Preventive Services Offered in Executive Physicals at Top-Ranked Hospitals

Abstract

This study describes health services offered by USNWR “best hospitals” in executive physical packages, daylong comprehensive evaluations offering testing and screening of wealthy individuals and corporate leaders.

Executive physicals are 1- to 2-day comprehensive evaluations offering putative preventive testing and screening. Executive physicals are provided by employers as perks for corporate leaders but can also be purchased by individuals; they may be offered by luxury spas, freestanding companies, or academic medical centers. Flat fees for executive physical packages generally include clinical assessments and specific laboratory and other diagnostic tests, with additional optional or personalized services. By their nature and price, they tend to be used by wealthy individuals and corporate leaders. Executive physicals are poorly described in the literature, with one 2008 article expressing concerns.¹ A 2017 news article suggested increasing participation.²

We examined the content of services offered within executive physicals at leading academic medical centers.

Methods

We evaluated “honor roll” hospitals from the 2018-2019 US News & World Report’s “best hospitals” ranking report.³ In states with no honor roll hospital, we included “best hospitals by state.” We obtained prices and lists of nonlaboratory services for each executive physical package from websites, excluding potential (eg, described as based on patient characteristics or physician assessment) or elective services listed on websites, and called program administrators to request missing information. We characterized services into 6 domains for purposes of discussion: cardiovascular, otolaryngology/ophthalmology, cancer screening, lung disease screening, bone health, and total body computed tomography.

We used US Preventive Services Task Force (USPSTF) guidelines to grade the appropriateness of services as A (recommended; high certainty of substantial benefit), B (recommended; high certainty of moderate benefit or moderate certainty of high benefit), C (selective offering recommended), D (recommended against), or I (no recommendation; insufficient evidence),⁴ and we recorded when services were not addressed. For appropriateness grades, we assumed all recipients were younger than 65 years because executive physicals are mostly intended for working-age people. Grading was performed by D.K and M.M.

Results

We identified 50 top-ranked hospitals in 43 states. Thirty-two hospitals (64%) offered executive physical packages; information about included services was available for 29 (Table 1), which offered 46 unique packages. We obtained most information from websites, with telephone calls yielding additional details for 4 packages. Eight hospitals offered multiple packages, 5 based on patient age and 3 based on price. Package costs ranged from $1700 to $10 000.

Table 1. Top Hospitals With Executive Physical Programs^a.

Hospital	State	Source List (Honor Roll Hospital vs Best Hospital)
Mayo Clinic–Phoenix	AZ	Honor rollb
Cedars-Sinai Medical Center	CA	Honor roll
UCLA Medical Center	CA	Honor roll
University of Colorado Hospital	CO	Best hospital
Mayo Clinic–Jacksonville	FL	Best hospital
Emory University Hospital	GA	Best hospital
Northwestern Memorial Hospital	IL	Honor rollb
University of Iowa Hospitals and Clinics	IA	Best hospital
University of Kansas Hospital	KS	Best hospital
Ochsner Medical Center	LA	Best hospital
Johns Hopkins Hospital	MD	Honor rollb
Massachusetts General Hospital	MA	Honor rollb
Mayo Clinic–Rochester	MN	Honor rollb
Nebraska Medicine–Nebraska Medical Center	NE	Best hospital
Morristown Medical Center	NJ	Best hospital
Mount Sinai Hospital	NY	Honor roll
NewYork-Presbyterian Hospital–Cornell and Columbia	NY	Honor rollb,c
NYU Langone Hospitals	NY	Honor roll
Duke University Hospital	NC	Honor rollb
Cleveland Clinic	OH	Honor rollb
Integris Baptist Medical Center	OK	Best hospital
Hospitals of the University of Pennsylvania	PA	Honor rollb
UPMC Presbyterian Shadyside	PA	Honor roll
MUSC Health–University Medical Center	SC	Best hospital
Sanford USD Medical Center	SD	Best hospital
Vanderbilt University Medical Center	TN	Honor roll
Houston Methodist Hospital	TX	Best hospital
University of Utah Hospital	UT	Best hospital
West Virginia University Hospitals	WV	Best hospital

Abbreviations: MUSC, Medical University of South Carolina; NYU, New York University; UCLA, University of California, Los Angeles; UPMC, University of Pittsburgh Medical Center; USD, University of South Dakota.

^aThe following hospitals have programs for which information was not able to be obtained: Brigham and Women’s Hospital, University of Kentucky Albert B. Chandler Hospital, and University of Michigan Hospital.

