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HealthFair Wins Wellness Industry’s Race to the Bottom

Ever wonder why students don’t just grade themselves?  For your answer, look no further than HealthFair.com’s self-assessed grade:

healthfair logo

And yet by any standard other than their own, HealthFair completely flunks the test.  Literally, their “basic package” proposes more “D”-rated tests (and “D” is a failing grade by US Preventive Services Task Force standards) than any vendor we’ve ever seen. They would lose their wellness vendor license tomorrow, except for the fact that wellness vendors don’t need licenses.

healthfair basic package

The first four all get “D”s.  Here are the screenshots if you don’t believe that any vendor could possibly offer so many inappropriate tests at all, let alone in the “basic” package.

uspstf stenosis

The abdominal aortic ultrasound test is such a stupid (where “stupid” is synonymous with “profitable”) idea for the non-elderly population that the USPSTF doesn’t even bother to say no:

USPSTF AAA

Along with their “D” as a general screening tool, The EKG gets a whopping “I” for individuals at risk, but since HealthFair’s basic package includes no basic tests to see who is at risk, and by law they can’t ask about history, they would still have to screen everyone whether or not they are at risk:

uspsts electrocardiogram

By earning another “I”, the peripheral artery disease test does well by HealthFair’s standards.  The USPSTF concludes that researchers don’t know enough about it to recommend it, which doesn’t stop HealthFair.

uspstf peripheral artery disease

As for “hardening of the arteries,” the USPSTF doesn’t bother to grade it due to the fact that no one uses this test as a screen…except wellness vendors.  But even the American Heart Association, not exactly shy when it comes to screening people for cardiac disease whose treatment can enrich their members who treat it, disses this test:

AHA arterial stiffness

Speaking of D-Rated tests, sorry, guys.  If you want a D-rated PSA screen — a screen not even recommended by its own inventor — you have to insist that your employer buy HealthFair’s “advanced” package:

healthfair psa

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Give your employees wellness that always earns an “A”

 

That brings us to the H Pylori screen, Healthfair’s groundbreaking, earth-shattering, pushing-the-envelope leap forward in the wellness vendor competition to out-stupid one another.

Where to start…

First, the US Preventive Services Task Force doesn’t bother to offer a recommendation on it, largely because no self-respecting doctor would ever screen patients for this.  Shame on the USPSTF for consistently failing to anticipate all the ways in which wellness vendors can misunderstand basic clinical science!

Second, most of us who harbor H Pylori have no symptoms.  So why screen for something that’s not causing problems?   That’s why this is a test, not a screen.  If you have an ulcer or symptoms that suggest an ulcer, go to the doctor.  Even then, the doctor probably won’t even bother to test you, since most people get relief simply from well-tolerated, commonly used, proton pump-inhibitor medications–some of which don’t even require a prescription.  It is only if the first-line medications fail that most doctors will even test you.

Third, there is a significant school of thought that says H. Pylori is beneficial.  Screening us for something we’re better off having in our bodies represents a new frontier in the wellness industry’s answer to overdiagnosis, which we call hyperdiagnosis.

Fourth ironically, given the wellness industry’s obsession with employees’ weights, it is even slightly possible that killing off H. Pylori contributes to weight gain.

Fifth, what exactly are we supposed to do, if it turns out we harbor H. Pylori?  Get a course of antibiotics to clear the bacteria out of our system?  That’s a great idea.  We’ve always maintained that one of the problems with America’s healthcare system is that patients don’t get to take enough antibiotics.

The good news for the pharmaceutical industry is due to the nature of H Pyroli, hiding in our stomach mucus, it takes a lot of antibiotics to ferret it out, plus a bunch of other pills.  Is this a great country or what?

Sixth, the H Pylori tests themselves are among the most complex, unhelpful  and inaccurate commonly used tests in existence.

Finally, half the world’s population has it.   Given the expense and inaccuracy of the test and the prevalence of the bacterium, why not eliminate the middle step and just put all your employees on antibiotics?

