18 Sep Who Benefits When Hospitals Offer Executive Physicals?
MedicalResearch.com Interview with:
Deborah Korenstein, MD FACP
General internist and Chief, General Internal Medicine
Memorial Sloan Kettering Cancer Center
MedicalResearch.com: What is the background for this study?
Response: Executive physicals are 1 to 2-day comprehensive health assessments offering disease screening and preventive testing. Large companies can arrange for these evaluations for senior executives. They are often offered by prestigious academic medical centers, but can also be located in less formal settings like spas. They generally include a set of tests that sometimes vary based on patient characteristics. Any tests that are done in response to from findings from executive physicals are billed to health insurance companies. A single 2008 paper described executive physicals and criticized them for being non-evidence based. Since then, executive physicals have grown in popularity, but their nature and impact have not been described. We set out to describe included services and cost of executive physicals at top academic medical centers.
MedicalResearch.com: What are the main findings?
Response: We identified 50 leading hospitals in 43 states, using the US News and World Report rankings. 32 offered executive physicals and we were able to obtain information about 29 of them. Cost ranged from $1700 to 10,000. We rated the appropriateness of included services according to recommendations from the US Preventive Services Task Force (USPSTF). The most commonly recommended services were hearing exam and EKG, neither of which is recommended by USPSTF (due to insufficient supporting evidence). We found that many programs included non-recommended services, including stress testing, chest x-ray, and pulmonary function testing. Conversely, some tests that are recommended by USPSTF were excluded entirely (e.g. CT scan for risk-based lung cancer screening) or included in relatively few programs (e.g. colon cancer screening was offered by fewer than half of hospitals).
MedicalResearch.com: What should readers take away from your report?
Response: Executive physicals at leading hospitals often offer non-evidence-based care. In an era of attention to improving value in healthcare, this finding has important implications. Because executive physical programs cater to the elite, the inclusion of non-recommended services suggests that a focus on value may be OK for the general population, but it’s not good enough for everyone. This, in turn, undercuts efforts to focus on the fact that unnecessary care does NOT improve health.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: We know very little about how many people are actually participating in these programs. Also, an important harm of unnecessary care relates to the downstream “cascade” of resulting follow-up tests and treatments. In the case of executive physicals, it is important to document the downstream impact of evaluations, which may lead to clinical harms to patients and unnecessary costs. Notably, these downstream services are billed to patients’ insurance companies, so it is possible that the opportunity to deliver downstream services may be a core factor motivating hospitals to offer these programs.
MedicalResearch.com: Is there anything else you would like to add?
Response: Executive physicals are also offered in settings other than leading academic centers. Given that the services delivered are not evidence-based, it may be appropriate for these programs to be limited to non-academic settings, where their maximal approach would be recognized as excessive rather than implying higher quality care.
I have no COI that is relevant to this discussion.
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