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Analysis

Study: Executive Health Programs Are a Crock

By MedPage Today  
   January 14, 2020

Want to guess how many of the included tests are recommended?

This article was first published on Monday, January 13, 2020 in MedPage Today.

By Senior Editor, MedPage Today   

Executive health programs may offer the semblance of doing all one can to get ahead on cardiovascular health, but they're ill-advised, researchers warned.

Programs analyzed in a new study offered 12 different cardiovascular screening tests and a resting electrocardiogram, none of which are recommended for asymptomatic adults by professional societies or the U.S. Preventive Services Task Force.

Such executive screening programs run afoul of healthcare's goal of evidence-based cost-effective equitable care, concluded Alan Ge, MA, of St. Louis University School of Medicine, and David Brown, MD, of Washington University School of Medicine in St. Louis, in a research letter in JAMA Internal Medicine.

"The premise of using these tests is that the results may help reduce mortality from cardiovascular disease through earlier disease detection or more precise risk assessment," they wrote.

However, "indiscriminate screening can create a cascade effect and thus violate the principle of primum non nocere (first do no harm) wherein unnecessary tests may create a chain of events resulting in additional ill-advised tests or treatments that may cause avoidable physical or psychological harm," Ge and Brown added.

An accompanying editor's note agreed. "Even if a patient is willing to pay for a test or medication, we should not be willing to cause them harm," wrote editor Rita Redberg, MD, and deputy editor Mitchell Katz, MD.

Furthermore, there's risk for the specialty itself, Ge and Brown suggested.

"Offering executive physicals with tests that are not recommended for healthy persons to anyone who can pay out of pocket potentially sends the message to trainees that a 2-tier health care system is acceptable, and that evidence is not important," they wrote.

Cardiovascular examinations included in executive health screening programs offered by 18 of the 21 top heart hospitals by U.S. News & World Report rankings that responded to the survey (out of 25 contacted) most commonly included a lipid panel (71%) and a cardiac stress test (68%). Cardiac CT scans to get calcium scores or to visualize the coronary arteries was included in 43%.

Hospitals charged from $995 to as much as $25,000 for these programs, including the appointment fee. Only three (10.7%) offer to submit charges to insurance, although it wasn't clear whether insurers would actually reimburse any of the services.

One limitation was that the survey couldn't determine how physicians in the programs might have individually tailored testing differently than what was represented by administrators who provided the information.

The researchers disclosed no relevant relationships with industry.

“Indiscriminate screening can create a cascade effect and thus violate the principle of primum non nocere (first do no harm).”


KEY TAKEAWAYS

Programs analyzed in a new study offered 12 different cardiovascular screening tests and a resting electrocardiogram, none of which are recommended for asymptomatic adults.

Such executive screening programs run afoul of healthcare's goal of evidence-based cost-effective equitable care.


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