One of us is a screaming libertarian. And even he thinks the cowboys that populate the wellness industry need to be reigned in with some regulation, before they screen the American workforce to death.  The regulation would be very straightforward:  employers and vendors must disclose the USPSTF recommendations to employees before making them take these tests. If after this disclosure, a few employees still insist on getting these D-rated or off-the-charts-inappropriate screens, congratulations!  Your screening program will have just done something useful:  identified employees who are totally incapable of making an intelligent decision.


 

To those of you who are reading this and thinking: “Haven’t I heard this song before?”, the answer is, you have.  HealthFair is the “Intel Inside” for the screening jihad offered by SSM Healthcare, the Sisters of Saint Mary health system we “profiled” a few weeks ago, thus once again proving that wellness mantra: great minds aren’t the only ones that think alike.

Star Wellness Illuminates the Health Hazards of Wellness

Dr. oz snake oil elixirOnce in every great while, when we’re least expecting it, a company comes along that makes us reconsider our viewpoint–and ponder the possibility that maybe we’re wrong about wellness. Maybe, finally, we’ve discovered a company that will motivate employees to get well.  Maybe a company that adheres to screening guidelines.  Maybe even a company that will solve America’s healthcare crisis.

Star Wellness is not that company.

Quite the contrary:  If you are an employee of an organization that has retained this outfit, your best course of action is simply to pay the fine and have nothing to do with these people.  Or take the tests to secure your money, and then don’t open the envelope with the results in them, because due to false positives, you are equally or more likely to be harmed than helped by taking their full panel of tests.

 

Star Wellness says doctors “typically order these tests during a routine physical.”  If you find a doctor that does so, please contact the licensing authorities because for many of these screenings, a doctor would be sanctioned for routinely ordering and billing for these tests on all patients.  However, this being the wellness industry, there are no authorities…but there are plenty of tests.   Not being doctors, wellness vendors are allowed to harm employees up to the limit of HR’s willingness to pay them to do so–and, being wellness vendors, they take full advantage of this budget.  (Among other things, the higher the budget, the more vendors can pay the employers’ brokers–and hence the more likely they are to keep the account.)

star wellness total tests

Leaving aside all the tests they do that the United States Preventive Services Task Force (USPSTF) does not recommend doing annually if at all (which is to say, most of them), let’s focus on the ones the USPSTF specifically recommends not doing.  In each case, we’ll use screen shots because otherwise no one would believe that any preventive services vendor could possibly be this out of touch with preventive services guidelines.

PSA screens for prostate cancer.  Perhaps Star Wellness’s internet connection is down because nobody does these any more.  Even the guy who invented the test recommends not doing it.

cdc psa

Carotid artery screening. Seriously?  Even the Highmark/Goetzel Penn State program, the industry’s most coercive and ill-conceived program ever, didn’t recommend those.

star wellness stenosis

uspstf stenosis

Our favorite is abdominal aorta screening.  These screens are so not-recommended for the <65 population that the USPSTF assumes nobody,no matter how stupid or dishonest, would ever do them.  So they don’t even bother to waste valuable electrons posting non-recommendations of this screen for the <65 population.   It would be like recommending not parking your car on a railroad crossing.  Instead, all of their recommendations start with the assumption that people being considered for these tests (tests on individuals, not screens on everyone, by the way) are over 65 to begin with.

star wellness aneurysm

uspstf aneurysm

Even their basic tests are mostly USPSTF not-recommended as screens (and certainly not annual screens), but more interesting is some of the misinformation they’ve piled on top of these tests.

They say these tests are a “$350 value.”  Since a checkup including tests costs $200 or less, the whole PCP profession would be going bankrupt if their math was right — and if doctors were actually doing these screens.

