Remember when full body scans were all the rage? People (often with no symptoms) spent $1,000 or more to get a CT scan without a doctor's prescription, all in an effort to find early signs of cancer, heart disease and any number of other conditions.
It was a lot of money and radiation exposure for so little benefit that the fad has faded.
Today, a less expensive form of no-prescription-needed screening is gaining popularity, particularly among people who can't afford traditional health care.
Patients select from a laundry list of screenings for various heart conditions, often bundled in a discounted package, and sometimes even get the tests done in a touring medical bus.
It sounded like a good deal to Tom Bremer of Clearwater Beach back in 2009. Bremer retired to Florida in his 50s, long before he would be eligible for Medicare. The insurance he could afford had a high deductible.
"With a $9,000 deductible, you don't go to the doctor," he said. Instead, Bremer, now 59, decided to manage his own care. He lost 80 pounds and exercised daily.
But two years ago he noticed that walking up steps left him out of breath. He struggled with symptoms for months. When he saw a big bus in a grocery store parking lot advertising heart screenings for $180, he got on board.
"They found it right away, stenosis of the aortic valve," says Bremer. An echocardiogram, a painless ultrasound of the heart, revealed that the aortic valve was abnormally narrow, restricting blood flow, a condition he probably had since birth. Bremer went to a cardiologist who repeated the tests and surgically replaced the valve.
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HealthFair, the company that found Bremer's heart defect, is based in Winter Park and operates 20 large green and white buses in 40 states. Each is outfitted with private exam rooms and technicians. For $179 anyone can sign up for tests such as carotid artery ultrasound, echocardiogram, ankle-brachial index, abdominal aortic aneurysm screening and electrocardiogram (EKG). No prescription is required and results are sent directly to the patient.
HealthFair estimates its package of tests would cost more than $2,000 if done in a physician's office. "You need to stay proactive about your health,'' says CEO James Ekbatani, noting that most insurance companies won't cover such tests unless a physician deems them necessary. "If you wait for the health care system to kick in it won't happen."
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Some heart specialists aren't impressed. Dr. James Smith, an interventional cardiologist at University Community Hospital in Tampa, says most doctors have seen a patient who has had a life-saving, self-directed cardiac screening.
"But you are still going to have to go to the trouble of seeing a cardiologist who will want to repeat the test to confirm the results and you're still paying out of pocket," says Smith. He questions the worth of some tests, like the ankle-brachial index, which he says any physician can perform with an old-fashioned physical exam. He also says he has seen accuracy problems with such test results.
So a serious diagnosis could be missed. Conversely, patients could get frightening results when there's no problem. Of course, that's always a danger no matter where a screening is done, but doctors say at least you'll know where to find them from week to week.
If a doctor orders an echocardiogram, for example, it's because he or she is looking for something specific based on an examination, detailed medical history and discussion of the patient's symptoms or concerns. That helps the technician focus on a certain area of the heart, put patients in a particular position, ask them to hold their breath, bear down or turn in a certain way. "It's a directed examination, ordered with specific instructions, looking for a specific defect," says Smith.
"The heart is so sneaky. Why would you do anything short of the best test you can get?" asks Smith.
Dr. Leslie Miller, chairman of the department of cardiovascular sciences at USF Health in Tampa, says preventive screening has merit if the tests are administered carefully in a high-quality facility.
But giving everyone the same tests — he calls it "drive-by screening" — shouldn't replace the doctor-patient relationship.
"If you are having that panel of tests done, it warrants someone with insight and knowledge to help you interpret the results and decide what to do next," says Miller. Simply forwarding test results "puts the burden on the patient to seek further advice."
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Still, the screening business is booming. HealthFair tests about 90,000 patients a year. One of its biggest competitors, Ohio-based Life Line Screening, does about a million screenings a year, and also covers the Tampa Bay area. Life Line doesn't have mobile units, but partners with churches, community centers and businesses to offer screenings in their buildings.
HealthFair officials discount criticisms from cardiologists, pointing to patients such as Bremer as proof that self-directed screening is worthwhile. Ekbatani says 3 to 5 percent of the people screened at HealthFair had no symptoms, but are found to have a potentially serious condition.
HealthFair directs such people to see their doctor right away, or if that's not possible, to go to the emergency room.
Irene Maher can be reached at firstname.lastname@example.org.