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Korenstein D, Mamoor M, Bach PB. Preventive Services Offered in Executive Physicals at Top-Ranked Hospitals. JAMA. 2019;322(11):1101–1103. doi:10.1001/jama.2019.10563
Executive physicals are 1- to 2-day comprehensive evaluations offering putative preventive testing and screening. Executive physicals are provided by employers as perks for corporate leaders but can also be purchased by individuals; they may be offered by luxury spas, freestanding companies, or academic medical centers. Flat fees for executive physical packages generally include clinical assessments and specific laboratory and other diagnostic tests, with additional optional or personalized services. By their nature and price, they tend to be used by wealthy individuals and corporate leaders. Executive physicals are poorly described in the literature, with one 2008 article expressing concerns.1 A 2017 news article suggested increasing participation.2
We examined the content of services offered within executive physicals at leading academic medical centers.
We evaluated “honor roll” hospitals from the 2018-2019 US News & World Report’s “best hospitals” ranking report.3 In states with no honor roll hospital, we included “best hospitals by state.” We obtained prices and lists of nonlaboratory services for each executive physical package from websites, excluding potential (eg, described as based on patient characteristics or physician assessment) or elective services listed on websites, and called program administrators to request missing information. We characterized services into 6 domains for purposes of discussion: cardiovascular, otolaryngology/ophthalmology, cancer screening, lung disease screening, bone health, and total body computed tomography.
We used US Preventive Services Task Force (USPSTF) guidelines to grade the appropriateness of services as A (recommended; high certainty of substantial benefit), B (recommended; high certainty of moderate benefit or moderate certainty of high benefit), C (selective offering recommended), D (recommended against), or I (no recommendation; insufficient evidence),4 and we recorded when services were not addressed. For appropriateness grades, we assumed all recipients were younger than 65 years because executive physicals are mostly intended for working-age people. Grading was performed by D.K and M.M.
We identified 50 top-ranked hospitals in 43 states. Thirty-two hospitals (64%) offered executive physical packages; information about included services was available for 29 (Table 1), which offered 46 unique packages. We obtained most information from websites, with telephone calls yielding additional details for 4 packages. Eight hospitals offered multiple packages, 5 based on patient age and 3 based on price. Package costs ranged from $1700 to $10 000.
Of 16 services included, 5 were for cardiovascular disease screening, 2 for otolaryngology/ophthalmology problems, 5 for cancer screening, 2 for lung disease screening, 1 for bone health screening, and 1 for total body computed tomography. The most commonly included services across hospitals were hearing examination (83%) and electrocardiogram (83%) (both have I grades from the USPSTF) (Table 2). Low-dose computed tomographic screening for lung cancer (grade A) was not included in any package. Papanicolaou test/pelvic examination was the only service that was grade A for all relevant ages; many included services were recommended only in specific subpopulations (eg, mammogram, colon cancer screening, and dual-energy x-ray absorptiometry for bone health). Four grade D services were included, 2 of which were graded I for specific subpopulations.
Executive physicals were commonly offered by top-ranked hospitals. Services with insufficient evidence designations by USPSTF or that are only recommended in subpopulations were frequently included. Some important recommended services, such as risk-based lung cancer screening, were missing from all packages.
Highly ranked academic medical centers are influential and respected. It is possible that inclusion of services in executive physicals at these institutions may be interpreted as endorsement of their importance, which could promote excessive, low-value care.
The study has limitations. The focus on services for all package recipients may have underestimated included services for some individuals. It is also unclear whether included services were actually delivered, but delivery of all package components is intended, so patients likely receive the majority.
Executive physicals help academic medical centers generate income and extend influence and allow companies to reward valued executives and perhaps reassure investors of executives’ health. Such packages should be structured to reflect best evidence and align with broader goals to enhance value.
Accepted for Publication: June 27, 2019.
Corresponding Author: Deborah Korenstein, MD, Memorial Sloan Kettering Cancer Center, 485 Lexington Ave, Second Floor, New York, NY 10017 (firstname.lastname@example.org).
Author Contributions: Dr Korenstein had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Concept and design: Korenstein, Bach.
Acquisition, analysis, or interpretation of data: Korenstein, Mamoor.
Drafting of the manuscript: All authors.
Critical revision of the manuscript for important intellectual content: Bach.
Administrative, technical, or material support: Mamoor.
Supervision: Korenstein, Bach.
Conflict of Interest Disclosures: Dr Korenstein reported receiving grants from the National Cancer Institute to Memorial Sloan Kettering Cancer Center. Dr Bach reported receiving grants from Kaiser Permanente, the Laura and John Arnold Foundation, and the National Institutes of Health; personal fees from the American Society for Health-System Pharmacists, Gilead Pharmaceuticals, WebMD, Goldman Sachs, Defined Health (now Cello Health BioConsulting), Vizient, Anthem, Excellus Health Plan, Hematology Oncology Pharmacy Association, Novartis Pharmaceuticals, Janssen Pharmaceuticals, Third Rock Ventures, JMP Securities, Genentech, Mercer, United Rheumatology, Morgan Stanley, New York State Rheumatology Society, Oppenheimer & Co, Cello Health, and Oncology Analytics; and consulting fees from Foundation Medicine and Grail. No other disclosures were reported.
Funding/Support: Drs Korenstein and Bach’s work was supported in part by a Cancer Center Support Grant (P30 CA008748) from the National Cancer Institute to Memorial Sloan Kettering Cancer Center.
Role of the Funder/Sponsor: The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
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