Of course they also make up their savings figures (all this overscreening somehow saves $250/employee net of the costs of the overscreening itself), but lying about outcomes is embedded in wellness vendor DNA.  We can’t fault them for that.  It isn’t possible to compete in this field without making up outcomes.

star savings claim

But they did make up at least one other statistic. As noted above, they said that 75% of Americans are deficient (or, more specifically, DEFICIENT!) in Vitamin D and need supplementation.  However, the CDC and the rest of the triple-digit IQ grownup crowd say the opposite.  The CDC notes that only 8% of Americans are deficient, while the Journal of the American Medical Association and the USPSTF also don’t recommend screening and supplementation.

cdc vitamin d

In addition to not understanding preventive medicine guidelines, Star Wellness appears to not understand the (very few) regulations putting even the slightest of constraints on the wellness industry’s overdiagnosis-today-overdiagnosis-tomorrow-overdiagnosis-forever ethos.  One of those very few constraints (ironically, a misguided one) is: wellness vendors can’t ask about family history.  And yet, here they are…asking about family history.   Now it’s possible they aren’t asking about family history and they mis-stated their own position, in which case by their own admission, they are doing this screen on people without a family history, people who shouldn’t get the screen at all.  Their other screen on this slide, C-Reactive Protein, is also not recommended by USPSTF.

star family history

Not all the news about Star Wellness is bad.  We always try to end on good news, and the good news is – if Star Wellness is to be believed – their needles are among the least contaminated in the entire industry!

star wellnessneedles

 


A postscript

Sal, Wyoming’s not a country.

Star, Vitamin B12 is not a vaccine

star vaccines

While we’re on the subject of vaccines, according to the CDC, the biggest categories of people who are supposed to get Hepatitis A/B vaccines include toddlers and street drug users.  If you are routinely hiring enough people fitting those criteria to be considering an on-site vaccination clinic, I’d say wellness isn’t your biggest problem.

Annals of Internal Medicine | Article

Thyroid_systemThe United States Preventive Services Task Force — the only believable resource for guidance on screenings — says screening for thyroid disease lacks a scientific basis. Specifically, they said: “The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for thyroid dysfunction in nonpregnant, asymptomatic adults. (I statement)” In other words, no one has studied this sufficiently to know whether it’s a good idea or not. The lack of evidence is not carte blanche to go ahead and do it anyway, but that’s never stopped wellness vendors before. The lack of evidence means to pause and take a deep breath before telling people to do “just in case.” You buckle your seatbelt “just in case,” you don’t submit to metabolic testing for the same reason.

How long do you suppose it will take the wellness industry to get this message? We’re betting three years or more.

http://annals.org/mobile/article.aspx?articleid=2208599

SSM and HealthFair: what happens when you don’t use Google

saint mary

By Vik and Al

SSM Healthcare is one of the nation’s largest hospital and healthcare systems (more than $3 billion in annual revenues). Based in St. Louis, Vik happens to live in their catchment area, and he was recently treated a promotional mailing promoting a veritable orgy of screenings for cardiovascular disease. SSM has partnered with an organization called HealthFair, which will drive one of its buses to a Walgreens near Vik, where he can clamber on and get screened.

The pitch is that Vik could get a package of six screenings, available for a limited time for the promotional price of $179 (total “value” $2,300), with an additional Know-Your-Numbers lipid panel assessment for just $99. Combine both offers and get an additional $20 off, with a total price of just $258. The six-test package of screenings includes:

  • Echocardiogram ultrasound
  • Stroke/carotid artery ultrasound
  • Abdominal aortic aneurysm ultrasound
  • EKG
  • Peripheral artery disease (PAD) test
  • Hardening of the arteries test (also called the Arterial Stiffness Index or ASI)

Let’s take a hard look at each of the recommended screenings. For the sake of consistency, we look first to the published recommendations of the United States Preventive Services Task Force (USPSTF) which is the closest thing we have to an independent, credible arbiter of data on preventive services. In cases where the USPSTF has not made a recommendation, we look to the literature.

USPSTF AAAAbdominal aortic aneurysm ultrasound: Rated “B” only for men aged 65 to 75 with a history of smoking. It’s a C for men in that age with no smoking history, “I” or inconclusive for women 65 to 75 who’ve smoked, and a D (more harmful than helpful) for women in this age range with no smoking history. Why does the promotional material contain no stratification by age, gender, or smoking status?

