0:06

Eight oh six thirteen ten WIBA and full scope with doctor Nicole Hemkiss, Wisconsin's

0:12

directcare doctor. And of course, doctor Nicole Hemkiss comes to us from Advocate

0:16

MD, a direct primary care practice. Three locations in the area to here

0:22

in Madison Westside and Middleton right at thirty two o five Glacier Ridge Road,

0:26

east side of Madison at one fifty seven South Fair Oaks Avenue, and in

0:31

Janesville ten twenty one Mineral Point Avenue. You can learn more about the clinics

0:36

and learn more about direct primary care. Also learn about the docs online at

0:40

Advocates DPC dot com. That's Advocate DPC dot com. Their telephone number to

0:45

make an appointment to become a member six oh eight two six eight sixty two

0:49

eleven. That's six oh eight two six eight sixty two eleven. And joining

0:52

us this morning is the doctor, doctor Nicole hemkis Doc. How you doing

0:56

this week? I'm doing well, Shaan, How are you doing it?

0:59

Really really good? And we're going to talk about interesting story in the news,

1:03

and and uh, you know I love technology. I know I know

1:07

you love technology as well. It's uh, it makes our lives, can

1:11

make our lives a whole lot easier, and a lot of times technology is

1:15

sold to us not only as a convenience but also a way maybe to reduce

1:19

some costs and save you some money. And uh, I think of during

1:23

the pandemic and other times where we were doing a lot of things online,

1:27

like corresponding, like folks that that have what's the my charts, like the

1:33

like the big one that that a lot of folks have, Like they can

1:36

send a message to their doctor and their doctor can reply to them and or

1:40

somebody can get back to them. That was It's it's neat to being have

1:44

that correspondence. And again it was sold to us as like, hey,

1:48

this is a quick and easy and free way to get in contact with your

1:53

doctor. What is going on with the messaging system and some of these big

1:59

healthcare systems doc? Yeah, so I you know, I think this started

2:04

maybe six months a year ago where we saw these news stories coming out about

2:07

these large hospital systems in different parts of the country that they were going to

2:12

start charging for these my chart messages. So, you know, I'm sure

2:15

most of the listeners have heard of my chart. You know, the big

2:19

EMR system here in town and the largest EMR system in the country, you

2:23

know, epic that they have this messaging system through the EMR, similar to

2:28

email, but you're messaging back and forth with your doctor, and you know, kind of the ironic part about it is that, you know, when

2:34

the Affordable Care Act was passed now it's been you know, eleven twelve years

2:38

ago, you know, it pushed a lot of people into these higher deductible

2:42

health plans. So now instead of a person having like a zero dollar deductible

2:46

or maybe one thousand dollars which they're probably going to meet throughout the year,

2:50

now they have a five thousand, eight thousand dollars deductible policy which they likely

2:53

will not you know, meet that deductible throughout the year, so they would

2:58

utilize you know, it pushed a lot of PEO people to kind of move

3:00

towards using these messaging systems. You know, I hear complaints from you know,

3:05

fellow doctors colleagues where they'll you know, they'll they'll you know that are

3:08

still in the insurance based system that they'll say, well, you know,

3:10

instead of people coming in for appointments anymore, they just send me these long,

3:14

my chart messages like describing this. Sometimes it's a simple problem. Sometimes

3:17

it's a more complicated problem, but it push people in that direction because I

3:23

mean, I I totally understand why people would do this. If if you

3:27

have a five thousand dollars deductible and it's going to charge you, you know,

3:30

they're going to charge you three or four hundred dollars to go into you know, ask a few questions or to get some guidance on an issue.

