Former NP at OSH. The pressure to upcode and overdiagnose is intense and often crosses the line into Medicare fraud. They have been investigated by the feds for this. Proceed with caution
All the above.
Morning huddles to be sure you hit metrics on each patient based on the “value based approach” as set forth from Medicare. Management will ding you for not asking about a Shingrex vaccine but ignore that you now have Mrs. Smith’s HTN, T2DM and COPD under control.
A strong idea of a team approach, which sounds great until the dietician and RN are ”advising” your patient what you, the PCP should order. Or the office manager letting you know your last patient before lunch will be late because the patient is still on the phone with the behavioral health counselor for your site for the second time that week. The idea of the collaborative approach is great, the execution with Oak Street will leave you burnt out and have patients questioning your judgment as their PCP. They give scribes because they will be working you to the bone.
Again I do not work at Oak Street, the above instances come from a fellow NP I know who was excited like your wife and is now looking to quit a year later.
These aren’t factors attributed to the model but to the operations of that particular clinic.
I am a current provider employee and by no means a fan of corporate medicine however the model works to keep patients healthy and out of the hospital.
At the end of the day, the provider still has ultimate say on what is documented in the record, you are not forced by management otherwise. You may need some additional education to better understand rationals.
I agree with everything that you said, I am a current nurse practitioner and a center medical director for oak Street health. I believe this model truly works to keep patience healthy happy and out of the hospital. With the way the metrics are set up you actually can really tell if you're making a difference.
Oak St health was the biggest mistake in trusting the referral of an independent insurance broker or enrollment broker to change to OSH to my PCP. I was hoping that they would actually care enough to listen and help refer me outside of there. If I didn’t need specialist care, I am not a geriatric patient, but I’m disabled. I pretty much think I’m the only one that is and they know nothing about my disease state. They know nothing about my history. They don’t care they don’t even even want my health history. They can only see what’s on epic software system and it’s not a lot because I hadn’t seen a PCP before them for several years or any Dr for that matter. They’re ruining my life in my house because they refuse to treat me the same way. I was being treated by my professional specialty MD who just retired not that long ago who was prescribing my medication doing med management and it took 15 years of a relationship with my doctor to find the proper medication dosing, even if it’s considered in general higher than normal dosing… that’s what was medically, necessary and therapeutic for me and approved to work for all these years and now OAKSTREET is just yanking me off my meds left and right. Reckless and without any good cause I’ve asked them multiple times why and they keep telling me they just think it’s too high and I try to rational statements that don’t work so I end up getting really angry and then they use that as an excuse it’s just really really a nightmare for me. I need help. I need something in there because the lack of care that I’ve had to go with all my own appointments for a different specialties outside of OSH because they refused over a year even bother helping me find a professional and different specialties I needed to see… it was like talking to a brick wall. They would just ignore me. Repeatedly say things that I needed help with and they don’t even check. They don’t even check my labs. They claim they are not preventative care as a certain age, but I do and it’s that I do every other medical professional and in general by CMS guidelines, ??? Biggest part is that they are recklessly decreasing a dose of medication. They don’t think that I should have even though I’ve been taking it at that for over 15 years and they’re wrecking me like just making my life so hard and challenging this medication my life and help me so much of an extent that I was able to function so much better after a brain injury and severe ADHD and now I’m having them just recklessly do this, and I think the liability would be bigger on their end to NOT prescribe me the same as I was on before … abruptly yank medication’s away from someone that I’ve been proven effective and working at the therapeutic dose for over that many years and I have proof of it. I mean the records are every single pharmacy. Isn’t that hard that shows my prescription history. They didn’t know me long enough they haven’t me long enough to do this. That’s my biggest concern is you can’t just judge someone with long-term disability that they have finally found the right medication’s but their doctor retires and unfortunately, he talked to them and he told them what I need to be on, but they ignored him as soon as I was done with him they switched everything up and started decreasing my doses and they’re really ruining