Stroke/carotid artery ultrasound: rated a D for all adults who are asymptomatic. Someone with symptoms doesn’t need a screening; they need a workup and therapy.

Carotid stenosis D

 

 

 

 

Echocardiogram ultrasoundEcho screening no benefit: the USPSTF doesn’t even have a recommendation on this, so we look to the literature. A large, long-term study from Norway, published in JAMA Internal Medicine in 2013, concluded that echo has no prognostic value. This jibes with the recommendations of the American Society of Echocardiography, articulated at Choosing Wisely, that echo is overused even in people who are symptomatic and should be avoided in people who have no reason to get one.

 

 

Electrocardiography or EKG: USPSTF rates this a D for adults with no symptoms and of inconclusive value even for people in moderate or high risk categories.ECG screening D

 

Peripheral artery disease (PAD) test: The USPSTF rates this screen as I or inconclusive. They do say, however, that the incidence of PAD in the general population is unknown. While this testing has value in people who are symptomatic, they were not coy about its value in people with no symptoms: “The USPSTF found no evidence that screening for and treatment of PAD in asymptomatic patients leads to clinically important benefits.”

 

Hardening of the arteries test (also called the Arterial Stiffness Index or ASI): The USPSTF has no recommendation on this. But, the American Heart Association, which typically doesn’t softsell cardiac goods and services, completely disses this test: “On the other hand, genotyping, other lipoprotein and apolipoprotein measurements, natriuretic peptides, hs-CRP for high- or low-risk adults, brachial/peripheral flow-mediated dilation, measurement of arterial stiffness, contrast computed tomography angiography and plaque imaging by magnetic resonance imaging are not recommended (Class III). The lack of support for these tests may change as more evidence is acquired. However, future recommendations will have to fully consider cost-effectiveness before reclassifying them.” AHA arterial stiffness

 

 

In sum then, we would like to know how and why SSM and HealthFair are selling their St. Louis audience a package of six screenings that, with only one exception, are recommended NOT to be done by the evidence-based medical community.  Read that carefully.  “Recommended NOT to be done” is different from — way worse than “Not recommended to be done.”

And yet this hospital seems to be unfamiliar with medical guidelines.

A cynic might say “No, they have an internet connection that reaches USPSTF and understand medical guidelines.  They choose to ignore them, in order to create followup revenue for the (mostly false) positives that these tests will inevitably reveal.  And the reason they are practically giving them away is that they not covered by insurance because the Affordable Care Act requires health plans to cover only screens that are A or B rated by the USPSTF.  However, all the followups will be well-reimbursed.”

SSM is not alone in the screenings charade; in fact, in St. Louis, Vik is regularly treated to an onslaught of screening propaganda from Siteman Cancer Center at Washington University in St. Louis: currently making the claim that “where you get your mammogram matters.” Other than singing the virtues of their own radiologists and perpetuating the myth that early diagnosis is the same as a life saved, we see no evidence on the Siteman website that their strategy actually reduces mortality. Last fall, Siteman was running an ad on St. Louis radio station enticing women to come get a mammogram and register for a cruise vacation.

Our suggestion to generally healthy, symptom-free adults living near any one of these organizations? Use your $179 to buy a couple of really good pairs of running shoes instead. Then, when some medical care vendor starts yammering to you about the predictive and life-saving values of screenings, you can literally run for your life.

Don’t depart without reading our Smoking Gun entry on SSM at this link.

Quizzify 4

The fun way to save your employees from the medical care industry

 

 

 

SSM – Smoking Gun

Quizzify

The only way to spend less is to spend less

Öèôðîâàÿ ðåïðîäóêöèÿ íàõîäèòñÿ â èíòåðíåò-ìóçåå Gallerix.ruBased in St. Louis, SSM Health was founded in 1872 by the Franciscan Sisters of Mary. It cares for people in a variety of settings including 19 hospitals, physician offices, a pharmacy benefit company, an insurance company, nursing homes, home care, hospice, telehealth and a technology company. It has affiliations with several rural hospitals, while operating facilities in four states: Wisconsin, Illinois, Missouri and Oklahoma.