3:36

It's much more you know, financially makes more sense and more efficient to just

3:40

send a my chart message to your doctor. So now systems, of course,

3:45

I always say Sean on the program that you know, health systems have

3:49

very smart people working for them, and they will figure out a way to

3:52

charge you for things. If they notice a pattern and they say, oh,

3:54

we're getting a lot of my chart messages now, they will figure out

3:58

a way to monetize that in some way. So that's what exactly what is

4:00

happening now. And so I think I think now the story that came out

4:05

a couple of days ago is that GHC Group Health Cooperative here in Madison is

4:10

I believe the first system locally to start doing this. But you know,

4:14

don't be shocked. I anticipate now that one system is doing it that the

4:17

other, you know, two systems are you know, we'll we'll start doing

4:21

the same thing. And you know, so the the interesting part is,

4:25

you know, we pushed people, really, I say, we the the

4:29

Affordable Care Act push people into utilizing this, you know, just because financially

4:34

it might have been the only way they get access care. Now we're going

4:38

to charge them for each you know, my chart message that they send to

4:42

a physician. And you know the other funny part about that is that they're

4:46

using the the excuse or the article that I read was using the excuse that

4:50

this has something to do with physician burnout or you know, which you know,

4:55

that's that's funny because you know, I mean, obviously there's there's many

4:58

things that cause physician burnout, and one of them is the EMR system.

5:01

But I don't necessarily think, you know, again, the my chart messaging

5:04

has increased. You know, that was kind of something that was pushed upon

5:09

people that they had to kind of utilize the my chart system. And the

5:12

other part that I was going to bring up is, you know what happened

5:15

Sean when you know, you remember back when COVID hit and there was a

5:19

period of time where people could not actually physically go in to see the doctor,

5:24

you know. I mean the ers of course were open, but like

5:26

your primary care doctor's office probably was closed for a period of time and they

5:30

were just doing phone calls and telemedicine. Do you remember that, sehn,

5:33

I do. I remember having my son having to do a telemedicine visit at

5:39

what is Yes, I do remember. I'd like to pack it out a

5:43

bit, but yeah, I know, I know, it's like, yeah,

5:46

you don't want to think about something like that could potentially ever happen again. But I remember at that point because I mean, the clinic, the

5:51

practice was not that that old, and you know, of course I didn't

5:55

have a lot of staff, and so I was having people pull up in

5:58

the park in the back driveway in Middleton, and I would just run out

6:01

there and like see them and we'd talk out you know, either the parking

6:04

lot or they would bring it cheer outside because at that point, you know,

6:08

we didn't really know what was happening with COVID. But side note,

6:11

you know when that happens, you know, again, the health systems pushed

6:15

people to use telemedicine, so you know, and it actually there was an

6:19

initial period with these large health systems where their telemedicine systems were not set up

6:24

or didn't have the capacity to handle all of this, so there was a

6:27

period of time where they there was a delay in that. But once they

6:30

had all that set up, they were pushing you know, obviously the doctors

6:32

and the patients to utilize telemedicine visits, you know, which usually is either

6:38

a phone call or a video visit. But then you know, the health

6:42

systems got reimbursed much less for those things, you know, so a telemedicine

6:46

visit versus when you physically come in to see the doctor, it was like,

6:50

you know, a fraction of the cost. So what happened, So

6:54

what happened was the hospital association lobbied you know, I think Congress, I

6:59

don't remember if it was as a federal law or a local law, but

7:01

basically they change the reimbursement for telemedicine visits and made it the same basically the

7:08

same as coming in to see the doctor. You know, they change the

7:11

way they coded and the way it's reimbursed. So now you know, of

7:15

course the systems are now pushing people to do telemedicine, like, oh,

7:17

you don't need to go in and see your doctor. You know, we can handle this. You I see even ads up. It's it's again very

7:24

ironic and kind of sad. You know. These ads will say something like

7:28

connecting you to your your doctor, connecting you to your medical care, and

7:31

it's a woman and a little kid staring into an iPad. And I always

7:35

like feel like this is kind of sad, you know, like we used

7:38

to actually or we do like I do, I touch my patience, you

7:42

know, I shake their hand or pat them on the back, and like

7:44

you kind of you know, we slowly are losing that that personalized physical connection.