^bTop 20 Honor Roll hospital that is the No. 1 hospital in its state.

^cData for Columbia program.

Of 16 services included, 5 were for cardiovascular disease screening, 2 for otolaryngology/ophthalmology problems, 5 for cancer screening, 2 for lung disease screening, 1 for bone health screening, and 1 for total body computed tomography. The most commonly included services across hospitals were hearing examination (83%) and electrocardiogram (83%) (both have I grades from the USPSTF) (Table 2). Low-dose computed tomographic screening for lung cancer (grade A) was not included in any package. Papanicolaou test/pelvic examination was the only service that was grade A for all relevant ages; many included services were recommended only in specific subpopulations (eg, mammogram, colon cancer screening, and dual-energy x-ray absorptiometry for bone health). Four grade D services were included, 2 of which were graded I for specific subpopulations.

Table 2. Services Included in Executive Physicals.

Domain	Service	USPSTF Gradea	Total, No. (%)
			Hospitals Offering (n = 29)	Packages Offering (n = 46)
Cardiovascular	Abdominal ultrasound	Not addressedb	10 (35)	10 (22)
Cardiovascular	Carotid ultrasound	D	10 (35)	11 (24)
Cardiovascular	Electrocardiogram	D (patients at low risk)	24 (83)	35 (76)
		I (patients at intermediate or high risk)
Cardiovascular	Stress testing	D (patients at low risk)	18 (62)	30 (65)
		I (patients at intermediate or high risk)
Cardiovascular	Coronary calcium	I	11 (38)	14 (30)
Otolaryngology/ophthalmology	Hearing examination	I for age ≥50 y	24 (83)	29(63)
Otolaryngology/ophthalmology	Eye examination	I (regarding glaucoma screening)	15 (52)	18 (39)
Cancer screening	Skin examination	I	10 (35)	12 (26)
Cancer screening	Papanicolaou test or pelvic examination (women only)	A for age 21-65 y	19 (66)	31 (67)
Cancer screening	Mammogram (women only)c	B for age 50-74 y	19 (66)	27 (59)
		C for age 40-49 y
Cancer screening	Prostate-specific antigen (men only)d	C for age 55-69 y	20 (69)	28 (61)
Cancer screening	Colon cancer screene	A for age 50-75 y	13 (45)	14 (30)
		No recommendation for age <50 y
Lung disease screening	Chest x-ray	Not addressed	17 (59)	33 (72)
Lung disease screening	Pulmonary function testing	D (regarding COPD screening in asymptomatic adults)	11 (38)	17 (37)
Bone health	Dual-energy x-ray absorptiometryf	B (women aged <65 y at increased risk), I (men)	12 (41)	14 (30)
Total body CT	Total body CT	Not addressed	1 (3)	1 (2)

Abbreviations: COPD, chronic obstructive pulmonary disease; CT, computed tomography; USPSTF, US Preventive Services Task Force.

^aRecommendation grades are for patients younger than 65 years; A = recommended (high certainty of substantial benefit), B = recommended (high certainty of moderate benefit or moderate certainty of high benefit), C = recommendation for selective offering, D = recommendation against, I = current evidence is insufficient to assess the balance of benefits and harms.

^bRecommendation only for patients aged 65 years and older.

^cFive hospitals with age-based packages included or recommended only for individuals aged 40 years and older.

^dFive hospitals included based on age: 2, age 40 years and older; 1, age 45 years and older; and 2, age 50 years and older.

^eThree hospitals included fecal occult blood test.

^fMany packages offer this service based on age and sex.

Discussion

Executive physicals were commonly offered by top-ranked hospitals. Services with insufficient evidence designations by USPSTF or that are only recommended in subpopulations were frequently included. Some important recommended services, such as risk-based lung cancer screening, were missing from all packages.

Highly ranked academic medical centers are influential and respected. It is possible that inclusion of services in executive physicals at these institutions may be interpreted as endorsement of their importance, which could promote excessive, low-value care.

The study has limitations. The focus on services for all package recipients may have underestimated included services for some individuals. It is also unclear whether included services were actually delivered, but delivery of all package components is intended, so patients likely receive the majority.

Executive physicals help academic medical centers generate income and extend influence and allow companies to reward valued executives and perhaps reassure investors of executives’ health. Such packages should be structured to reflect best evidence and align with broader goals to enhance value.

Section Editor: Jody W. Zylke, MD, Deputy Editor.