Advocacy Group Blasts Mobile Cardiovascular Screening Company for ‘Unethical’ Practices

The appropriateness of relationships between a mobile health screening company and hospitals has come under scrutiny by an advocacy group claiming the company’s marketing for consumer-driven cardiovascular screening packages relies on “fearmongering” and potentially causes more harm than good.  

HealthFair (Winter Park, FL), the company in question, partners with various medical centers around the country to offer mobile preventative testing directly to the consumer. Their basic package costs $179 and, as described on the company’s website, includes:

• Echocardiogram
• Electrocardiogram
• Screening for hardening of the arteries
• Stroke/carotid artery ultrasound
• AAA ultrasound
• Peripheral arterial disease (PAD) test

A Call to Sever Ties  

The Washington, DC-based advocacy group Public Citizen mailed letters to 20 US hospitals on June 19, 2014, urging them to “immediately terminate” their relationships with HealthFair and accusing the company of “erroneously suggest[ing] that for most adults in the general population, these screening tests are useful in the prevention of several potentially life-threatening cardiovascular illnesses… and make them sound like an appealing bargain,” according to a press release.

The letters claimed that HealthFair’s screenings and their promotional materials are inappropriate and unethical and accused them of scaring healthy patients and increasing the chances that the tests would show false-positive results leading to overdiagnosis. Public Citizen stressed that continuing to work with HealthFair “does a great disservice to the community that you serve and to public health more broadly.”

Further fueling the fire, American College of Cardiology (ACC) President Patrick T. O’Gara, MD, of Brigham and Women’s Hospital (Boston, MA), released a statement supporting Public Citizen’s criticisms. “The questions raised about screening have some merit,” he said. “Other than assessing blood pressure and serum cholesterol, being attentive to diabetes and promoting a healthy weight with regular exercise, we do not recommend broad and untargeted screening. Decisions about the need for additional testing should be based on each patient’s circumstances.”

In response to Public Citizen’s claims, a press release from HealthFair says their testing 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.”

Education More Valuable than Testing  

Representing the Society for Cardiovascular Angiography and Interventions (SCAI), John P. Reilly, MD, of Ochsner Medical Center (New Orleans, LA), said the “broad population should not be getting every one of those tests every year.” He told TCTMD in a telephone interview that he agreed with the ACC recommendations and that “there are certain populations of people where it is appropriate to give those tests; how frequently will depend on how high-risk those people are.”

Education, he indicated, is key to maintaining a healthy population and preventing disease. “Patients becoming aware and knowing what their risks are for cardiovascular disease is important,” Dr. Reilly said, but they should be screened as advised by their physician to ensure appropriate assessment.

“Most of the untargeted screening that occurs without the participation of a healthcare provider is unnecessary and potentially dangerous,” said Kishore J. Harjai, MD, of Geisinger Wyoming Valley Medical Center (Wilkes-Barre, PA). “Most people do not need such screening, unless advised specifically by their physician.”

He told TCTMD in an email that “unnecessary screening is known to lead to additional testing, including invasive testing, which can potentially be expensive (at best) and harmful (at worst).”

Hospitals should “promote evidence-based screening and treatment,” Dr. Harjai added, that follow guidelines developed by professional organizations.

While not commenting on any specifics of the debate, John J. Lopez, MD, of Loyola University Medical Center (Maywood, IL), one of the institutions petitioned by Public Citizen for working with HealthFair, told TCTMD in a telephone interview that “our department of cardiology has not had a relationship with HealthFair for some time.

“While I believe that any effort to engage patients who are not otherwise part of the healthcare system can be worthwhile, there is some merit to [Public Citizen’s] criticism,” he added.

Advocating for Consumer Choice  

In their press release HealthFair stated that although they offer a direct-to-consumer program, “those with multiple risk factors for cardiovascular disease are targeted.”

Furthermore, the company contends, “those considered at ‘low risk’ may still suffer a cardiovascular event. HealthFair does believe in risk stratification and routinely practices it as part of participant education,” they explain. “Those who indicate they do not have risk factors are informed that they fall into a low-risk category. The choice to participate in testing is that of the consumer. HealthFair provides education and encourages interested individuals to speak with their physician to determine what choice is right for them.”

HealthFair reports that nearly 30% of their patients, whose average age is 61, have identifiable PAD and 37% have carotid plaque.

As for false-positive results, the press release alleges that these are an “infrequent, but inherent, part of medicine” that can be “obviated by immediate consultation with one’s doctor.” They add that “oftentimes, an abnormality that is determined to not be medically significant is incorrectly labeled as a false-positive.”

A Closer Look at the Economics  

HealthFair’s website claims their screening packages save patients money—they value their basic package at $2,300 if performed in a traditional healthcare setting, although they promote their mobile clinics as using the same “state-of-the-art equipment that can be found in hospitals nationwide.”

But Dr. Harjai said a crucial question is: “How are these companies able to do screening tests at a fraction of the cost of formal testing in physician offices or hospitals?” Interestingly, he noted that there might be “efficiency lessons” that established hospitals can learn from “lean” for-profit companies.

“Can we combine their low-cost structure with prudent, physician-directed screening in selected and targeted patients based on their individual circumstances?” Dr. Harjai asked.

For the time being however, the potential of preventative testing saving patients money in the long run, he said, remains unclear.