HealthFair

HealthFair provides consumers easy access to affordable health screenings using mobile health centers, hospital quality equipment and highly trained health professionals. HealthFair eliminates inconvenience and gives control back to the consumer by providing the right combination of tests at the lowest possible cost – all in one convenient 45 minute appointment.

Give the consumer control of their healthcare.

No prescription needed.

Bring state-of-the-art preventive healthcare to your community.

Screening packages are priced affordably.

Short summary of interventions as described by SSM and its vendor, HealthFair:

IMG_20150204_085031091_HDR[1]

Such a deal!

A package of six screenings, available for a limited time promotional price of $179 (total value $2,300), with an additional Know-Your-Numbers lipid panel assessment for just $99. Combine both offers and get an additional $20 off, with a total price of just $258. The six-test package of screenings is:

  • Echocardiogram ultrasound
  • Stroke/carotid artery ultrasound
  • Abdominal aortic aneurysm ultrasound
  • EKG
  • Peripheral artery disease (PAD) test
  • Hardening of the arteries test (also called the Arterial Stiffness Index or ASI)

The results will be reviewed by a board-certified physician and sent to the screenee within one week. Recipients are encouraged to share the results with their personal physician.

IMG_20150204_085105556_HDR

Wow! More than 1M lives saved. But, who’s counting?

HealthFair has done over 1,000,000 screenings since 1989 and saved “thousands of lives.”

Materials being reviewed

  • Cover letter
  • Flier
  • Flier insert

Questions for SSM

What follow-up and data tracking has SSM done on HealthFair’s claim that since 1989 it has done over 1 million screenings and saved “thousands of lives?”

ANS: Refused to answer

If the results are sent from a bus to a HealthFair doctor to a client that the screening vendor likely never sees again, how is it possible to know that thousands of lives have been saved?

ANS: Refused to answer

What’s the basis for the claim that these screenings are recommended starting at age 45?

ANS: Refused to answer

Why does the flier insert allude to the value of annual exams (“Think an annual check-up is enough?”) when there is no supporting evidence for annual exams in the literature, and in fact, there is a growing consensus against doing them? Even the Obama advisor who helped codify them in the Affordable Care Act now acknowledges reality: in generally healthy adults, they are worthless.

ANS: Refused to answer

How much of the $179 fee goes to SSM? Even though the marketing materials aim to convince consumers this is a great value ($2,300 worth of testing for just $179), and that’s why SSM is doing this, how does it make economic sense for SSM other than in the hopes of generating followup business from all the true and (much more likely, according to the authorities, false positive) diagnoses?

ANS: Refused to answer

How many unnecessary physician visits and subsequent diagnostic tests and therapeutic procedures happen after these screenings? Who is tracking the cost and medical consequences of all that inappropriate care?

ANS: Refused to answer

Quizzify

We actually answer questions.

What do the United States Preventive Services Task Force and the responsible evidence-based medical literature say about each of these screenings?

ANS: Refused to answer

Well, actually, we answer that question for everyone in our blog post related to this Smoking Gun. The post is available here.

More bad news for the pro-screening crowd

The news for the pro-screening crowd just keeps getting worse. More data on the futility of screening and more questions about if it is so darn valuable, but it doesn’t alter mortality, just what is it good for and why aren’t screening proponents measuring those supposedly critical endpoints?

Does screening asymptomatic adults for major disease save lives? It seems not — ScienceDaily

Does screening asymptomatic adults for major disease save lives? It seems not -- ScienceDaily

Screening doesn’t save lives in adults with no symptoms.

Yet even more (and better) evidence that screening healthy adults for disease is a complete non-starter. You cannot save lives with screening tests even in conditions for which mortality is a common outcome. That would include, you know, life itself.

via Does screening asymptomatic adults for major disease save lives? It seems not — ScienceDaily.

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