7:49

But anyways, so they pushed people to do telemed now because the reimbursement

7:56

rates are the same. So for a health system's perspective, now they don't

8:00

have to pay you know, the receptionist and the medical assistant that's going to

8:03

room you, and you know the facility, you know, the the overhead

8:07

of having a physical office. It's great for them because the doctor could be

8:11

either sitting in the office or they could be sitting at home. The health system incurs very minimal cost for that visit and then they're reimbursing out at the

8:18

same rate, which is crazy. So it is interesting to me how things

8:24

have kind of evolved, you know, with the technology and how they're charging

8:28

for things, you know, just in the course of the last you know,

8:31

three or four years. It is pretty it's it's pretty weird. And

8:33

I'd say weird. I know, all this stuff happens, but how this

8:37

progress happens. And and unfortunately for a lot of folks they feel trapped.

8:41

And the great thing is you're not trapped. There are better alternatives. There's

8:43

a better way to something called direct Primary Care and Advocate MD. You can

8:48

learn more online Advocates DPC dot com. That's Advocates DPC dot com and doc

8:54

I know something that's important to you, as you were talking about actually seeing

8:58

your page in person, I know one of the things that's very important to

9:01

you is that access word and having access to your doctor when you need them,

9:07

and whether it's an in person visit or a phone call or a text.

9:11

That's something that's very important for you and all the doctors at Advocate MD.

9:15

How does that work at Advocate MD and what does it cost? Yes,

9:20

So, as you mentioned Sean. The access piece of this is so

9:24

critical because you know, sometimes we hear from patients things like, you know,

9:28

I don't really go to the doctor very much, Like why why would

9:31

I? You know, I have insurance, So why would I pay this

9:33

additional fee to go to a direct primary care clinic when I have insurance and

9:37

I don't really have a lot of medical issues. I don't really need to

9:39

go into the doctor maybe once a year, maybe not even that often.

9:43

And the way I try to present it to people is that you're not paying

9:46

for utilization, Like that's why I hate the gym membership comparison. You're not

9:50

paying necessarily like that you're going to come in and see us, you know,

9:54

once a month or twice a month or something like that. You're paying

9:56

for access, right, And that's really what insurance was intended for. Right.

10:00

Insurance was intended to give you access to healthcare and to allow you to

10:03

be able to afford healthcare in a better way. But ironically, now insurance

10:09

has made healthcare less accessible because it's made it more expensive. And what I

10:13

always tell people is, you know, we have great doctors here at Madison.

10:18

We have you know, wonderful hospitals. But it doesn't really matter how

10:22

great the doctor is or how wonderful the hospital is if you can't get an appointment to see them, and if it's going to bankrupt you to go in

10:28

there. Right Like, if you have a ten thousand dollars deductible in the

10:31

doctor's visit is one thousand dollars, people are going to avoid going to the

10:35

doctor. So the cost of it also relates to access, because if you

10:43

create a system that is so expensive, you are going to decrease access to

10:46

care. So yeah, I view direct primary care is access to care.

10:52

You know, whether it's your regular checkup or whether you need an urgent care

10:56

thing or you need a minor procedure done. You know, you're not going to wait six month to get a dermatologist appointment to get a mole removed.

11:01

You're not going to wait or sorry, you're not gonna have to go into

11:05

an urgent care and emergency department on a Friday at eight o'clock when you twist

11:09

your ankle because you're not sure if it's broken or not. You have a

11:13

doctorate that you can text or call and they're gonna, you know, send

11:15

him a picture and they're going to walk you through it and tell you what

11:18

to do and tell you if you need to be seen or not, and

11:20

if they need to, they'll come into the office. So it's really that

11:24

access and that one you know again, you know that one visit to an

11:28

urgent care and emergency department could be a year's worth of direct primary care.

