December 29, 2012

Less-expensive vascular screenings fill niche

Posted in Between Us column, Health at 5:27 pm by dinaheng

With an aging population looking to stay healthy without depleting their wallets, the business of offering preventative screenings at affordable prices is growing. But how helpful such screenings are depends on many factors.

According to an IBISWorld Industry Report, released in September, revenue for the diagnostic and medical laboratory industry has grown at an average of 2 percent annually to $48 billion during the five years leading to 2012, and is forecast to increase at an average rate of 4.5 percent per year to $59.8 billion by 2017.Dinah Eng

More than 700,000 strokes a year occur in the United States, many without warning, says Dr. Andrew Manganaro, chief medical officer for Life Line Screening of Independence, Ohio, which offers mobile vascular screenings in the United States and the United Kingdom. For those who have health issues that can lead to a stroke, taking the proper drugs and behavioral changes may help prevent one, if the issue is discovered early enough, he said.

“But a person can also walk around with problems and show no symptoms,” said Manganaro, a retired cardio-vascular and thoracic surgeon from the Dayton, Ohio, area. “These problems can be identified immediately with a non-invasive ultrasound, but in general, these screenings are not covered by insurance companies because most won’t cover testing unless a person has symptoms.

“So physicians are in a quandary. If you have a patient with risk factors, you can’t order that ultrasound and have it paid for by insurance. Patients may have problems with the carotid artery and not know about it.”

Manganaro said Life Line Screening offers a battery of tests starting at $139, which would cost thousands if done in a hospital. Instead of going to a medical facility, Life Line mobile units go to a community location, such as church halls or recreation centers, and set up testing there. The company screens a million patients a year, and test results are reviewed and interpreted by board-certified physicians.

“Part of the reason we can do it so affordably is because of volume,” he said. “Also, the efficacy of performing these tests outside insurance companies means the costs are less. These are screenings, and not diagnostic exams, so the savings can be passed on to the patient.”

Whether vascular screenings are useful or not depends on the patient and the risk, says Dr. Daniel Stone, medical director of Cedars-Sinai Health Associates in Beverly Hills, Calif., and a practicing internist.

“There are people who can benefit from these screenings, but it’s like the law of unintended consequences,” Stone said. “With healthy people, you want to be sure you do no harm. Back in the 1980s, when CT scans became popular, you saw a lot of body scans offered, but you don’t see that anymore.

“The scans ended up leading to more tests and procedures that weren’t helpful and sometimes even proved harmful. Once people get on a medical test treadmill it can be hard to get off. You have to look at the implications downstream, which are not always apparent.”

Stone says carotid artery screening is one of the most controversial topics in medicine. In the United States, he notes, there are many unnecessary carotid surgeries done because patients are afraid of getting a stroke.

More than half of the 140,000 carotid surgeries and stent procedures performed in the United States each year are done for patients without symptoms, according to the Center for Medicare and Medicaid Services in a 2010 report.

Many blockages, Stone says, can be addressed with diet, exercise and the proper drugs. For those who have no symptoms, risk factors should be assessed before getting a screening.

“If you’re a man who’s a smoker, age 65 or older, and have hypertension, screening for an abdominal aortic aneurysm makes sense,” Stone said. “In women, the risk is very low. For a woman who has normal blood pressure and doesn’t smoke, that screening makes no sense.”

He says those who are interested in assessing their 10-year risk of having a heart attack can take a free online survey offered by the National Heart Lung and Blood Institute at http://hp2010.nhlbihin.net/atpiii/calculator.asp.

“Most people who have no symptoms would be better off addressing the risk factors, rather than getting a screening,” Stone says. “Stop smoking, address cholesterol issues, exercise more. Patients should always talk to their doctor first to see if a screening is worth doing.”

(By Dinah Eng. Distributed by Scripps Howard News Service, shns.com.)

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