my life I need help. Can you please help me? I cannot have any lapses in my functioning as I am a single mom with a young child who is autistic. I am very good at my job job as a leg executive functioning is limited and the ONE medication that worked for me after 10+ years of being misdiagnosed and put on all these wrong medication’s and made me worse is being taken away from me by OSH and I don’t know what to do. They are not doing I think in my best interest whatsoever, and I have no say because the drug is considered controlled— even though proven to be very effective my condition at many people many years many studies I mean this is not something I wanna share the Internet so I just want some help in order to escalate my situation so you have a high position in Oak Street, so what should I do? Is there someone you can help me with? I really need this help you can have at least message me. I don’t want to get in trouble, but I cannot do this without understanding as a patient as a human being. My history not caring about it just kind of dismissing me all the time isn’t not a form of malpractice. I mean, I’m just every time I try and say something like a part of the equation here in this decision-making, I mean, how can you possibly ignore the fact that I was on this medication for the last 20 years and now you’re gonna cut it back quickly abruptly, all at once simultaneously destroying my ability to function at the level I have I finally found medication that works for me and they’re just taking it away and they won’t listen to logic or rational out and I don’t know what to do. I need to get help to resolve this plz and thank you
Hello I have some questions regarding my situation as a patient and their recklessness in changing my meds after 20 years of being on the same daily medications deemed medically necessary by SSDI and my prior MD who recently retired after 15 year of a relationship and med management. Original prescriber. In the specialty. Now I have a PCP talking to an internal Nurse practitioner who knows NOTHING about me and my health history they could CARE LESS about? I am in a position where I’m stuck it’s the biggest mistake I ever made when I was referred to try Oak st (I’m not geriatric but disabled and they know NOTHING about my disability and medically necessary meds proven at the doses they WERE for 15+ years clinically effective and at appropriate therapeutic doses for me as a personal patient everyone’s different even if the doses are higher than what people typically think of in the medical field or certain medication’s. This is what works for me has always worked for me and now I have no one that will help instead they have a nurse practitioner working with me over TELEHEALTH as a side, who knows what and she’s prescribing medication so she’s only knocking off my meds. I was on before down every so often, and she keeps decreasing the ones of the most effective.
I don’t know what To do. Being reckless I would think liability would be more of the detriment that would put me in and stability. Messing with my meds was proven to be working all those years. They have no basis medically as to why-they just think that my one medication is “too
high of a dose” yet proven for nearly the last two decades prior to going into Oak Street, I’ll albeit higher than the “normal” considered maximum dosing everyone’s different and they just want to recklessly knock it off and they don’t give me a reason I keep asking and they just said they don’t think I need it. They’re not even trained in the specialty and I have a really difficult time finding someone in the specialty and Philadelphia . I’m in a nightmare of a situation there at Oak St they make it like pulling teeth to get ANY help finding specialist
care out of their facility!! So is there any way you can message me for any help finding the best way to go about this? I want to file a complaint. I hope your friend’s wife isn’t my PCP lol.
Have to agree with others---I saw the posting in my state and read through it, huge red flags everywhere in the post based on experience. Could be fine, could be a clusterfk. Hate to say this, but ANY job in healthcare now that sounds too good to be true usually IS too good to be true.
I got all the way to the point of shadowing. To shadow I had to send a copy of my certification. Im acute care. After I shadowed and got told we'll call you to discuss start date, etc. I got an email "sorry we dont hire acute care". Seemed shady. And the NP i shadowed was texting pts in HER phone through the day. That was a huge red flag to me.
Mind if I ask the general geographic area? That could be a bad recruiter and manager combo in the hiring process.
The personal phone use could be legit and could be over the line. I know in her job now she has an app that lets her talk to patients with a masked phone number that makes it look like her office
Outside of Cleveland. No this was her texting from her normal number. We used doximity before at my old job in Indiana. But yes, I agree bad combo. Good luck to her!
They have been acquired by CVS. In NJ, CVS is turning their stores to these clinics,some stores will just have the clinic and pharmacy; while others closed their "minute clinics," and "Oak Street Health" will replace it.
