S(Uch) S(Trange) M(Edicine)

SSM Health, 1 of the nation's largest infirmary in addition to wellness attention systems, has adopted a disceptation of values which includes the following:

Excellence
We await the best of ourselves in addition to 1 another.
Stewardship
We locomote our resources responsibly.

I'm certain they practise many expert things (and accept gotten lots of awards) but at that spot is 1 exceptionally bad affair they are doing that deserves review. It's outlined inwards this weblog post past times Al Lewis in addition to Vik Khanna. Here are some excerpts:

The pitch is that Vik could larn a packet of 6 screenings, available for a express fourth dimension for the promotional toll of $179 (total “value” $2,300), alongside an additional Know-Your-Numbers lipid panel assessment for only $99. Combine both offers in addition to larn an additional $20 off, alongside a full toll of only $258. The six-test packet of screenings includes:

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

What's the problem? The employment is that these tests are non entirely to a greater extent than oftentimes than non useless, absent a clear example of medical necessity, but they are every bit good affirmatively non recommended past times those organizations who report such things. The authors note:

For the sake of consistency, nosotros facial expression start to the published recommendations of the United States Preventive Services Task Force (USPSTF) which is the closest affair nosotros accept to an independent, credible arbiter of information on preventive services. In cases where the USPSTF has non made a recommendation, nosotros facial expression to the literature.

Abdominal aortic aneurysm ultrasound: Rated “B” entirely for men aged 65 to 75 alongside a history of smoking. It’s a C for men inwards that historic catamenia alongside no smoking history, “I” or inconclusive for women 65 to 75 who’ve smoked, in addition to a D (more harmful than helpful) for women inwards this historic catamenia hit alongside no smoking history.

Stroke/carotid artery ultrasound: rated a D for all adults who are asymptomatic. Someone alongside symptoms doesn’t demand a screening; they demand a workup in addition to therapy.

Echocardiogram ultrasound: the USPSTF doesn’t fifty-fifty accept a recommendation on this, in addition to then nosotros facial expression to the literature. A large, long-term study from Norway, published inwards JAMA Internal Medicine inwards 2013, concluded that echo has no prognostic value. This jibes alongside the recommendations of the American Society of Echocardiography, articulated at Choosing Wisely, that echo is overused fifty-fifty inwards people who are symptomatic in addition to should last avoided inwards people who accept no argue to larn one.

Electrocardiography or EKG: USPSTF rates this a D for adults alongside no symptoms in addition to of inconclusive value fifty-fifty for people inwards moderate or high adventure categories.

Peripheral artery illness (PAD) test: The USPSTF rates this enshroud every bit I or inconclusive. They practise say, however, that the incidence of PAD inwards the full general population is unknown. While this testing has value inwards people who are symptomatic, they were non coy virtually its value inwards people alongside no symptoms: “The USPSTF flora no prove that screening for in addition to handling of PAD inwards asymptomatic patients leads to clinically of import 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 in addition to services, completely disses this examination [as] non recommended (Class III).

The authors advise that commercial interests powerfulness last prompting these activities past times SSM:

They . . . empathise medical guidelines. They take away to ignore them, inwards monastic tell to practise followup revenue for the (mostly false) positives that these tests volition inevitably reveal. And the argue they are practically giving them away is that they non covered past times insurance because the Affordable Care Act requires wellness plans to encompass entirely screens that are A or B rated past times the USPSTF. However, all the followups volition last well-reimbursed.

I accomplish no determination except that this computer program violates SSM's disceptation of values: