by Al Lewis
OK, so maybe those weren’t their exact words, but a Health Affairs article just confirmed what we’ve been saying since Day One: even if there were no cost involved, it is not clinically appropriate for every employee to get checkups every year.
Don’t shoot us. We’re just the messengers.
This is not us talking. This is the New England Journal of Medicine, the Journal of the American Medical Association, and Choosing Wisely.
So, why, then, does the Affordable Care Act make checkups “free,” meaning you pay? Why does Quizzify only offer an employee quiz question on this topic with specific advance permission from our customers? Why do the majority of people still get them?
Because, as it turns out, less than a fifth of medicine is based on high-quality evidence.
Nor is the answer to ditch the annual checkup altogether. As with everything else in healthcare (example: preventive dental care), one-size-fits-all is the wrong answer for checkups. Some employees don’t get enough, while the vast majority may be getting too many.
The version without pizazz
Here is the “long version” of this study. Analyzing basically the entire Medicare population, researchers found no difference in health outcomes or future health utilization amongst people who got the annual checkups vs. people who didn’t. And this was a senior population, which presents with far more findable health risks than a working-age population.
The best argument against the credibility of this study is that the annual Medicare wellness visit has become a check-the-box affair. However, that is also true in many cases in the working-age population, especially in employers whose outcomes-based programs require doctors to report employees who haven’t “hit their numbers,” so that those employees can forfeit their incentives or be fined. The financial harm of this reporting may violate their Hippocratic Oath.
What to do instead
The body of research and expert consensus is far more consistent on what not to do (require every employee to go to the doctor every year, subject to a forfeiture or penalty) than what to do, and that’s where Quizzify comes in. While we follow the lead of our customers, sometimes our customers ask us for advice. In those cases, we recommend two alternatives to annual checkups, which are both more clinically appropriate and more cost-effective.
The first is that the “doctor’s note” that employees bring back from their checkups to qualify for their incentive might include a line:
