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‘Executive physicals’ at top-ranked hospitals may lack recommended screenings

(Reuters Health) – Executive physicals may lure corporate clients and wealthy individuals with the promise of personalized attention and comprehensive preventive care, but a new study suggests many of these pricey exams may skip recommended screenings.

These physicals are often provided by employers as perks for corporate leaders. They’re also marketed to high net worth individuals who may want the convenience and peace of mind that comes with one or two days of personal attention during checkups instead of the brief encounters most people in the U.S. get when they go to the doctor.

Although executive physicals can cost upwards of $1,700 to $10,000, it’s not clear to what extent they make patients healthier, researchers note in JAMA.

The current study analyzed executive physicals at 50 top-ranked hospitals in 43 states to see how well they did at providing preventive care. Researchers assessed how often these physicals offered screenings and tests recommended by the U.S. Preventive Services Task Force as well as how often they included services that aren’t backed by much evidence.

Overall, recommended hearing checks and electrocardiograms to assess heart health were offered by 83% of the executive physicals, the study found. But none of the physicals included recommended lung cancer screenings, and several physicals offered services that aren’t recommended because little if any evidence suggests they work.

Many services offered as part of these physicals were recommended only for certain patient groups based on variables like age and whether individuals are at high-risk for specific diseases, such as mammograms, colon cancer screenings, and certain bone health tests.

“Clearly only a small elite minority of people is offered executive physicals, so our results do not directly impact the majority of patients,” said Dr. Deborah Korenstein, lead author of the study and a researcher at Memorial Sloan Kettering Hospital and Weill Cornell Medical College in New York City.

“However, because the medical community and the public look to leading academic centers as models of best care, the fact that these programs offer excessive, often non-evidence-based care and sometimes fail to offer recommended care has broad implications in this era of health care value,” Korenstein said by email.

“The confluence of privilege around executive physicals, where elite institutions offer expensive care to the elite of the business world, telegraphs the message that while focusing on value, evidence, and avoidance of unnecessary care is appropriate for the masses it is inadequate for the elite,” Korenstein added. “This message then undermines broader efforts to improve healthcare value and impacts all patients.”

One limitation of the study is that the analysis focused on services listed as part of physicals, and it’s possible these checkups were customized for individual patients, the study team notes.

Still, the results suggest that executive physicals may not help patients and could harm them, Korenstein said.

“I don’t think anyone benefits from executive physicals except the institutions providing them,” Korenstein said.

People are better off getting personalized, evidence-based care from their primary care provider rather than an over-the-top executive physical, she said.

“Because executive physicals are generally paid for by the employer and not the patient himself/herself, I’m sure many people who undergo them think they are getting extra benefit at no cost, but health care does not work that way,” Korenstein added.

“When services are not recommended (in medical guidelines), it’s generally because they are more likely to be harmful than helpful,” Korenstein said. “So by subjecting people to lots of extra tests, executive physical programs are exposing those people to potential net harm.”

SOURCE: JAMA, online September 17, 2019.

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