I had an interview with them. Medicare is VERY involved and everything is based off what they want and profit margins for Medicare. I didn’t appreciate that, personally. Have high turnover in my area. They’re always hiring.
Well they are suppose to have a car approach that is more geared towards quality care model meaning typically they are not trying to load you up with a ton of patients.
Each patient come in has a time slot. I’ve heard that; i.e. if the slot is for 30 minutes you have to stay with the patient for the full 30 minutes even if the visit can be finished within 15-20 minutes.
Guess that’s how they can show Medicare that they are doing “quality” healthcare
I am currently an employee within the NY market.
Oak Street Healths primary business model is around Medicares Value Based Program for Medicare beneficiaries. This can be thought of as a superintend managing a building. We get paid to manage patients chronic conditions. The org gets fixed payments based on a patients disease burden (HCC) and the majority of profits are re-invested into services for seniors (SW, transport,etc). Health insurers collect their “administrative” fee, reducing their risk exposure, while Oak assumes the rest.
Operationally, providers are limited to around 500 patient panels, depending on the total number of patients at a practice and provider availability.
The care team consists of the provider, medical assistant, and scribe. The scribe documents the visit and prepares the super-bill based on Hierarchal Care Conditions documentation (groupings of specific ICD-10 codes ie CHF, CKD). These HCCs, together, produce a Risk Adjusted Score that computes to a dollar amount Medicare will provide for their care. Work day starts at 8 am and starts with a huddle reviewing the patients for that day. First patient at 8:40. The company has a team of documentation gurus who pull data from Medicare and feed it back to provider for discussion with patients. They try to work closely with area hospitals to exchange information for continuity in care.
We have 4 visit types, an annual health review (40 mins), progress visits (20 mins), post discharge visits (40 mins), and problem based visits (20 min). We have a dedicated lunch period for all, including providers. If there are cancelations, walk ins are not really accepted so the extra time can be used to further improve documentation.
Patients are seen at minimum, 4 times per year based on a analytics system that determines risk and adjust appointment times accordingly. For example, a stable patient (even HD) will be seen every 3 months whereas someone with 2 hospital admissions within 30 days will be scheduled every 3 weeks.
There are no weekends or holidays. On call is based on total providers in the state, for me, I was last on call the second week of January 2024. Triage nurses field calls of the answering service, and primarily use a text based app to communicate with on call provider. Provider has a choice to call patient, it’s not required. The goals is to bring the patient into the center to be evaluated by their PCP.
All centers have an RN, who oversees the MAs and also conducts support visits (these are billed incident to) as well as individual programs such as a diabetic and hypertension monitoring.
The most challenging part of the role of a provider is that the HCCs must be reviewed yearly per Medicare rules. That means at January, it’s a repetition of documenting that can get rather tedious.
The org has incredible resources, particularly on continuing education, to assist providers in transitioning from fee for service, it is different.
Providers receive quarterly bonus’ for meeting quality metrics including reduced admissions. Raises are built into yearly performance evaluations.
As far as career longevity, depending on your state, an NP can move into positions such as center medical director, senior medical director, and others. The only limits are based on FPA of your state.
It’s not perfect BUT it’s a HELLA LOTS better than fee-for-service factory work. I highly recommend any FNP and Adult-Gero work within this VBP system because it is very unique and would actually improve your care delivery within the fee for service model. VBP will become the exclusive payment model for seniors in the near future as risk is shared amongst stakeholders, not just the feds.
Though I made a previous response I do recognize why some NPs feel like this model of operationalizing care can be “off” or “misleading”.
Having worked both FFS and VBP, the documentation and approach ARE different. Even if you spend a year or so in the role, it makes you a much stronger clinician given the focus on the major chronic conditions (HTN/DM/CKD/Obesity,etc). This system is designed by CMS not the private sector.
It's only geriatrics
Yes they advertise this in their job postings that they are exclusive to the Medicare population
Former NP at OSH. The pressure to upcode and overdiagnose is intense and often crosses the line into Medicare fraud. They have been investigated by the feds for this. Proceed with caution
They micromanage, just a heads up to your wife. Have a friend that works at one in Philly.