11:33

So it's really being kind of thoughtful in the way we view healthcare and looking

11:39

more instead of looking kind of at the immediate, kind of looking further out

11:43

and like big picture to say, you know what, if something happens and

11:46

I needed to utilize an er and urgent care and I have a high deductible

11:52

insurance policy, it's going to be very very expensive. Or what happens. Let's say, if I go into the doctor and I need a few sets

11:58

of blood work, that's going to be six or seven hundred dollars to get

12:01

you know, five different panels of labs run, and if I do it

12:03

with a direct primary care clinic, it's going to be twenty dollars. I

12:07

mean, seriously, the difference in cost is that is that extreme. So

12:11

it's kind of looking at a bigger picture and you know, just kind of

12:15

realizing that right now the system has very poor access and is very expensive.

12:20

And that's the two I would say, And then that doesn't even cover the

12:24

whole quality part of it. But those are the things that the primary direct

12:28

primary care is trying to solve for. It's a pretty amazing model too.

12:33

And we talk about direct primary care, and we talk about access, we

12:35

talk about patient care, we talk about the opportunity to see your doctor and

12:39

communicate with your doctor when you need to, and of course you're not going

12:43

to pay extra for those types of things. And of course other important part

12:46

of direct primary care is transparency. You can learn more all about direct primary

12:52

care becoming a member, learn a little bit more about the doctors at Advocate

12:54

MD, as well as the three locations of Advocate MD. And I saw

12:58

something on the fourth location, but I will save that from I let doctor

13:03

talk about that one of these weeks. But I will tell you this at check out the website ADVOCATESDPC dot com. That's Advocates DPC dot com. You

13:11

can learn more online ADVOCATESDPC dot com. You even better pick up phone,

13:13

give call six oh eight to six eight sixty two eleven. Become a member

13:16

at Advocate MD again at number six oh eight two six eight sixty two eleven.

13:20

You heard doctor Hemkis mention all the great doctors that we have here in

13:24

the area. What's happening with them. There's a lot of folks that maybe

13:28

have a doctor that they've maybe been seeing for years. It's getting harder and

13:33

harder to actually see them in person, if not impossible. What is going

13:37

on there? We'll get the details from doctor Nicole Hemkiss next as full Scope

13:41

continues right here on thirteen ten wibi A twenty two thirteen ten wib A Full

13:54

scope with doctor Nicole Hemkiss, Wisconsin's direct care doctor. Of course, Doctor

13:58

Hemkiss comes to is from Advocate MD, a direct primary care practice. The

14:01

website ADVOCATESDPC dot com. That's Advocates DPC dot com telephone number six eight two

14:07

six eight sixty two eleven. That's six eight two six eight sixty two eleven.

14:11

And one final thing on there. Our previous segment conversation, you had

14:16

shared a story from Channel twenty seven WKOW Channel twenty seven. We're talking about

14:22

transparency just mentioned before the break, and I highlighted something during the break that

14:26

jumped out of me. In the story and they say in the document shared

14:30

with patients, GHC said there was no way for people to know ahead of

14:33

time. Their message went in kurd the fee, and I thought, how

14:37

typical is that? I mean, real quick, before we talk about about

14:43

what's happening to doctors and the burnout and why also why it's so difficult to

14:48

see it if you do have a primary care doctor in the system, why

14:52

it's so difficult to actually see that doctor real quick? That that transparency part.

14:56

That is something that I know is very important to you, that that

15:00

people understand fully what things are going to cost and what they're paying for.

15:05

That's an important part of what you do, isn't it. Doctor? Yes,

15:09

you know, I think that the COVID magnified or brought a lot of

15:13

things to the surface that we're underlying, and it's led to I would say,

15:18

more people having a distrust of the medical system. You know, I

15:22

think that when we aren't transparent about pricing it. You know, even though

15:28

I'd say doctors, you know, ninety nine point nine percent of doctors have

15:31

really good intentions and if they're prescribing you a procedure or a test of medication,

15:35

you know, they're not getting any benefit from ordering that test or that

15:39

you know, medication, but they also don't know the cost of any of

15:45

those things. So I do think that we should have some responsibility to be

15:48

informed as medical professionals and to be informed about what we are ordering, the

