The Value of Screen Examinations
Letter to Prevention Magazine

Anne Alexander
Editor, Prevention Magazine
Rodale Press
400 South Tenth Street
Emmaus, PA 18049

Dear Ms. Alexander:

On behalf of the more than 3,700 Vascular Technologists, (a specialty of the Diagnostic Ultrasound Profession), physicians and other allied health professionals who are members of the Society of Vascular Technology (SVT), I am writing in response to an advertisement that appeared in recent issues of Prevention. Designed to look like editorial copy, the "Wellness Matters" ad contained misinformation about the value of screening examinations to detect stroke.

Life Line's ad states that people use Life Line "to obtain screening tests that would not be routinely ordered by their doctor or HMO due to lack of symptoms. . . ." . There are many risk factors for vascular disease (including high blood pressure, high cholesterol, diabetes, heart disease, history of smoking, or family members' health status), but without accompanying signs or symptoms none of these risk factors - alone or together - is sufficient reason for a person to undergo a "screening" examination for stroke. Persons with any symptoms of vascular disease (regardless of whether they have any of the risk factors for vascular disease) should undergo a thorough medical examination. If the physician detects any signs of vascular disease, the person will be asked to undergo an examination to determine the presence or absence of disease. The co-payment a patient will pay for an exam ordered under these circumstances is substantially less than the fee charged by screening organizations such as Life Line Screening.

In fact, we've seen several references to "hospitals charging amounts like $500 for a similar 'carotid' exam". As of 1 August 2000, the national average allowed amount for a complete carotid duplex examination for Medicare patients is $131.88 (unadjusted for geographic variation). Furthermore, the unadjusted coinsurance (that part for which the patient or their coinsurance is in fact responsible) ranges from $26.38 to $80.06. The charged amount is immaterial; given that many Medicare patients have coinsurance, the monetary difference is often 0 patient out-of-pocket dollars for a complete study performed by a certified individual in an accredited laboratory with a well-qualified physician reviewing all the data. Finally, we take issue with any company performing medical testing that denies any medical responsibility according to their "consent".

It is important to realize that a "screening" exam such as offered by Life Line Screening can detect only absence or presence of narrowing in an artery; it cannot detect the presence or absence of any other cause of vascular disease. Patients may be falsely reassured if they are told that the absence of narrowed arteries means they will not suffer a stroke or other vascular disease.

Additionally, it is very important that the public realize diagnostic services like those offered by Life Line Screening are dependent on the skill and judgment of the persons performing the service. Many of our members report an increase in the number of patients who are coming to them for follow-up exams (being advised after undergoing screening that they have serious vascular disease), only to discover that a well-performed study for vascular disease, which takes much more time than provided by most screening services, shows no significant disease.

For this reason, SVT believes very strongly that all personnel providing non invasive vascular testing be credentialed (certified). We suggest that all patients ask the educational background and certification status of all health care professionals who perform vascular tests. We advise, "ideally, the person performing your test will have at least one year's experience and if not, that your test will be done under the personal supervision of someone appropriately credentialed and with at least one year's experience." Please be aware that SVT does not perform any credentialing or certification of vascular technologists and does not benefit in any way from the certification processes of the independent certifying organizations in ultrasound.

The ad also states that Life Line was started "to make people aware of the existence of health problems with symptoms that may go undetected . . . ." SVT is very much in favor of an educated patient and encourages people to undergo screening tests for conditions and diseases with symptoms that often go undetected by patients (such as osteoporosis). Stroke and other vascular diseases do not fit that category.

Indeed, SVT's mission of continuing education encompasses patient education, and it is in furtherance of that mission that I offer our services to write an article or series of articles about vascular disease and its cause, diagnosis, and treatment. Sample article titles include "Ultrasound Screening for Sources of Stroke, High Blood Pressure, and Other Related Blood Vessel Diseases" and "Stroke, Hypertension, and Other Blood Vessel Diseases: The Benefits and Dangers of Ultrasound Screening." Another idea is that we could prepare a series of articles, the first of which would define common vascular disorders and provide an overview of the noninvasive techniques used to diagnosis and monitor treatment of vascular disease. Subsequent articles would focus on specific topics such as carotid disease, deep vein thromboses, and renal exams. These would be provided at no cost to Prevention.

I would be most pleased to discuss this offer more fully with you. In the meantime, I am enclosing our "Patient Questionnaire for Vascular Studies" and invite you to visit our web site: www.svtnet.org

Sincerely,

Suzanne Stone