Two St. Louis-based researchers are denouncing “executive screening programs” targeted at affluent individuals who do not have any cancer symptoms, but want to avoid any future surprises.
Such preventative offerings are growing in popularity and can cost upward of $25,000 at some of the top heart hospitals. Oftentimes, these imaging tests are conducted with little regard to clinical best practices or costs, according to a recent piece published in JAMA Internal Medicine.
“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 two-tier healthcare system is acceptable, and that evidence is not important,” Alan Ge and David Brown, MD, with the St. Louis University and Washington University schools of medicine, respectively, wrote in the Jan. 13 research letter.
To back their claims, Ge and Brown conducted an informal phone survey of the top 25 hospitals for cardiology care, as ranked by US News & World Report; they chose heart care because it’s the leading cause of mortality in the U.S. The duo quizzed each provider institution on whether they offer such screening packages, if insurance covers them and typical costs.
Twenty-one hospitals responded to the inquiry, with 18 offering executive health screening programs. They found that costs range anywhere from $995 for a “comprehensive health assessment” at Houston Methodist to $25,000 for the Premier Executive Health Program at Cleveland Clinic, the nation’s No. 1 heart hospital.
All told, 12 different cardiovascular screening tests were offered across these 28 different programs, along with a resting electrocardiogram. Those included cardiac CT scans in 43% of programs to determine a calcium score or visualize the coronary arteries, along with lipid panels and stress tests. None of the 12 are recommended by the American College of Cardiology or American Heart Association to be applied “indiscriminately” to symptom-free adults, the pair concluded. Three of the 18 hospitals typically submit charges to insurance carriers.
The study is limited, authors noted, with information coming from administrators rather than physicians, and no details about whether offerings are tailored specifically to individuals. But Ge and Brown believe their analysis is enough to give hospital leaders pause about these programs, which they believe violate physicians’ guiding principle to “first do no harm.”
“Unnecessary tests may create a chain of events resulting in additional ill-advised tests or treatments that may cause avoidable physical or psychological harm,” they concluded. “In summary, executive screening programs are not consistent with the goals of healthcare to provide evidence-based, cost-effective equitable care.”
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.