The first time I read it I interpreted the "their" the other way, and was quite surprised! :D
That little scam is used by my local hospital also. If you don't ask for a specific doctor when you make an appointment you get a PA (Physician's Assistant). Then they bill the same amount as a doctor would. The justification is that the PA has access to a doctor if needed. So presumably you are getting the same level of service, since the PA can talk to the doctor if needed, so this expands his abilities to the same level as a doctor.
This practice is legal. To avoid getting a PA specifically ask for a "MD Doctor". If you don't say "MD" they will give you a PA even if you ask for a "Doctor".
In your example, the hospital very likely billed the same services and charge amounts. This is standard practice. Also, captured on the claim form they submit to the payor is who rendered the services and also other modifiers/adjustments that indicate you were seen by a mid-level provider that was overseen by a physician. Regardless, what ultimately matters is the negotiated rate. As a general rule of thumb, payors reimburse mid-level providers (nurse practitioners/physician assistant/etc) at 80% of the physician equivalent reimbursement. So if a doctor gets paid $100 for a wellness check, then a PA would get $80 for a wellness check assuming everything was the same.
This all can get a little hairy / confusing as each state has different laws around what nurse practitioners and physician assistants can or can not do (which then impacts billing). Some states allow little to no oversight by a physician, where as other states it is more strict.
I have no idea about other tradeoffs (quality, access, etc) regarding the use of mid-level providers in replacement of traditionally physician services.
I think people assume that they are receiving worse service from a PA vs a MD.
A PA may have more time to research your condition. They have more experience with your particular condition.
I went to a PA recently when my usual MD was not available. They knew of a recently(ish) released test that could be helpful in the situation. I did the test, and the MD reviewed it. The MD wasn't familiar with the test, but it ended up being very important.
And they have a right to make that assumption. The important thing is making sure the patient is aware they are getting a PA and not an MD. Let the patient decide if that's OK.
That said, my experience with pa vs md hasn’t really been that different, they all just follow the same flowchart
On top of that, it's been mostly easy to get prompt COVID testing when I've needed it, and for a while they even had 8-hour PCR test results.
For the most part I'm still very happy with the service, though this news about the Amazon acquisition is definitely making me question whether or not I will renew next year.
It was enough that i was wondering if they were financially struggling (having seen a lot of startups go through this cycle of at-first-excellent then degrading service). And i guess they were.
Forward's 'body scanner' thing and 23andMe results interpretation are both embarrassing farces, imo. The former much more so than the latter, but even the docs will admit that their use of genetics information is basically a dog and pony show that rarely if ever impacts how they approach care.
I've given up and joined a concierge medical practice attached to a local hospital instead. It's only ~25% more expensive than Forward.
For me Forward has primarily been an anxiety thing. I have really bad anxiety largely around health issues. (Real or not) and I have found that since being with Forward that at least the idea that I can talk to someone at any point helps with that anxiety. I do recognize that a lot of that is placebo, but being able to help with anxiety without medication is preferred to me.
That being said, they are only just now opening up in Boston so it will remain to be seen how they actually perform in person and not virtual. But their competition here is... its a low bar to be better.
Forward outsources a lot of their clinical stuff, so the service ends up being much less premium
But it's also a matter of perspective. As someone that is privileged enough to shop for improved healthcare quality and access, I've jumped from an old-school cash-basis solo practitioner, to One Medical, to Forward, to about the highest end concierge practice available in my metro region. Every time I've increased my spending, the quality of care and accessibility has generally increased. One Medical and Forward were still improvements over what I'd had access to previously even though I chose to move on and pay more money elsewhere for an improved experience.
Forward was expanding to my city and I joined based on SF friend’s recommendation. They charged me a total of $500 without ever actually opening the office.
When I requested a refund they said they could only give one month, then took so long to process that I got another monthly charge in the meantime! I had to follow up weekly for months just to get back to the original promise.
Bad, bad experience, and I’m not even medically complex.
> boutique experience
Man, Americans say the weirdest $h@t
I expect the same to happen (or already happening) in the UK.
Think of all the money that is wasted in todays system. Its not a lack of money,its how its badly spent and all the red tape in between. Much more efficient to let individuals manage it than a burocracy based on forced taxation which leads to a lack of accountability as poor performance still gets funding.
> They will charge your insurance for a doctors visit but only have Nurses and P.A's available to see.
I can't comment on how One Medical bills for this sort of thing. But almost always, at any other "standard" clinic/hospital/etc, they will get reimbursed by the payor for 80% of what a physician would get paid for an equivalent visit.
As a general rule of thumb, payors reimburse mid-level providers (nurse practitioners/physician assistant/etc) at 80% of the physician equivalent reimbursement. If you do a little napkin math you can see why there is a financial incentive to use mid-level providers. Say a family physician makes $250k and a nurse practitioner makes $125k each year, and if they bill for a similar amount of visits in dollars each year, say $500k worth. For the physician the clinic has a $250k profit, for the nurse practitioner they have a $500k * 80% = $400k, minus the $125k salary, so $275k profit.
I have no idea about other tradeoffs (quality, access, etc) regarding the use of mid-level providers in replacement of traditionally physician services.
This is so disconnected from Google's main business it doesn't care. It'd be more likely to cut the benefit entirely to save money.
"When we looked at usage of the benefit, we saw that less that 1% of our employee base were DAUs of the benefit, so we have decided to discontinue the benefit and focus on other efforts instead"
Personally my experience with One Medical went from amazed in 2015 to pretty bad by 2019. They will charge your insurance for a doctors visit but only have Nurses and P.A's available to see. I don't even know the legality of that, but it definitely didn't feel like they were replacing having a personal doctor follow your health
The few M.D's i did like left within a year or two, always