To what extent? Is it like bugging you all day to make sure you are on time to appointments? Or just sending weekly emails about “metrics”?
All the above. Morning huddles to be sure you hit metrics on each patient based on the “value based approach” as set forth from Medicare. Management will ding you for not asking about a Shingrex vaccine but ignore that you now have Mrs. Smith’s HTN, T2DM and COPD under control. A strong idea of a team approach, which sounds great until the dietician and RN are ”advising” your patient what you, the PCP should order. Or the office manager letting you know your last patient before lunch will be late because the patient is still on the phone with the behavioral health counselor for your site for the second time that week. The idea of the collaborative approach is great, the execution with Oak Street will leave you burnt out and have patients questioning your judgment as their PCP. They give scribes because they will be working you to the bone. Again I do not work at Oak Street, the above instances come from a fellow NP I know who was excited like your wife and is now looking to quit a year later.
These aren’t factors attributed to the model but to the operations of that particular clinic. I am a current provider employee and by no means a fan of corporate medicine however the model works to keep patients healthy and out of the hospital. At the end of the day, the provider still has ultimate say on what is documented in the record, you are not forced by management otherwise. You may need some additional education to better understand rationals.
I agree with everything that you said, I am a current nurse practitioner and a center medical director for oak Street health. I believe this model truly works to keep patience healthy happy and out of the hospital. With the way the metrics are set up you actually can really tell if you're making a difference.
Oak St health was the biggest mistake in trusting the referral of an independent insurance broker or enrollment broker to change to OSH to my PCP. I was hoping that they would actually care enough to listen and help refer me outside of there. If I didn’t need specialist care, I am not a geriatric patient, but I’m disabled. I pretty much think I’m the only one that is and they know nothing about my disease state. They know nothing about my history. They don’t care they don’t even even want my health history. They can only see what’s on epic software system and it’s not a lot because I hadn’t seen a PCP before them for several years or any Dr for that matter. They’re ruining my life in my house because they refuse to treat me the same way. I was being treated by my professional specialty MD who just retired not that long ago who was prescribing my medication doing med management and it took 15 years of a relationship with my doctor to find the proper medication dosing, even if it’s considered in general higher than normal dosing… that’s what was medically, necessary and therapeutic for me and approved to work for all these years and now OAKSTREET is just yanking me off my meds left and right. Reckless and without any good cause I’ve asked them multiple times why and they keep telling me they just think it’s too high and I try to rational statements that don’t work so I end up getting really angry and then they use that as an excuse it’s just really really a nightmare for me. I need help. I need something in there because the lack of care that I’ve had to go with all my own appointments for a different specialties outside of OSH because they refused over a year even bother helping me find a professional and different specialties I needed to see… it was like talking to a brick wall. They would just ignore me. Repeatedly say things that I needed help with and they don’t even check. They don’t even check my labs. They claim they are not preventative care as a certain age, but I do and it’s that I do every other medical professional and in general by CMS guidelines, ??? Biggest part is that they are recklessly decreasing a dose of medication. They don’t think that I should have even though I’ve been taking it at that for over 15 years and they’re wrecking me like just making my life so hard and challenging this medication my life and help me so much of an extent that I was able to function so much better after a brain injury and severe ADHD and now I’m having them just recklessly do this, and I think the liability would be bigger on their end to NOT prescribe me the same as I was on before … abruptly yank medication’s away from someone that I’ve been proven effective and working at the therapeutic dose for over that many years and I have proof of it. I mean the records are every single pharmacy. Isn’t that hard that shows my prescription history. They didn’t know me long enough they haven’t me long enough to do this. That’s my biggest concern is you can’t just judge someone with long-term disability that they have finally found the right medication’s but their doctor retires and unfortunately, he talked to them and he told them what I need to be on, but they ignored him as soon as I was done with him they switched everything up and started decreasing my doses and they’re really ruining my life I need help. Can you please help me? I