15:54

test we are ordering for patients and the costs in the met or whether it's

15:58

a medication. You know, if the cost is high, again, that's

16:02

going to harm the patient financially, which you know is going to make it

16:04

It's going to give them more mistrust of the system, it's going to make

16:07

them less likely to engage in the system, and you know they're going to

16:11

avoid medical care when they need it and things like that. So it is

16:14

a very complex kind of interrelated thing. But yes, in our system,

16:18

everything is transparent. You can log into our website. All of our membership

16:22

prices are on there. If we have a patient come into the office and

16:26

they need a medication, you know they're going to know the cost of that medication before they walk out. If we order blood tests, you know,

16:30

most of our labs are four or five dollars for a panel, so you

16:33

know they're not getting a surprise medical bill in the mail two or three months

16:37

later where these labs, you know, even though they have insurance, the

16:40

labs cost five hundred dollars or six hundred dollars. You know, I've experienced

16:44

that. It's very frustrating and you you feel a sense of not being able

16:48

to do anything about it. So again, we are trying to empower patients

16:53

and provide you know, very affordable care, high quality care. It's pretty

16:59

amazing stuff what you're able to do. And for folks that haven't had a

17:02

chance to learn more. If you're listening this morning you say I like what

17:04

doctor Hemkiss is talking about, you can learn more of course online ADVOCATESDPC dot

17:10

com. That's ADVOCATESDPC dot com. Also, of course looking for options for

17:14

yourself, your family, employers. If you're looking for some great options for

17:18

your employees, definitely make sure you're checking out Advocate MD and Direct Primary Care

17:22

to make an appointment. If you like what doctor Nicole Hemkiss is saying,

17:25

today is the day to start to get that appointment in. All I got

17:27

to do is give them a call six eight two six eight sixty two eleven

17:30

to become a member. That's six h eight two six eight sixty two eleven.

17:33

It's got a couple of minutes left. Doctor. But something that I

17:37

think we hear in news stories quite often, and for anybody that's ever had

17:41

a chance to have a personal conversation with a doctor, they understand medicine has

17:45

become, especially for folks in the system, become a very demanding profession,

17:51

and I think for a lot of doctors not what they went into the profession

17:56

for. You're talking earlier about EMR electronic medical records. Most people that I

18:02

know that our doctors didn't do it because they love sitting in front of a

18:06

computer screen. Now there's probably some outliers out there that are like, yeah,

18:10

I like this stuff, but for the most part, doctors really don't

18:14

like doing that stuff. Let's talk about what's happened to the doctors and where

18:18

they've all gone, and why it's so hard then on the patient side to

18:22

actually see your actual doctor. Yes, and you know, I talk sometimes

18:27

about physician burnout, but it's not a topic that I like to bring up

18:30

a lot because I feel like, you know, when you talk about physician

18:34

burnout, you know sometimes people are listening to this thinking, oh, poor

18:37

physician, Like oh, you know, you don't make enough money, like

18:41

you know, that sort of thing. But so instead I like to talk

18:44

about it from the perspective of the patient or the general public of like what

18:47

happens when you can't see a doctor? Right, Like you know what happens when there is not a doctor available to you? What happens when you walk

18:52

into an emergency department and there's not a doctor or you need to make an

18:56

appointment for an issue that you're having and you can't and appointment. So yeah,

19:02

you know, I kind of say, where are all the doctors going? What is going on with them? You know, the burnout component of

19:07

it is making doctors retire early, cut down to part time. You know,

19:11

it used to be I remember the old school family medicine docs. They'd

19:15

work into their late sixties seventies. You know, they loved it. They

19:18

had this connection with their patients. They felt and I'm not saying that that

19:22

still doesn't exist. I think it does. But I think they also felt

19:27

a sense of obligation because these were their patients. You know, they owned

19:32

the practice, they lived in that community. You know, now patients are

19:36

no longer doctor's patients. They're they're patients of the healthcare system. So when

