Critics urge UI Health Alliance to sever ties with ‘health bus’

Five hospitals or medical organizations in Iowa were among those targeted by a consumer advocacy group Thursday demanding health care providers 'immediately terminate” affiliation with a health bus that offers tests aimed at detecting heart disease and stroke risks.

The University of Iowa Health Alliance - which includes Mercy Health Network in Des Moines, Genesis Health System in Davenport, Mercy-Cedar Rapids and the UI Hospitals and Clinics - began partnering in February with HealthFair, a Winter Park, Fla.-based organization that provides mobile heart screenings via 'health bus.”

UI spokesman Tom Moore said the UI Health Alliance and UIHC are offering the voluntary screening service through HealthFair on a trial basis 'to determine if it may benefit the patients we serve.” Moore said UI leaders are reviewing Thursday's letter that cites concerns with the screening.

'UI Health Alliance members are committed to the highest standards of quality, safety and ethics in caring for patients,” Moore wrote in an email.

HealthFair touts itself as a mobile health testing service accredited to provide easy access to six tests aimed at detecting heart disease and stroke risk factors.

For $179, individuals can hop on the bus and - in one hour - undergo the series of tests valued at $2,300, including an echocardiogram, 12-lead electrocardiogram, hardening of the arteries test, carotid artery ultrasound, peripheral arterial disease test and abdominal aortic aneurysm ultrasound.

Another $99 can buy a 'know your numbers” assessment aimed at predicting a patient's five-year risk for stroke, diabetes, heart disease, lung cancer and other conditions.

HealthFair says test results are interpreted by board-certified physicians, and abnormal findings are shared with the patient, who can choose to allow the results to be shared with a partner hospital.

But critics have expressed concern about potential harm that can come from running those tests on people without symptoms, and one advocacy group on Thursday sent letters to 20 hospitals in eight states urging them to sever ties with HealthFair.

'The company's heavily promoted, communitywide cardiovascular health screening programs are unethical and are much more likely to do harm than good,” according to Public Citizen Health Research Group, a Washington D.C.-based consumer advocacy organization with more than 300,000 members and supporters.

In Iowa, the group's letter went to the UI Health Alliance and its members.

'Your institution's sponsorship of HealthFair and promotion of its screening programs directly to the public does a great disservice to the community that you serve and to the public health more broadly,” according to the letter. 'It is therefore imperative that your institution sever its relationship with HealthFair.”

One of the group's primary concerns is the impact false positives might have on patients and on the health care system as a whole. Michael Carome, Public Citizen director, said it's not uncommon for these types of tests performed on asymptomatic populations to produce abnormal results when no abnormality is present.

'For many people, false positive test results from this screening lead to unfounded anxiety and additional unnecessary, risky, and costly diagnostic procedures and treatment interventions,” according to the letter.

One example laid out in the letter points to screenings for carotid artery stenosis. The U.S. Preventive Services Task Force has said the test in low-prevalence populations results in a high number of false positives, according to Public Citizen.

And statistics show a small number of patients who follow up with confirmatory tests suffer strokes or undergo procedures that come with a risk of death.

'Some people might actually go on to get treatment for a condition, and that treatment can harm them when they don't have the condition at all,” Carome said.

Financially, false positives can cost patients money and impact a broader population.

'It drives up cost for all of us at large in terms of the insurance premiums we pay,” he said.

In the group's letter, Public Citizen researcher Christopher Gudas says promotion of the mobile health screenings is unethical because it uses 'misleading and fearmongering advertisements and solicitations in order to generate medically unnecessary but profitable referrals to your institution.”

HealthFair did not respond to The Gazette's attempt to reach out Thursday.

Since its partnership began in February, the UI Health Alliance has offered 72 screening events. Of the 634 people who were screened, 361 were normal and did not require follow up, according to UI spokesman Moore. The tests produced 259 findings that were considered abnormal, and those people were advised to discuss the findings with their primary care provider to determine if any follow-up was needed.

One person's results were considered 'urgent,” and that person was advised to follow-up with a primary care provider or cardiologist within a week, according to Moore. Two people had findings considered 'critical” and told they needed to go to the nearest emergency room 'because their lives were in danger.”

Moore said the Iowa providers 'fully recognize that an abnormal screening test must be evaluated in the context of the patient.”

'The decision to proceed with further testing is a result of the review of the test, evaluation of the patient and then a discussion between patient and provider,” he said.

The UI Health Alliance does not pay HealthFair to be a sponsor and included in its promotional materials, according to Moore.

A HealthFair website dedicated to the UI Health Alliance identifies criteria for those who 'should be tested.” Anyone 45 or older might consider the screening when risk factors are present - like the presence of hypertension, diabetes, smoking or a family history of cardiovascular disease, according to the website.

HealthFair on its website says the health screenings are 'very useful in early detection of all types of illnesses and risk factors,” and they offer 'potentially lifesaving” information that can also save patients money.

Screenings via the HealthFair bus can be scheduled online. The next opportunity is June 26 at the Coralville Walmart, 2801 Commerce Drive, or Iowa City Fareway, 2530 Westwinds Drive.