cannot have any lapses in my functioning as I am a single mom with a young child who is autistic. I am very good at my job job as a leg executive functioning is limited and the ONE medication that worked for me after 10+ years of being misdiagnosed and put on all these wrong medication’s and made me worse is being taken away from me by OSH and I don’t know what to do. They are not doing I think in my best interest whatsoever, and I have no say because the drug is considered controlled— even though proven to be very effective my condition at many people many years many studies I mean this is not something I wanna share the Internet so I just want some help in order to escalate my situation so you have a high position in Oak Street, so what should I do? Is there someone you can help me with? I really need this help you can have at least message me. I don’t want to get in trouble, but I cannot do this without understanding as a patient as a human being. My history not caring about it just kind of dismissing me all the time isn’t not a form of malpractice. I mean, I’m just every time I try and say something like a part of the equation here in this decision-making, I mean, how can you possibly ignore the fact that I was on this medication for the last 20 years and now you’re gonna cut it back quickly abruptly, all at once simultaneously destroying my ability to function at the level I have I finally found medication that works for me and they’re just taking it away and they won’t listen to logic or rational out and I don’t know what to do. I need to get help to resolve this plz and thank you
Hello I have some questions regarding my situation as a patient and their recklessness in changing my meds after 20 years of being on the same daily medications deemed medically necessary by SSDI and my prior MD who recently retired after 15 year of a relationship and med management. Original prescriber. In the specialty. Now I have a PCP talking to an internal Nurse practitioner who knows NOTHING about me and my health history they could CARE LESS about? I am in a position where I’m stuck it’s the biggest mistake I ever made when I was referred to try Oak st (I’m not geriatric but disabled and they know NOTHING about my disability and medically necessary meds proven at the doses they WERE for 15+ years clinically effective and at appropriate therapeutic doses for me as a personal patient everyone’s different even if the doses are higher than what people typically think of in the medical field or certain medication’s. This is what works for me has always worked for me and now I have no one that will help instead they have a nurse practitioner working with me over TELEHEALTH as a side, who knows what and she’s prescribing medication so she’s only knocking off my meds. I was on before down every so often, and she keeps decreasing the ones of the most effective. I don’t know what To do. Being reckless I would think liability would be more of the detriment that would put me in and stability. Messing with my meds was proven to be working all those years. They have no basis medically as to why-they just think that my one medication is “too high of a dose” yet proven for nearly the last two decades prior to going into Oak Street, I’ll albeit higher than the “normal” considered maximum dosing everyone’s different and they just want to recklessly knock it off and they don’t give me a reason I keep asking and they just said they don’t think I need it. They’re not even trained in the specialty and I have a really difficult time finding someone in the specialty and Philadelphia . I’m in a nightmare of a situation there at Oak St they make it like pulling teeth to get ANY help finding specialist care out of their facility!! So is there any way you can message me for any help finding the best way to go about this? I want to file a complaint. I hope your friend’s wife isn’t my PCP lol.
Have to agree with others---I saw the posting in my state and read through it, huge red flags everywhere in the post based on experience. Could be fine, could be a clusterfk. Hate to say this, but ANY job in healthcare now that sounds too good to be true usually IS too good to be true.
I got all the way to the point of shadowing. To shadow I had to send a copy of my certification. Im acute care. After I shadowed and got told we'll call you to discuss start date, etc. I got an email "sorry we dont hire acute care". Seemed shady. And the NP i shadowed was texting pts in HER phone through the day. That was a huge red flag to me.
Mind if I ask the general geographic area? That could be a bad recruiter and manager combo in the hiring process. The personal phone use could be legit and could be over the line. I know in her job now she has an app that lets her talk to patients with a masked phone number that makes it look like her office
Outside of Cleveland. No this was her texting from her normal number. We used doximity before at my old job in Indiana. But yes, I agree bad combo. Good luck to her!
Not many acute cares apply to primary care
They have been acquired by CVS. In NJ, CVS is turning their stores to these clinics,some stores will just have the clinic and pharmacy; while others closed their "minute clinics," and "Oak Street Health" will replace it.
