For the last year and a half, residents of the Washington, D.C., metro area have been blizzarded with direct mail and print and media ads promoting a $139 package of "five life-saving tests for heart disease and stroke." The tests are targeted at consumers who are worried about their risk of sudden death or disability. To get tested, they need only to show up at a given location on a given day and climb into a specially equipped van operated by a medical-screening company called HealthFair. Those with worrisome findings need not look far for a referral for follow-up testing or more sophisticated care — the buses carry the reassuring logo of Inova Health System, one of the region's largest hospital networks, a system that prides itself on providing high quality medical care.
Consumers also must be prepared to pay; the tests are not usually covered by insurance. And there's good reason for this. In most cases, the tests aren't necessary, and may expose patients to additional risks through follow-up tests and procedures, according to a story reported by Kaiser Health News and published in Tuesday's Washington Post. The story notes that the influential U.S. Preventive Services Task Force, an independent government panel that evaluates the evidence and rules on which tests have value and which do not, as well as several medical specialty associations and other groups that craft medical guidelines, reject the use of most of the tests on people who lack symptoms or significant risk factors. The evidence is strong, say these organizations, that the tests' benefits fail to outweigh their risks, including false positives (results that suggest nonexistent problems) that generate followup procedures and unnecessary operations drive up the cost of care, generate needless anxiety, and put patients at risk.
"It's outrageous that they could be advertising and calling those tests life-saving, because they're not," UCSF cardiologist Rita Redberg told U.S. News. Redberg is editor of the Archives of Internal Medicine and an outspoken advocate of evidence-based medicine and cracking down on needless medical tests and procedures.
It is unsurprising that hospitals are struggling to find new ways of attracting patients in an era of ever-tightening costs constraints, with growing emphasis on prevention and community-based care. Hospitals that team up with testing companies like HealthFair can build their brands and attract new patients, according to the Kaiser Health News report. Inova gets no money from the the testing; instead it pays HealthFair to put its name on the buses. Patients may sign a form allowing someone from Inova to contact them to discuss abnormal findings. A list of Inova doctors is available on the buses.
Cardiologist Loring Flint, Inova's chief medical officer, told U.S. News that while he knows that such a testing program is controversial, he does not feel it is much more so than medical testing generally. He said the arrangement with HealthFair was scrutinized "in detail" by a committee of cardiologists and heart surgeons who pronounced it sound and issued an "overwhelming recommendation" to proceed at about the same time Inova opened a new Heart and Vascular Institute in Falls Church, Va., where its flagship, Inova Fairfax Hospital, is located.
The five-test package offered by HealthFair includes ultrasound testing for blockages of the carotid artery in the neck and dangerously thin spots called aneurysms in the abdominal aorta; a resting electrocardiogram, or EKG, to check for abnormal heart rhythms; a test of the flexibility of the arteries; and an ultrasound probe for blockages in leg arteries known as peripheral vascular disease. HealthFair CEO Terry Diaz told Kaiser Health News in an email that many uninsured people cannot afford regular healthcare, and the testing package offers a relatively low-cost way to be screened for heart and stroke risk and gives patients access to hospital physicians in case results are abnormal.
Inova spokesman Tony Raker says that last year the Inova HealthFair unit screened 5,486 patients. Of those, slightly under half had one or more findings that seemed to warrant a followup; 11 out of those roughly 2,600 patients had results that Raker called "critical" or "urgent." Inova physicians saw about half of the patients advised to seek further help, Raker told U.S. News.
Similar tests are offered by other companies, including Life Line Screening, an Ohio firm that partners with 180 hospitals, according to the Kaiser report. The U.S. Preventive Services Task Force does recommend ultrasound testing for abdominal aortic aneurysms, but only in men 65 to 75 with an extensive smoking history. Redberg says even this recommendation has recently come under fire.
Cardiologist Stuart Seides, director of MedStar Heart Institute, an arm of MedStar Washington Hospital Center and an Inova competitor across the Potomac River in Washington, D.C., says his hospital network recently considered a similar arrangement with HealthFair. "I actually had a conference call with the principals of the company," he told U.S. News. "We declined to get involved."
MedStar's Seides says he can appreciate the marketing value of such an arrangement. "I'm a modern guy, I understand marketing," he says, "but there's a lot of marketing that goes on in the health-care world that's built on very flimsy science."
The U.S. News Best Hospitals and Best Children's Hospitals rankings do not consider whether hospitals offer or promote such tests. But if the U.S. News assessment did factor it in, pursuing the controversial practice would likely have a negative impact a hospital's performance.