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Tag Archives: overscreening
Once 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.)
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.
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.
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.
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.
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.
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.
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!
Sal, Wyoming’s not a country.
Star, Vitamin B12 is not a vaccine
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.
Total Wellness is very concerned about “fostering a positive culture in your office.”
And what better way to “foster a positive culture,” and “recruit talented employees to your workforce” so that they can “improve relationships with one another” than by screening the stuffing out of them?
To start with, don’t just ask your “talented employees” that you just “recruited” if they smoke. That would be too easy and obviously they would all lie, right? Isn’t lying exactly what talented employees do the day after you hire them? Of course! And isn’t deceit what a positive culture is all about? Of course! That’s why you have to test their nicotine 7 ways to Sunday.
And if those tests are too easily gamed, here’s another one — just in case a few of those lying, cheating employees manage to pass the first set of tests, a la Lance Armstrong. And we wouldn’t put it past them to game the test. After all, they are “talented.”
When you’re done with nicotine, screen them for body fat. Nothing spells “talented employee” like an absence of body fat.
But wait…there’s more. Total Wellness offers a package of seven additional tests that aren’t recommended by the US Preventive Services Task Force. Now how much would you pay?
A lot, as it turns out (not even including follow-up from false positives). The more inappropriate tests you authorize, the more money they make.
Total Wellness is able to do this through their “partnership with Clinical Reference Laboratory.” Translation: they charge you, send some of the money to this other outfit, and keep the rest.
Let’s go test by test down their list.
First are two sets of tests that the USPSTF doesn’t even bother to evaluate because it would never occur to them that anyone, even a doctor, would use them as a screen.
Chem-20s aren’t even recommended as screens by the doctors who get paid to do them.
No one bothers to recommend against CBC screens…because CBC tests aren’t screens. A CBC is a test that actual doctors, not wellness vendors, order for patients who are not feeling well. Get it? As has been well-established for two decades, it’s not a screen. it’s a test. It’s useful for finding the sources of symptoms in a patient who presents in an actual doctor’s office, not for telling healthy people they’re sick. By analogy, if you think you broke your arm, the doctor might x-ray it. That’s a test. But even the dumbest wellness vendor wouldn’t propose X-raying all your employees as a screen to see if their arms are secretly broken.
Assuming a CBC were used as a screen, it would be much more potentially hazardous than if a doctor were to do the test. Since apparently Total Wellness doesn’t understand the concept of false positives anyway (a prerequisite for being in the screening business is not understanding false positives), they would likely misinterpret the results.
How did Total Wellness manage to get a license as a wellness vendor without knowing the difference between a screen and a test? Simple — you don’t need a license to be a wellness vendor. That means wellness vendors are allowed to charge employers to perform screens on employees that would get doctors in a lot of trouble if they tried to bill insurers for them.
We’d encourage you to visit their site to see a few more proposed screens that the USPSTF doesn’t recommend doing, like TSH, homocysteine, CRP. But let’s end with the mother lode of the screening industry: screens that the USPSTF specifically recommends not doing, but are very profitable for vendors.
The good news is, Total Wellness isn’t overselling this test. They say it is “possibly an indicator of ovarian cancer cells,” which makes the test literally less than useless, due to the overwhelming number of false positives and false negatives from such a test. That’s why no grownup doctors use it as a screen and that’s why the USPSTF says:
You may say: “Yes, but this ‘D’ recommendation doesn’t apply to women with the BRCA mutation.” Alas, by law, wellness vendors aren’t allowed to ask an employee whether she has a BRCA mutation or any other family history question, dramatically the reducing the already abysmal odds that a screening vendor might do something useful.
Let us close with my favorite test:
Ask vendors why they do it and they’ll say exactly what this one says: this test is “non-invasive and painless.” Sure. In that respect it’s not unlike palm-reading. The more relevant adjective that applies to both: useless.
If you want to get technical, “D” means less-than-useless.
We do like to close on a high note. Total Wellness is right in that this screening program would indeed help your employees “improve relationships with one another.” Forcing your employees to participate in this costly and misanthropic jihad might lead them to use their “talents” to all get together and revolt–just like at Penn State.