My patients and I continue to receive mailings from SSM Health Care (here in St. Louis), informing us that they have “partnered with HealthFair to deliver ultrasound tests of the heart and arteries” in our neighborhood.
If you are considering getting these, I recommend reading my previous post on them (Shoddy Cardiovascular Screenings are more likely to cause harm than good). Also, I recommend this summary (which points out in well-referenced detail that these are not recommended by major preventive organizations) from a blogger who writes eloquently on the lack of benefit of wellness programs.
HealthFair’s financial model involves partnering with hospitals like SSM to promote these unnecessary screenings performed in mobile vans that travel to settings like Walgreen’s out in the community. The hospital system pays HealthFair (typically an “undisclosed amount”) to put the SSM name on their promotional flyers. SSM does not provide any review of the quality of the studies performed.
SSM benefits by having its “brand” spread around and when abnormalities are detected on the exams, these patients are then provided with the names of SSM physicians.
Both SSM and HealthFair benefit in this relationship by identifying as many abnormalities as possible. It doesn’t really matter to either if the abnormalities detected are real or important. The bottom line is getting more patients into the SSM system, getting down stream referrals and testing and adding to the SSM bottom line.
Steven Weinberger, MD executive vice president and chief executive of the American College of Physicians. and two co-authors wrote in the Annals of Internal Medicine journal, calling hospital involvement without disclosing potential downsides “unethical.”
“Because of a lack of counseling by these companies about the potential risks of an “abnormal” test result, the consumer is initially unaware that this may open a Pandora’s box of referrals and additional testing to monitor or treat these abnormal findings. Our medical system and society bear the cost of poor coordination of care and additional testing and treatment to follow up on unnecessary “abnormal” screening test results (10). That most of these tests are not medically indicated in the first place is left undisclosed to the consumer, nor is there a discussion of potential adverse consequences or additional costs.”
The Particular Dangers of Screening Echocardiography
In my previous post I warned in particular of the dangers of getting a screening echocardiogram, a test which I have spent my professional lifetime studying, writing on, teaching and interpreting.
I’ve also discussed in detail how easy it is to botch an echocardiogram and what to look for to guarantee that you are getting an accurate study.
Let me provide another example of how a poorly performed and/or interpreted echocardiogram can lead to a lifetime of unnecessary anxiety and inappropriate testing.
I saw a patient in my office recently who was changing cardiologists because of dissatisfaction with communication. Reviewing records from the prior cardiologists, I saw that an echocardiogram was performed in 2012 and read as showing enlargement of the aortic root and pulmonary hypertension.
A greatly enlarged aorta or aortic aneurysm can rupture or tear resulting in sudden death. It’s a very serious condition, consequently once enlargement of the aorta is identified, we counsel patients on appropriate activities, screening of relatives, and follow them lifelong with tests to monitor the size of the aorta.
I reviewed the echocardiogram which was performed in the cardiologists’ office and it was clear that an older echocardiographic technique called M-mode had been utilized, and that the measurement was invalid. When I repeated the echocardiogram in my hospital’s echocardiography laboratory, it was normal (we have a very rigorous quality assurance program and review on a regular basis with the sonographers and physicians best practice for recording and measuring the aorta by two-dimensional recordings).
Pulmonary hypertension (elevation of the pressures on the right side of the heart) can also be a sign of very severe and life threatening cardiac or pulmonary problems. If diagnosed, it typically requires extensive testing with associated risks. Like aortic root enlargement, it must be followed carefully, lifelong.
Pulmonary hypertension can be measured reasonably accurately by a well done echocardiogram utilizing a combination of Doppler flow measurements and imaging of the inferior vena cava. Because of the critical importance of getting these measurements right, I have devoted numerous educational conferences to reviewing them with our sonographers and reading physicians.
In the case of my patient (and I presume, numerous patients undergoing less rigorously performed screening echocardiograms) the initial echocardiogram did not truly show pulmonary hypertension and the echocardiogram I did confirmed this.
The Profit Factor
Ultimately, these types of screenings done in the name of promoting wellness, are being done for money.
HealthFair is strictly in it for profit; they want to get as many patients as possible paying for these screenings. Their bottom line is not enhanced by spending time and money on guaranteeing that good equipment, trained sonographers and experienced physician readers are involved.
SSM is only interested in getting more patients funneled into their system. They are paying HealthFair to identify abnormalities and therefore, abnormalities will be found. SSM in this relationship is going against good medical practice and recommendations of national medical organizations in order to make money.
A program that on the surface is promoting wellness, therefore, in the final analysis may be promoting unwellness.
If you have had one of these echocardiographic screenings and had an abnormality detected, I would be happy to review the initial recordings and provide my opinion on their accuracy. I would do this gratis as the skeptical cardiologist in the interest of research and knowledge, not to accumulate patients or revenue.