Hospitals in several states are advertising health screenings on their websites, and splashing their names across health-screening firms' specially equipped buses that test people inside with ultrasound, EKGs and more. People in their communities, not considered at-risk and likely not asking doctors' advice, are reading mailings and newspaper ads touting preventative cardiovascular health screening.
Is this good medical practice and effective community outreach aimed at improving public health? Or is it a scramble by hospitals to link up with screening firms as a way to grab referrals in a competitive market?
Public Citizen thinks it's the latter. The consumer advocacy group on June 19 sent a letter to 20 hospitals in eight states – Arizona, California, Florida, Illinois, Indiana, Iowa, Ohio and Virginia – and called on them to cut their ties to HealthFair, a Florida-based health-screening company, for engaging in what it described as “unethical” practices.
The consumer group, founded more than 40 years ago by Ralph Nader, insisted that hospital/HealthFair partnerships are doing more harm than good by promoting widespread and indiscriminate screenings.
Too often when large populations are screened, people with false positive results or with minor, nonthreatening abnormalities end up getting costly, and perhaps risky, follow-up tests and treatment, said Michael Carome, M.D., director of Washington, D.C.-based Public Citizen's Health Research Group. This could add to the entire U.S. healthcare system's costs, he said.
“We're not saying, 'Never screen.'” But screening has to be done to the at-risk population,” Carome, a board-certified internist, told Healthcare Dive. “Only then do the benefits exceed the risks.”
The American College of Cardiology seems to agree. In a June 19 statement, ACC said questions raised by Public Citizen about the screenings “have some merit.” ACC said it doesn't recommend “broad and untargeted screening,” instead suggesting that doctors work with patients on individualized care plans.
Carome asserted that HealthFair, based in Winter Park, Fla., uses poor tactics to attract customers. “It is exploitative to promote and provide medically non-beneficial testing through the use of misleading and fear-mongering advertisements in order to generate medically unnecessary but profitable referrals to the institutions partnered with HealthFair,” he stated.
According to its own website, HealthFair markets a “basic” screening package for “heart disease, stroke and aneurysm prevention.” Six tests, including an echocardiogram, electrocardiogram, stroke/carotid artery ultrasound, and abdominal aortic aneurysm ultrasound, cost $179. The firm describes the package as being valued at $2,300 if done elsewhere in the healthcare system, adding that its “mobile clinics use the same state-of-the-art equipment that can be found in hospitals nationwide.” Its website says it also tests for risk factors related to “cancer, diabetes, and more.”
Noting that HealthFair also sells a “men's package” that includes a prostate specific antigen (PSA) test, Carome said: “We shouldn't be screening all men for prostate disease.” Public Citizen focused on HealthFair's basic cardiovascular package because it is the company's “central promotion,” he said.
“No major institution should be affiliated with this company [i.e., HealthFair],” Carome told Healthcare Dive. Other health-screening firms, similar to HealthFair, are “peddling bad medicine,” he added, and they also will be subject to Public Citizen's scrutiny and possible censure down the road.
In a 17-page response, HealthFair said June 20 it “categorically disagrees” with Public Citizen's assertions. HealthFair said its program educates consumers, pre-selects those who are candidates for screenings, and offers testing to them. Its partnership with hospitals “gives the consumer an avenue to have their results reviewed and discussed with qualified healthcare providers,” the firm stated.
Overall, HealthFair has screened more than 1 million individuals, “with thousands of life-saving testimonials,” the firm stated. “In addition, HealthFair has found thousands of individuals that, while asymptomatic, had clear end-organ disease. Through hospital care coordination, these individuals sought and received the necessary care, and made the necessary lifestyle changes, they would not have otherwise.”
HealthFair cited its collection of a vast amount of data showing the “significant prevalence of subclinical atherosclerosis in the general public,” and noted that most episodic cardiac events such as heart attacks and sudden cardiac death occur without any prior symptoms or warnings. HealthFair said its program identifies individuals “who are asymptomatic but at risk of a cardiovascular event, so that they may work with a medical provider of their choosing to reduce their risk.”
According to HealthFair, the average age of its health-screening participants is 61 and many have multiple risk factors putting them at moderate to high risk for cardiovascular disease: 59% are pre-hypertensive or hypertensive; 36% are on medication for high blood pressure; 40% are overweight, and an additional 33% are obese. Thus, while offering a consumer-driven program, HealthFair's screenings are “primarily provided to those with multiple risk factors for cardiovascular disease,” the firm asserted.
Here's how some of the 20 affected hospitals are responding to the situation:
At least one hospital on Public Citizen's list already seems to be backing off the endeavor. “In an effort to raise awareness of heart disease and the comprehensive cardiovascular services available to our community, Sharp Chula Vista Medical Center implemented a limited pilot program with HealthFair this year,” spokesperson Christina Page said in a June 19 statement to Healthcare Dive. “While it is still too early for us to evaluate any results of the four screening events held over the past month [two in May and two in June], no future screening dates are planned."
Other hospitals remain noncommittal. "We are aware of the discussions surrounding health screenings of many different kinds. As an academic medical center, we are constantly reviewing, studying and determining the optimal standards of healthcare practice, including screenings,” Cassie Jones, a spokeswoman for Virginia Commonwealth University Medical Center, said in a June 20 statement to Healthcare Dive. “We have no comment on this matter at this time but this [i.e., HealthFair] partnership, like any other, is always under this same level of scrutiny and evaluation."
Yet other hospitals defend their partnerships with HealthFair. A spokeswoman for Mercy Health in Cincinnati, which also works with HealthFair, told USA Today on June 19 that screenings “can be a lifesaving tool." She said Mercy Health's use of the screenings is “consistent with our values of compassion and human dignity while expanding access to care in the communities we serve.” She added that Mercy Health's providers are closely involved in managing patient care.
In Arizona, Scottsdale Healthcare, also sent a letter by Public Citizen, promotes HealthFair on its website, describing it as offering a "quick, affordable and convenient way to get a preventative cardiovascular health screening.” Scottsdale's online ad says it entered into a “partnership” with HealthFair aiming to help “identify potential heart issues even before symptoms appear, optimizing the health and well-being of each individual we serve.” Its press office did not return a call for comment.