A Broad Overview of DPC

Episode Transcript

Speaker 1 (00:00):
Thirteen ten WIBA and full scope with Wisconsin's direct care doctor,
doctor Nicole Hempkiss. Of course, doctor Hempkiss comes to us
from Advocate MD, a direct primary care practice with four
locations east side right on fair Oaks A, west side
in Middleton, right on Glacier Ridge Road, Janesville location ten

(00:21):
twenty one Mineral Point Avenue in the newest location in
Fitchburg right at thirty two to twenty Sigin Road. Actually
had a chance to stop in Fitchburg location yesterday and
doctor Fitchburg location looks app They all look fantastic, but
the Fitchburg location looks looks really good. How you doing
this morning?

Speaker 2 (00:39):
I'm doing great, son, How are you?

Speaker 1 (00:40):
It's really good to talk to you. And we're going
to get back to basics when it comes to understanding
direct primary care, all the great benefits with it, what
makes it different from maybe the insured model, and what
people may want to know about direct primary care. We'll
talk about that in just a moment mention. The four
locations also eight doctors eight physicians at Advocate m D
for you. You can learn more online the website Advocates DPC

(01:04):
dot com. That's Advocates d PC dot com the tell
themph number to make a point. Become a member at
Advocate MD six oh eight to six eight sixty two eleven.
That's six oh eight two six eight sixty two eleven.
And before we get it at talking about DPC and
direct primary care and what makes it so special and
a great option and opportunity, let's real quick talk about
the clinics. Four area locations for locations globally, they're all

(01:28):
in the area. Let's talk a little bit about the clinics.
Doctor and one of the things I know you work
very hard at is as as Advocate NB expanded from
the first original one on the west side of Madison,
You've always looked for new locations that were very convenient
to folks and really easy and accessible for folks to
get end, inn't you.

Speaker 3 (01:48):
Yes, you know, kind of strategically, you know, we're trying
to make it so that people aren't having to drive
probably more than twenty minutes to get to the doctor.

Speaker 2 (01:57):
You know. Of course, we can't compete with the huge.

Speaker 3 (02:00):
Hospital systems that you know, have twenty clinics, you know,
in the greater Madison area. But you know, I think
we're able to kind of make it a little bit
easier for people. So originally when the clinic started, we
had patients that were driving from you know, an hour
away to come and see us. So now maybe that
drive is a little bit shorter if we have a
clinic on the east side, a clinic on the west side,
a South clinic, and then a Jansville clinic. So you know,

(02:23):
hopefully the plan is to continue to expand that and
you know, add more clinics, you know, slowly in the
Greater Madison greater Jansville area.

Speaker 2 (02:31):
So you know, we're we're looking forward to that.

Speaker 1 (02:33):
Let's talk a little bit about the growth not just
in the physical buildings, but also the number of physicians available,
and that kind of ties nicely in with what we're
going to talk about with direct primary care and specifically
what you do at Advocate MD. I know when you
started Advocate MD, one of one of the main goals
was to make sure that when folks were coming to
the clinics, they were seeing their doctor and an actual doctor,

(02:56):
not not being passed off to you know, to some
other some other type of medical professional, but literally getting
in to see not just any doctor, either their very
owned doctor. Let's talk a little bit about how that
structured doctor MkIS.

Speaker 3 (03:09):
Yeah, so this direct premary care model. I think for
some people this might be the first time that they're
hearing about this. You know, I think in Wisconsin it
was kind of slower to make its way here, but
it is something that's existed now for fifteen or twenty
years in various parts of the country. You know, it
was very big down in Florida, Texas, states like Colorado, Kansas.
For some reason. Most of this has to do with

(03:31):
not only were there you know, kind of brave doctors
out there that were willing to, you know, ten or
fifteen years ago start these type of practices, but also
kind of the insurance financial conditions in those states where
you know, I would say states like Texas and Florida
that are more you know, quote unquote free market friendly
in terms of allowing people to start businesses and kind

(03:53):
of do independent medicine. That really drove a lot of
that growth in those particular areas. You know, as most
of us know, in Wisconsin, we are heavily HMO dominated,
especially in this area of Madison where we have situation
where the large hospital systems own a stake in the

(04:14):
insurance companies. So UW owns courts and some capacity. SSM
Health owns some of Dean insurance, and that creates some
issues for patients because there is not necessarily a incentive
to control cost, right because you'd think that, you know,
some I've heard one of these healthcare economists a while

(04:36):
back talking about this and it was like, oh, you know,
they're they're going to kind of work with each other
to make sure costs are lower because you know, the
insurance companies paying out the claim, so they want, you know,
they want to make sure they're getting the best deal
from the hospital system. But it doesn't actually in theory
that sounds good, but the practicality of it is that
it doesn't really work that way because what happens with

(04:57):
insurance is that as go up and up and up,
they just continue to, you know, push shift that cost
onto the consumer or the employer through elevated insurance premiums
every year. So again it goes back to this idea
that who is looking out for the patient? Who is
looking out for the employer who's paying for the health

(05:18):
insurance premiums and advocating on their behalf because the insurance
company is not doing that.

