial pressures. "Hospitals have to be nonprofits but also take care of the uninsured or Medicaid patients," he said.

Rick Wade, senior vice president of the American Hospital Association, said hospitals would "like to junk their ad budgets" but can't, to stay competitive.

Berge, the Marietta dentist, is delighted he heard the Emory ad and has embarked on a get-healthier course.

"I got a wake-up call," he said. "And now I'm going to do what they said."