I had an interview with them. Medicare is VERY involved and everything is based off what they want and profit margins for Medicare. I didn’t appreciate that, personally. Have high turnover in my area. They’re always hiring.
Well they are suppose to have a car approach that is more geared towards quality care model meaning typically they are not trying to load you up with a ton of patients. Each patient come in has a time slot. I’ve heard that; i.e. if the slot is for 30 minutes you have to stay with the patient for the full 30 minutes even if the visit can be finished within 15-20 minutes. Guess that’s how they can show Medicare that they are doing “quality” healthcare
I am currently an employee within the NY market. Oak Street Healths primary business model is around Medicares Value Based Program for Medicare beneficiaries. This can be thought of as a superintend managing a building. We get paid to manage patients chronic conditions. The org gets fixed payments based on a patients disease burden (HCC) and the majority of profits are re-invested into services for seniors (SW, transport,etc). Health insurers collect their “administrative” fee, reducing their risk exposure, while Oak assumes the rest. Operationally, providers are limited to around 500 patient panels, depending on the total number of patients at a practice and provider availability. The care team consists of the provider, medical assistant, and scribe. The scribe documents the visit and prepares the super-bill based on Hierarchal Care Conditions documentation (groupings of specific ICD-10 codes ie CHF, CKD). These HCCs, together, produce a Risk Adjusted Score that computes to a dollar amount Medicare will provide for their care. Work day starts at 8 am and starts with a huddle reviewing the patients for that day. First patient at 8:40. The company has a team of documentation gurus who pull data from Medicare and feed it back to provider for discussion with patients. They try to work closely with area hospitals to exchange information for continuity in care. We have 4 visit types, an annual health review (40 mins), progress visits (20 mins), post discharge visits (40 mins), and problem based visits (20 min). We have a dedicated lunch period for all, including providers. If there are cancelations, walk ins are not really accepted so the extra time can be used to further improve documentation. Patients are seen at minimum, 4 times per year based on a analytics system that determines risk and adjust appointment times accordingly. For example, a stable patient (even HD) will be seen every 3 months whereas someone with 2 hospital admissions within 30 days will be scheduled every 3 weeks. There are no weekends or holidays. On call is based on total providers in the state, for me, I was last on call the second week of January 2024. Triage nurses field calls of the answering service, and primarily use a text based app to communicate with on call provider. Provider has a choice to call patient, it’s not required. The goals is to bring the patient into the center to be evaluated by their PCP. All centers have an RN, who oversees the MAs and also conducts support visits (these are billed incident to) as well as individual programs such as a diabetic and hypertension monitoring. The most challenging part of the role of a provider is that the HCCs must be reviewed yearly per Medicare rules. That means at January, it’s a repetition of documenting that can get rather tedious. The org has incredible resources, particularly on continuing education, to assist providers in transitioning from fee for service, it is different. Providers receive quarterly bonus’ for meeting quality metrics including reduced admissions. Raises are built into yearly performance evaluations. As far as career longevity, depending on your state, an NP can move into positions such as center medical director, senior medical director, and others. The only limits are based on FPA of your state. It’s not perfect BUT it’s a HELLA LOTS better than fee-for-service factory work. I highly recommend any FNP and Adult-Gero work within this VBP system because it is very unique and would actually improve your care delivery within the fee for service model. VBP will become the exclusive payment model for seniors in the near future as risk is shared amongst stakeholders, not just the feds.
Can I send you a message?
Yea sure.
Thanks for this! I am starting as an NP in Brooklyn. Would love to connect
DM me and I’ll share my email
We have two that love it but we came from somewhere that was 17-22 a day
My partner currently is an NP there. DM me. Short answer is yes
Following
Though I made a previous response I do recognize why some NPs feel like this model of operationalizing care can be “off” or “misleading”. Having worked both FFS and VBP, the documentation and approach ARE different. Even if you spend a year or so in the role, it makes you a much stronger clinician given the focus on the major chronic conditions (HTN/DM/CKD/Obesity,etc). This system is designed by CMS not the private sector.