The executive physical: taking care of business means taking care of the people at the top.

BOUNCING FROM MEETING to meeting, traveling for days at a time, grabbing fast food or dining on rich restaurant fare and being connected to the office 24/7--the demands of running a company can take a toll on the health of its executives. In the 1970s many hospitals began offering executive physicals to help businesses protect one of their biggest investments--the people at the top. Typically paid for by the company, usage of executive physicals ebbed and flowed in relationship to the economy and other business-related factors, but today many businesses consider this "perk" a strategic part of doing business.

"In the early '90s we had some large companies in Fort Wayne, which we worked with exclusively, that sent their top-level employees to us for physicals," says Pam Potts, executive physical coordinator, Business Health Services of RediMed, which is part of Fort Wayne's Lutheran Health Network. "By the late '90s we started to see cutbacks in their health care and wellness programs. Then about three or four years ago, we started seeing an increase again. Today we have some very committed corporations and they are quite regular with their scheduling."

Taking control. Even though it means half-a-day to an entire day away from the office, executives usually don't need prompting to take advantage of this perk.

Dr. Michael Busk, medical director of the Indiana University Executive Health, Corporate Wellness and Prevention Program, says executives are excellent patients because they have incentive to get healthy and stay healthy, "The Wall Street Journal has published quite a few articles about the benefits," he says. "The RAND Corp. (a global non-profit research firm headquartered in Santa Monica, Calif.) did a 10-year study which shows that those who are in good physical condition, are physically fit, maintain a proper weight and don't smoke, will double their income in 10 years."

IU Medical Group, in partnership with the National Institute for Fitness and Sport (NIFS) in downtown Indianapolis, has been offering executive physicals since 1988. Currently it has 36 corporate clients--including such high-profile accounts as Indianapolis-based Eli Lilly and Co. and WellPoint Inc.

"Our main focus is to prevent disease," Busk says. "Prevention is like defense in football. Offense gets the publicity, but it's the defense that wins the Super Bowl (Sorry, Peyton Manning.) If I can get someone to walk 30 minutes per day or three-and-a-half hours per week, and if I can get them to stop smoking, I've got a 68-percent chance that they won't show up in an intensive-care unit."

A recent New England Journal of Medicine article reported a decrease in the number of people dying of heart disease since the 1980s. "Forty-seven percent of that drop was due to lifestyle improvements," Busk says. "That's huge. What we do a lot of is help people take control of their lives."

The convenience factor. The goal of executive physicals is to make it easy for executives to get the screenings, tests and information they need in a very streamlined, efficient manner.

"Convenience is the main thing," says Jill Waiters, wellness manager, Business and Industry Wellness Center for Deaconess Health System in Evansville. "Before Deaconess LifeQuest started offering executive physicals, executives would have to drive out of town to get one done. Executives often comment on how much time this program saves them."

Deaconess has been offering physicals to executives in the Tri-State area for five years, and averages one per week. "They just make an appointment with us and we get them registered," Waiters says. "Everything is on a tight schedule. We get them to each place and there is very little wait time, and then they just run through all the tests. The physician comes to them, here in our office. Typically it is all done in a half-day's time. And it is more comprehensive. They are getting more done than what they would get with just an annual physical."

Each basic package varies according to the facility, but typical components of the executive physical include the gathering of a comprehensive health history, a lifestyle assessment, physical exam, blood work, urinalysis, fitness assessment and vision and hearing screenings. Other items that are often part of the basic executive physical are EKGs, pulmonary function testing, body composition analyses, treadmill stress tests and chest x-rays. Consultations are often available with nutritionists and fitness experts, and diet and exercise programs are tailored to each individual.

Optional tests are available according to gender, age, individual risk factors and company guidelines. Optional tests or "add-ons" may include mammograms, prostate exams, colonoscopies, immunizations or vaccinations, CT scans and specific tests recommended for the individual by the physician. Optional tests may be scheduled for the same day as the basic exam, or another day, depending on the facility and the patient's wishes.

Ports says some companies have "tiered" executive physicals, with the basic package for employees age 50 and younger, the second tier for ages 50 to 60 and the third tier for executives age 60 and above.

