What Is a Health Assessment?

Too many people go through life only visiting a doctor when they are ill. However, doctors can help you when you’re not ill in the form of a general check-up. In some countries, it’s perfectly normal to visit your doctor every year for a check-up, in order to ensure that your body is working as it’s supposed to. In the UK, the NHS manages a high demand for GPs, so diagnosis and treatment is given priority. That’s why many people with the means to do so turn to private hospitals, getting a health assessment for their own peace of mind. But what exactly is a health assessment and what does it involve?

Essentially, a health assessment is a general check-up on the health of your body. It involves tests that can take from an hour to all day, which will tell you about the general state of your health and help you identify any potential problem areas. Often, people who undergo a health assessment come out of it reassured that their body is in tip-top condition. Sometimes, it can help people spot a problem, such as high blood pressure or high cholesterol. In some cases, it can even help catch fatal diseases like cancer in their early stages.

A health assessment may include the following elements: a medical history and lifestyle questionnaire, in order to gain a better understanding of your health; a physical examination that assesses the state of your health through a number of tests; and a consultation with a doctor or medical advisor to discuss the results of your assessment. A comprehensive health assessment will also give you the chance to discuss your own concerns and come up with a plan for improving your health with your doctor. Some health assessments may be spread over two days, if test results are not available immediately, while others may be concluded in one day.

Many people undergo a health assessment as an essential requirement of their health cover. However, some choose to take one if they’re worried about a particular aspect of their health. If you fall into the latter camp, don’t simply pick the first hospital you see that provides the service. Remember that health assessments aren’t a one-size-fits-all procedure; they can vary from basic check-ups to detailed investigations in particular areas of your body. Some hospitals offer specialist health assessments for women and for older people, so consider what your health priorities are – and how much you can spend – before opting for a particular service.

The author of this article is a part of a digital marketing agency that works with brands like Bupa. The views and opinions expressed within this article about health assessments and health cover belong to the writer and any reference or summary of Bupa Health Information Factsheets or product information is that of the writers and does not represent Bupa or the information contained within the Bupa website. The contents of this article are of a general nature only and do not constitute specific advice. This article does not take into account your circumstances or needs and must not be relied upon in place of appropriate professional advice.

Placement Health Assessments and Best Practice Within Business

In line with the Equality Act 2010 pre-employment health assessments are not encouraged and in fact may lead, if used, to legal proceedings in the UK. All employers should now use placement questionnaires or work health assessment questionnaires. Within this article we will use the term placement assessments. The information gained from these needs to be in relation to specific work tasks or procedures and not be used to discriminate on the grounds of health conditions expressed.

Placement assessments have been common practice within an occupational setting for many decades for the collection of information on the health status of an individual. This includes details of their occupational history and clinical measurement tests to identify abnormalities, which would provide a baseline at placement and assess individual fitness for a particular job.

Systematic screening may help to determine if someone is fit to do the job and expands the use of this process in identifying those who poses health and/or safety risks to themselves or others, those who poses financial risks to employers, and to reduce accident compensation risks and absenteeism.

The aim of a pre-placement assessment is to ensure that people are placed in suitable work and that any reasonable adjustments on the grounds of disability are able to be made. For certain specific activities there are legal duties to carry out pre-placement assessments of an individual’s fitness for work.

Some occupational health commentators suggests that the placement assessments appear to be unnecessary when many of the questions are also covered by legal requirements to undertake risk assessments of all staff regardless of whether they have pre-existing health conditions. I ask, is the placement questionnaire seen in some industries as the risk assessment it’s self or at least a pre-requisite to the process.