Speaker 2 (05:23):
The hospital is not doing that.

Speaker 3 (05:25):
You know, these people that are making millions or in
some case billions of dollars, you know, off of the
current situation, they are not going to try to change anything, right,
you know, if they're you know, profiting from the way
things are, why would they want to change it?

Speaker 1 (05:39):
And I think too sometimes the confusion comes down to it,
and and and part of why this goes on is
people confuse. And something you've you've discussed is is the
difference between health insurance and health care and that that
I think a lot of times people say, I've got insurance,
therefore I have health care I have access to and

(06:03):
anybody that's you know, that's gone through you know, gosh
forbid something something significant or even something as simple as
sometimes making a basic appointment, realizes it's not a golden
ticket simply having insurance. And you know, having health insurance
doesn't get you any type of you know, again, it
doesn't get you I think for what a lot that
health care that I think a lot of people kind

(06:24):
of expect that that's what they're paying for.

Speaker 2 (06:28):
Exactly.

Speaker 3 (06:29):
You know, it's kind of ingrained in us, probably for
the last twenty years or more that health insurance is
synonymous with health care, and I really try to break that.
I mean, it's a hard habit to break where we
refer to those things kind of interchangeably, because there's a
lot of people out there that have health insurance that
don't have good access to healthcare. There's a lot of
people out there that you know, pay a lot for

(06:50):
their insurance, but they still have high deductibles, so they're
you know, scared to go to the doctor, or they
you know, they get huge medical bills because they haven't
met their deductible yet they can't get an appointment with
a doctor. It's crazy when you think about it, that
you could be paying hundreds or thousands of dollars every
month for your health insurance and then when you call
you to schedule an appointment with your primary, you're told

(07:11):
that it's nine months or a year to get in
with your primary.

Speaker 2 (07:13):
So it's like, what are you paying for?

Speaker 3 (07:16):
Why am I paying every month for this thing that
I can only see the doctor every nine months or
every twelve months. So, yes, health insurance is a mechanism
to pay for health care, but we know that it's
very broken, and you know, just the whole way we
the whole model of healthcare in this fee for service
insurance based model right now is very broken.

Speaker 1 (07:35):
So kind of going back to that earlier point you
were making about about in theory the health insurance should
lower costs a little bit more into that is when
it comes to you know, looking at health care, it
is it is crazy expensive and health insurance doesn't seem
to be seem to be helping. I mean, why is that?

(07:58):
Why is that the case is? Is it literally just
strictly about about profits and they say, well, what about
those nonprofit operations? Why are there why are there prices
just in line with those other with those other for
profit operations.

Speaker 3 (08:14):
It's yeah, you bring up an interesting point.

Speaker 2 (08:16):
And it's funny that you.

Speaker 3 (08:17):
Say that, because I was just in a meeting yesterday
with an employer and one of the people had brought
up the question of you know, whether one of the
local you know, health systems is a nonprofit or a
not for profit. My response is, like most of them
are nowadays, right, Like it didn't used to be like that.
I think in the eighties and nineties the statistics were,

(08:40):
you know, either either more of them were for profit
or it was like fifty to fifty split. Now it's
like a eighty five percent of health systems are non profits.

Speaker 2 (08:49):
Why is that?

Speaker 3 (08:50):
Because they figured out that there is massive tax statings,
right if they can somehow structure their their business in
a way that shows that they're putting back in So
they're obviously generating a profit, but then they're putting that
profit back into facilities and equipment and you know all
these other things. And again I am not an economist

(09:12):
or an expert in this at all, but the way
I understand it is that, you know, they don't function
exactly like a corporation in terms of having stockholders and
you know, getting like a stock payout at the end
or anything like that, but they do obviously make a profit.

Speaker 2 (09:28):
They have CEOs.