19:40

a doctor leaves the health system, that's not their patient, that's that's you

19:42

know, the big hospital system's patients. But you know they I read something

19:48

recently saying that by twenty thirty four, so ten years from now, there

19:52

will be a physician shortage of one hundred and twenty four thousand positions, and

19:56

we can't educate and train physicians fast enough to fill that. So as you

20:02

will see, and I'm sure anyone listening has seen this experience, this you

20:06

will likely be seen by a non physician. And there are some great physician

20:11

assistants and nurse practitioners out there, but they aren't doctors. Their level of

20:15

education and training is much much different than a physician. I mean the number

20:21

of hours of clinical training that they go through prior to getting out in practice,

20:25

the number of years of education they don't they don't have any specialized residency

20:30

training like doctors have to go through. So it is a very different level

20:33

of care that they are able to provide. So what we see in a

20:37

system is that when a doctor starts to become burnt out or they are unhappy,

20:45

you know, and many times they will go to their healthcare administration of

20:48

these large health systems. I mean I hear the story all the time from

20:51

the doctors that have joined our practice or doctors that we are talking to to

20:55

potentially join, and you know, they'll go to their administrators and say like,

20:59

hey, you know, there's these couple things that you know, can

21:02

we change these? Or could could I see less patients? Or could I

21:06

spend more time with patients? Or you know, can I have a little bit more flexibility in my schedule? And the response they typically get is like,

21:11

nah, I don't think so, you know, which is shocking to

21:15

me because there's a physician shortage as we just talked about, and these you

21:21

know, large hospital systems, including all the ones locally, do very little

21:25

to try to keep their doctors. So basically, if you are unhappy,

21:29

you leave and they don't try to convince you to stay, and then you

21:32

are replaced in you know, ninety percent of cases by a non physician.

21:36

So this will be the trend that will continue. I don't foresee that this

21:38

will change very much. So what differentiates our practice advocate in d direct primary

21:45

care is that we only have physicians. You know, we believe in this

21:48

model where you are being seen by the person that has the most years of

21:52

education, you know, years of experience, trained to do these procedures,

21:56

trained to take care of a variety of patients. And so that is our

22:02

model. And also the thing that will differentiate our practice is that when you

22:06

call to get an appointment, there's an appointment available to you in one week

22:10

or two weeks, rather than six months or nine months, which is what

22:12

we're hearing from again these large systems, because they do not have enough doctors

22:18

to see patients, they don't have enough non physicians to see patients. So

22:22

again, you know, it's so ironic and frustrating because you know, patients

22:26

pay all this money for health insurance. You know, you're paying thousands of

22:30

dollars. For some people, it might be their most expensive thing that they're

22:34

paying for besides like their mortgage payment. And so you pay all this money

22:38

for health insurance and it actually doesn't guarantee you access to healthcare. I mean,

22:42

you could wait like nine months to see a doctor, and again that

22:47

does not happen in the direct premary care model. So if you are a

22:51

member of Advocate MD, you need to be seen for urgent care. We get you in the same day. We don't direct you to an urgent care

22:55

clinic or an er if you need to be seen for just a regular follow

22:59

up or new patient apployment, Like I said, usually one to two weeks

23:02

typically for our doctors. It's amazing and it's affordable. That's the that's the

23:07

other thing you're like. I think sometimes people hear that sound like, yeah,

23:10

it's got to cost so much. It's actually very affordable. Going back

23:14

to that transparency, you can learn more about I'll becoming a member, learn

23:17

a little bit more about Direct Primary Care all on the website. Advocate MD

23:22

ADVOCATEDPC dot com. How many years have been doing the show together, doctor,

23:26

I think five now five, and I've never I have never butchered the

23:30

website until just there, ADVOCATEDPC dot com. Advocate d PC dot com is

23:38

the website, the telephone number six eight to six Friday weekend exactly today is

23:45

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