Placement assessments ultimately are a way of reducing the risk of injury at source and therefore the placements procedure needs to be based on a solid risk assessment relevant to the specific environment the potential employee is expected to work in. For example the use of vibration equipment can cause significant damage to nerves and blood vessels resulting in irreversible damage. It is at the point of the placement medical, to identify individuals that would be at risk of further damage if symptoms are present or a history of use is given. This is a statutory requirement under the Physical Agents Directive (vibration) 2002/44/EC on the minimum health and safety requirement regarding exposure of workers to risks arising from vibrating equipment. Similarly, employees exposed to noise under the Control of Noise at Work Regulations 2005 which replaced the Noise at Work Regulations 1989.

Formulas have been written to calculate the effectiveness of the placement examination. These measure the cost of completing the placement assessment with the number of prospective employees designated as unfit for the task, against the cost of employing that employee and taking a chance on the employee remaining fit for work. It suggests the placement medical is likely to make only a small contribution to safe working practices, hazard control and sickness absence.

The role of the occupational health nurse is to identify risks to health, measure current health statue and give informed evidence-based advise to referring managers. Although responsibility for recruitment rests with the referring manager, the OH department’s role is to provide specialist confidential advice to the employer and applicant. This role has to be taken forward whilst recognising that the OH professional has a duty not only to the potential employee to whom they are providing a professional service but also to that applicant’s potential employer and colleagues.

Best practice should ensure the following process is followed.

No medical information will be given until after the job offer has been made.
The medical questionnaire should be sent out with the job offer letter. This may or may not be subject to satisfactory medical depending on type of role.
HR referral form should be completed by HR and sent to OH in time for when we receive the medical questionnaire.
OH will assess the information including results of targeted health assessment if required.
OH will then send a health report to HR.

Note: In relation to internal transfers, HR Managers are advised that internal transfers should be treated in the same way as external applicants.

Health Assessments, Office Visits and Modifier 25, Oh My!

Many providers find coding Preventive Medicine (Health Assessments) and Office Visits very confusing. In fact, many feel that it is not worth it. It seems simple enough, an established 34-year-old male patient comes in for their annual health assessment and also have other conditions like HTN, Diabetes Mellitus and Hyperthyroidism that were addressed. Why shouldn’t I be able to use a Preventive Medicine code (99395) with at least a low-level established patient visit (99213) and modifier 25?

Well your partially right. See, a Health Assessment is…. well exactly that. It is an assessment of your patients overall health. The extent and focus of the services will largely depend on the age of the patient. When a provider conducts a health assessment it is expected that the provider will chart a comprehensive age and gender appropriate history /exam. At this time I would like to explain the term “comprehensive”. As you may be aware, Office visits have Comprehensive history and exams too. However, Comprehensive in a Health Assessment (99381-99397) is not synonymous with comprehensive exam in an office visit (99201-99215). Meaning, the Nature of the presenting problem dictates the elements in your history, exam and medical decision-making for office visits. In other words, if a patient presents for a splinter on a finger, a comprehensive history and exam should not have to be attained to gather the information, and the medical decision-making should only show the necessary treatment for removing a splinter (Always remember medical necessity). Other important facts about health assessment are anticipatory guidance, risk factor reduction interventions or counseling, and management of insignificant problems.

So, what should you do when you have a patient with an acute condition (chest pain) and/or chronic condition (HTN) presenting for an annual Health Assessment?

You should take a comprehensive history, comprehensive exam and order proper laboratory/diagnostic procedure. Now lets take a look at the acute and/or chronic conditions. Providers should ask themselves if the condition is requiring work up that is over and beyond their usual. Remember, documentation guidelines are not the same for health assessment. In other words, Health Assessments does not rely on a chief complaint or a history of presenting illness. Also, a health assessment is not problem oriented. Health Assessments rely on a comprehensive ROS (Review of Systems), a comprehensive PFSH and a comprehensive assessment of risk factors. Since you already documented a comprehensive history and exam, this would be considered overlapping. Therefore, the E/M reported for the problem visit (99201-99215) should be based on additional work performed by the provider in determining the best course of action in treating this problem.

Ask yourself, can this condition stand on its own? Is this condition significant enough to have its own encounter?