Tammy Reibly--sales coordinator, Occupational Health for Community Health System (Community Hospital in Munster, St. Catherine Hospital in East Chicago and St. Mary Medical Center in Hobart)--notes that most executives elect to take advantage of all optional tests. "Because they can get everything done all in one day, and where else can you do that? If they were scheduling all these tests individually through a hospital, they would spend two weeks trying to get them all done. So the benefit is one-stop shopping. They are able to come to our clinic. They don't need a referral. We do all the tests for them, if not in our clinic, then onsite at our hospital. Most of the results they have back that day, especially if they are here for all eight hours. Our ultimate goal is to have the one-stop shopping where they don't have to come back at all."

Lutheran Hospital, which has been offering executive physicals for more than 20 years, has a three-phase program, with the first two phases completed in three to four hours. In phase one, the majority of the tests in the basic package are administered. Results are in the physician's hands before phase two, which consists of the physical exam and the treadmill cardiac stress test.

Latest reporting technology. Phase three of Lutheran's executive physical program is the final consultation. It may not take place for a week or two, depending on patients' preferences and schedules. If several executives in a company have taken the test, Potts may travel to the company to deliver and discuss the 20-page report with each executive individually.

The timing of the report varies with facility and the scope of the tests. If requested, results may be forwarded to the patient's primary-care physician.

"We recently purchased a new personal wellness profile software package that is really the cornerstone for our revamping our Executive Physical program," says Reibly. "The program, which is completed by the individual and then reviewed by the wellness staff prior to the individual's initial visit, is loosely based on a health risk appraisal. People answer the questions, and once we get the results from their tests, we can plug in what their blood pressure was, what their cholesterol was, how all their tests came out and it gives us a report that tells us how healthy or unhealthy they are. It also accesses each person's health age. So an individual may have a chronological age of 40, but a health age of 58, based on the fact that he drinks too much, he smokes and he has never exercised."

Up-to-date software is also important for tracking and trending information that helps companies calculate their return on investment.

"Although everything is confidential, we are still able to give them numbers back and say, of the 50 people that you sent in, 25 percent were overweight or 'x' amount were still smoking," Potts says. "So this gives the company a way to figure out what they can do [to improve executives' health] within the organization."

Program perks may include breakfast, catered lunches, showers and executive suites with phones and Internet access. Some providers will continue to respond to email or phone questions throughout the year.

"We are here if they want to use us for ongoing support," Waiters says. "Some we don't see for a whole year, but some will call every month with a question, such as 'You mentioned calcium when we talked about my diet. What do you think about this supplement?'"

NIFS also encourages questions from executives who have participated in their program. "Many come back on a regular basis," Busk says. "I have over 200 that are in my primary-care program right now that continue to follow with me. My business plan is that they never get sick."

The cost. Typically companies or individuals pay for executive physicals out-of-pocket, and hospitals do not bill insurance. Lutheran Hospital heavily discounts the services provided in the basic package, so it does not bill insurance. And basic package costs vary considerably, ranging from $500 to $1,200, just as the package components and sophistication of the equipment used vary. Added options can boost the cost of an executive physical to over $3,000.

The demand for executive physicals continues to grow as companies equate dollar savings with keeping their executives healthy (individual studies have indicated a return of more than $2 for every $1 spent on prevention) and executives realize the value of getting and staying healthy.

"Executives are very bright people," Busk says. "They get it, and very quickly."

What's Included?

Example of an executive physical.

The Indiana University Medical Group and the National Institute of Fitness and Sport in Indianapolis offer a four- to seven-hour comprehensive exam and feedback consultation including a host of diagnostic tests that have been shown to detect disease in its early stages. Controllable factors that contribute to chronic disease are identified and a plan of action is developed. Costs range from $750 to $2,000.

INITIAL EXAM

* Complete history and physical exam

* Preventive health and wellness education

* Comprehensive blood work

* Resting EKG 

* Spirometry (lung function testing)

* Fitness assessment, including body composition analysis

* Exercise treadmill stress testing with VO2 max

* Glaucoma screening

* Colonoscopy screening (per age and risk guidelines, requires additional three to four hours)

FEEDBACK CONSULTATION

* Complete medical results review and recommendations

* Exercise prescription jointly developed by physician and exercise physiologist

* Nutrition consultation (as needed)

* Complete summary packet, including all medical results

* Patient-specific education and literature

Let's take a good look

Dr. Alan Richards is with Business Health Services of RediMed, which offers a three-phase executive physical program. RediMed is part of Fort Wayne's Lutheran Health Network.