Practical Analytic Approaches to Healthcare Challenges
There has been an ongoing debate in United States (US) on the value of the annual comprehensive physical examination. One school of thought recommends elimination of the annual comprehensive physical exam due to lack of value. Choosing Wisely 2014 states that healthy people often do not need annual comprehensive physicals[i], and systematic reviews[ii] back this up by finding these examinations do not significantly reduce morbidity or mortality. In addition to the fee for the physician, billions of dollar are spent on potentially unnecessary tests ordered during annual comprehensive physical exams and follow up diagnostics.
A second school of thought defends the importance of annual comprehensive physical exams considering these critical to maintain and reaffirm a patient-physician relationship. Arguments have been made to improve the annual comprehensive physical exams instead of eliminating it by using a multidisciplinary team based approach, providing physicians with time for a more personalized in-depth review and a more comprehensive and satisfying overall experience for the patient.[iii]
We wanted to understand if this ongoing debate has had an impact on the rate of annual physical exams. Using data from a MedInsight client with 12 million members, we reviewed recent trends in annual physical exams[*] over a five (5) year period 2012-2016. We restricted our analysis to healthy members between 18 and 64 years of age who did not have a chronic condition in a given year (defined as being in a non-chronic CCHG (Chronic Conditions Hierarchical Group)).
We had the following findings:
- About 7 percent of members aged 18-64 years are getting annual physical exams.
- Rate of annual physical visits over the five-year period was relatively flat for all age groups; the 51-64 age group had a slightly increasing trend in the rate of annual physical visits.
- No substantial difference in annual physical visits was observed between male and female members.
Our analysis shows a recent decline in the number of people getting an annual physical examination. The reason for this decline could be the possible harms associated with these health checks such as fear of false positive results, over diagnosis, unwarranted treatment, follow-ups, and adverse emotional stress due to false labelling.2 Some individuals also find it a waste of their productive time waiting for the care; which could have been utilized better elsewhere. We assume these likely factors may be facilitating drop in numbers of annual physical exam visits.[i]
Systematic review and meta-analysis have also provided evidence that annual physical examination does not reduce morbidity or mortality for any cause, although they increased the number of new diagnoses. Replacing the annual physical examination with a more personalized health review involving more discussion and limited examination would be more acceptable to the patients. This would not only suffice the purpose of preventive health review; but also help in improving the physician-patient relationship.[ii]
Limitations
The results and interpretations are solely based on the administrative claim data.
References:
[*] An annual physical exam was identified using procedure codes 99395 and 99396 when reported along with ICD9 diagnosis code V700 or ICD10 diagnosis code Z0000.
[i] Consumer Reports Health, 2014. Choosing wisely.Health checkups, when you need them and when you don’t. Available at: http://www.choosingwisely.org/patient-resources/health-checkups/
[ii] Krogsboll LT, Jorgensen KJ, Gronhoj Larsen C, Gotzsche PC. General health checks in adults for reducing morbidity and mortality from disease: Cochrane systematic review and meta-analysis. BMJ 2012;345: e7191. Available at: http://www.bmj.com/content/345/bmj.e7191
[iii] Allan H. Goroll, M.D., 2015. Toward Trusting Therapeutic Relationships — In Favor of the Annual Physical. Available at: http://www.nejm.org/doi/full/10.1056/NEJMp1508270?query=featured_home
[iv] Mehrotra, Ateev and Prochazka, Allan. Improving Value in Health Care — Against the Annual Physical. New England Journal of Medicine. October 2015; 373:1485-1487. Available at : https://www.nejm.org/doi/full/10.1056/NEJMp1507485
[v] Bloomfield HE, Wilt TJ. Evidence Brief: Role of the Annual Comprehensive Physical Examination in the Asymptomatic Adult, VA-ESP Project #09-009; 2011. Available at: https://www.ncbi.nlm.nih.gov/books/NBK82767/