When using an office visit code (99201-99215) with a health assessment (99381-99397), a modifier 25 should be used to show the separately identifiable service that was performed within the annual exam.

Modifier point: Modifier 25 is used to show a significant, separately identifiable evaluation and management, service by the same physician on the same day of the procedure or other service. This modifier can only be appended with an E/M code.

Methods of Cardiovascular Health Assessment

In the modern world people constantly experience the influence of many negative factors such as stress, a polluted environment, overpopulation, poor quality industrial food processing, food substitutes and many others, causing health problems. Many diseases develop very slowly not showing any symptoms for a long time. When symptoms begin showing up, the disease may reach a point when it is extremely difficult if not impossible to cure. Therefore proper and systematic health assessment among the population becomes very important regardless to whether or not people have any health problems.

Unfortunately our healthcare system does not utilize the full potential of preventive measures to guard the health of our citizens using existing technologies and methods of conducting regular health assessments. Thus it is very important to show how to use these efficient methods of mass health assessment.

We all know that cardiovascular diseases are number one cause of mortality in many countries of the world. In the U.S.A. alone about 1 million people die every year due to cardiovascular problems. Therefore it is extremely important to focus on using methods of cardiovascular health assessment on a large scale.

The general public, employers, government and healthcare organizations should share responsibility for public health. Timely and adequate cardiovascular health assessments will equally benefit everyone. People will save their lives. Employers will save money by cutting their expenses on health insurance, treatment, and work absenteeism. The governments will cut tax losses. The healthcare organizations will increase the efficiency of their services.

So how can cardiovascular health assessment be organized on a population level? The most effective approach is to organize and regularly carry out mass health screening of the general public. This can be done at the workplace with large number of employees, in government and public organizations, universities and schools, malls, supermarkets, drugstores, sport clubs and health fairs. To conduct such mass health assessments, small healthcare businesses and mobile groups from large medical centers can be involved by being encouraged by a special national healthcare program.

What tools can be utilized to conduct cardiovascular health assessment as a part of health screening program? There is a wide variety of medical equipment and technologies designed for thorough cardiovascular diagnostic routines such as CT and MRI scans, angiography, ultrasound scanners, stress-test systems and many more. As a rule those are quite expensive procedures conducted in specially equipped medical centers. At the same time there are modern technologies designed for cardiovascular health assessment based on simple and non-invasive methods of testing.
For example, Biocom Technologies has developed a portable system for cardiovascular health assessment based on a special method of pulse wave recording and its further deep analysis to evaluate vascular elasticity and heart rate variability (HRV).

The screening process takes into account the patient’s personal information, their answers to a few health questions, their blood pressure reading, and a 5-minute pulse wave reading, recorded by a pulse oximeter.

The computer program produces a detailed analysis of the given information and formulates a conclusion on the state of the patient’s cardiovascular health, including the following data:

1. Patient information
2. Biometric data
3. Blood pressure evaluation
4. Overall health risk evaluation
5. Autonomic balance and tone evaluation
6. Evaluation of peripheral artery elasticity
7. The patient’s biological age, determined from the state of their cardiovascular health
8. Adaptation capabilities of cardiovascular regulatory mechanisms
9. Blood oxygen saturation
10. General conclusions about the patient’s cardiovascular health condition.

The screening process using this program must be provided by a specially trained technician. After the completion of this process, the patient receives a report which can then be forwarded to their physician who can give them a detailed explanation on their test results and their cardiovascular health condition.

After the completion of the screening process, the technician forwards the patient’s test results to the main test result repository located on a secure Internet server. The patient or their physician can then access the repository archive using a security code. From the archive, they may receive test results for review or see the patient’s testing history. It is recommended to conduct this health assessment four times a year in order to be better able to detect subtle changes in the function of the cardiovascular system and properly adjust treatment methods.

