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:
Surely a trained physician who has just examined an employee is in the best position to recommend the next visit interval?
In the years between those checkups, an employee could earn their checkup points by playing Quizzify, or doing any number of other things that improve their health or health literacy. The beauty of trying to improve the latter is that it doesn’t matter if you are already healthy enough to skip multiple years of checkups. Everyone – including people who work for healthcare quiz companies, as we have all learned here at Quizzify – can improve their health literacy.
The slight drawback of this proposal is that an employee would have to waive his or her HIPAA rights to show HR the sentence above. However, one would guess that bragging about one’s health status is the easiest type of HIPAA right to waive. For instance, our CEO is dying to tell people his PCP says there is no reason for him to get any checkups at all, because he plays on her ultimate frisbee team. But no way he’s disclosing his actual ongoing health problem, which peripherally involves one of his PG-rated body parts.
Another possibility is a shorthand, easily remembered, version of age-appropriate checkups: 2 in your 20s, 3 in your 30s, 4 in your 40s, 5 in your 50s and then annually after that. This is Quizzify’s default answer. It isn’t just us speculating. It carries the Harvard Medical School “shield,” having been reviewed by doctors at Harvard Medical School, just like most of our other material.
So where does this leave us?
We follow your lead. You can easily customize the Quizzify curriculum to fit your policies with regard to preventive care. But if asked, we would recommend the following:
Offer employees age-appropriate screens, as recommended by the US Preventive Services Task Force -- on a totally voluntary basis or with a minor incentive.
Encourage employees (reinforced by Quizzify questions) to develop a relationship with a PCP and get at least one checkup, to establish a baseline.
Recommend checkup intervals that match the clinical status of the employee, or at a minimum are age-appropriate.
Give employees a pass on screening if they get a checkup, or vice-versa.
Play ultimate frisbee.