In the near future, Biocom Technologies plans to release an inexpensive simplified method of cardiovascular health assessment for home use. This will enable general consumers to perform their health assessment at home and to monitor its dynamics. Furthermore, they may periodically share their test results with their physician to receive qualified advice on how to improve the state of their cardiovascular health.

Professional Health Assessment – A New Approach

How beneficial would it be if we could assess the state of our health on a daily or weekly basis? Most of us would agree that it would be a better system than what we are accustomed to – going to the doctor once a symptom, pain or condition appears. Recognizing and correcting a problem before it becomes a disease or syndrome could change our lives in a dramatic way. That could be called real ‘health care’ rather than ‘disease care’, which is basically what we have now. Are there any methods or tools that will assess health? If yes then how objective, specific and sensitive are they?

Health assessment: a traditional approach. Most of us become concerned about our health at some point. As a rule, this happens when we notice something is going wrong with our bodies, whether it is something visible or it sends us other alerting signals. These are called “symptoms” in both common and professional language. Most of our problems develop slowly and are very silent for some time. This is due to the fact that nature has equipped our bodies with the power to adapt to environmental changes. This ability hides common signs of the problem from us. In a simplistic sense, we treat the absence of any symptoms as a condition of health. When any symptoms appear repetitively, we are forced to visit a doctor to seek professional help. What happens then? The doctor will perform an initial checkup and come up with an initial diagnostic hypothesis. If there are any unanswered questions or it’s not possible for the doctor to make a diagnosis, the doctor will then call for more in-depth instrumental (special testing, lab works, etc.) evaluation until the hypothesis is created and proved or disproved. In any case, this is a process of finding a specific disease. In other words, the health assessment is limited to finding specific maladies. However the effects of more complex factors causing health problems or influencing how they are progressing remains obscured, or their importance is not adequately considered.

Health assessment: a new approach. A more commonsense way of thinking would be to shift from a paradigm of assessing the level of “unhealthiness” or diagnostics of already existing diseases to a new paradigm of preventive health assessment. This approach would not limit the professional to physical exams with traditional blood work, EKG, etc., but implement the use of additional proactive methods to allow a broader view on health. Such methods must be more effective at the early stages when no clinical symptoms have occurred. Are there any key signs that will give a more in-depth health assessment? Modern science believes that the status of the autonomic nervous system can be considered as such an indicator. The autonomic nervous system is responsible for complex dynamic non-voluntary control of most of the body’s vital functions and processes of its adaptation to ever-changing internal and external factors affecting the body. It is very important to not only assess its current regulatory function but also what it costs to the body to adapt. In other words, it is important to be able to measure its adaptation reserves. Because of these reserves, the organism can remain in condition of adequate regulation for a long time. However, a prolonged strain on these regulatory mechanisms to ensure an adequate body function leads to exhaustion of the body’s adaptation reserves. Finally their total exhaustion is followed by regulatory failure and causes the development of a specific pathological process (disease) in the weakest link of the affected body function. Thus periodic assessment of the autonomic function and its adaptation reserves allows for a full and adequate health assessment way before any typical clinical symptoms occur.

Health assessment: how to do it. It is agreed then that we need to measure the level of the autonomic regulatory function and its adaptation reserves for proper health assessment. But how to do it? In the past two decades biomedical scientists have developed fairly simple yet effective methods of assessment of the body’s autonomic regulatory function using analysis of the heart rate variability (HRV). These methods utilize very simple recordings of either EKG or pulse wave signals and their respective processing using special mathematical algorithms. As a result these methods produce data indicating the level of functional activity of the autonomic nervous system and its balance and reserve capacity. Scientists showed that these methods produce very objective and placebo-free results. Although these methods do not produce any specific diagnostic conclusions, they are extremely sensitive. They quantitatively evaluate the level of the autonomic dysfunction much earlier than any clinical symptoms occur and solve the problem of early detection of various functional disturbances. This helps the doctor take proactive measures to fix the problem.