Speaker 3 (09:30):
And healthcare administrators that make millions of dollars every year,
you know. I mean, you can look up a lot
of this is publicly accessible because because of the fact
they're nonprofits. You can see how much their top ten
executives make and the local systems here they make a lot.
And again most of these executives with one of the
local systems, they are not based in Wisconsin. So so

(09:52):
why are they allowed to call themselves that. You know, Again,
it has to do with how they're structured and how
they take their profit and put part of that back
into the overall you know, organization, overall healthcare system. But
as you can see, you know, they're constantly building new buildings.
You know, it brings up the question of do we

(10:12):
need to rip down the building and rebuild a brand
new one every ten years?

Speaker 2 (10:16):
You know, do we need the player piano in the
in the water feature inside the lobby?

Speaker 3 (10:21):
You know, because because when you look at it, when
you kind of reframe your thinking a little bit and think,
I pay for this, right you paid for that water feature,
and you know, the fancy tile floor and the gigantic building,
you and me paid for that through our insurance premiums,
through our healthcare bills. So so again it's not to
go down the rabbit hole on this. But if you

(10:42):
look at hospitals and other countries, you know, countries, not
third world countries, but you know countries with similar socioeconomic
levels that have really good healthcare systems. Hospitals are not
as fancy as they are here, you know. And then
you can, of course there's many countries and have a
two tiered system where they have you know, government run
hospitals versus private and I'm sure the private ones are nicer,

(11:04):
but here we have really kind of shifted in the
last twenty years to where hospitals look like hotels. You know,
the rooms are very fancy, you know, and again there's
a cost associated with all of that, right, I mean,
you know, should we be focusing more on the quality
of the care and the time with the patient and
the getting the best you know, doctors and nurses and

(11:25):
maybe focus less on you know, whether we're getting gourmet
food and you know how.

Speaker 2 (11:30):
Many channels are on the TV.

Speaker 3 (11:31):
I you know, I it's an interesting kind of scenario
to think about, but definitely there has been a shift
and and you know, again I think people should just
look at this as you know, you are paying for
all these fancy facilities. You are paying every time that
new hospital is constructed if this is a non for profit,
because they're taking their profit and kind of building this

(11:53):
new thing.

Speaker 1 (11:53):
Yeah, you talk about some of the you know, some
of the hotel like amenities at hospitals. The irony too
is at the same time they are they're putting all
this money into these you know, into these fancy decors
and these designs and the cable and the different channels
and stuff. They're keeping you in the hospital less time
than they're they're getting you in, getting you out and
on your way. It's like, oh, that stuff is all

(12:14):
nice and fancy, You're not ever going to take it
in because they're going to try and get you out
of that out of that bed and somebody else in
there as soon as they can. I would you also
mentioned to doctor one of the things that I find
interesting is how American hospitals are. And you mentioned, you know,
going and traveling to other countries and seeing, you know,
how their healthcare systems work and how their hospital systems work.
You can even for folks that think back to like

(12:36):
the eighties and nineties and remember how hospitals used to be.
They were very functional. They were you know, they weren't
It wasn't like they were like run down or anything.
They were well maintained, but they weren't these extravagant, opulent
buildings and structures. They were a place you would go
to have surgery. They were a place you would go
to visit a you know, a family member that had

(12:58):
a baby. These weren't like what we're seeing now. And
for a lot of people, they kind of think back
and they go, oh, yeah, I remember those days. Those
hospitals work perfectly, and I remember, you know, having a
kid delivered and it only cost me a few hundred
dollars one thousand dollars. And boy, have things definitely changed,
speaking of kind of how things used to be and
things that are affordable. We'll talk with doctor Nicole Hemkiss

(13:20):
about direct primary care and folks may wonder, how does
how does doctor Hempkis, how does the clinics that Advocate
MD keep costs so low? We'll talk with the doctor
about that next as Full Scope with doctor Nicole Hempkis
of Advocate MD continues right here on thirteen ten wib
A thirteen ten wib A Full Scope with Doctor Nicole Hemkis,
Wisconsin's direct care doctor. You can learn more about doctor Hempkiz.

(13:43):
You can learn more about Advocate MD as well as
direct Primary Care all on the website Advocate d PC
dot com. That's Advocates DPC dot com. Great data to
make an appointment, become a member at Advocate MD six oh
eight two six eight sixty two eleven. That's six 'oh
eight two six eight sixty two two eleven. Talking this
week with doctor hamkis a little bit about direct primary

(14:03):
care and kind of an overview of how it works,
and you know, we're kind of kind of compare and
contrast that last segment to kind of set things up
for what the insurance system looks like. Let's talk a
little bit about direct primary care and specifically when it
comes to things like cost, people are amazed, almost to
the point where they're like, I've got to be missing something.

(14:24):
There's got to be some more that I'm not fully understanding.
People are absolutely amazed when they find out how affordable
direct primary care is. Why is that? How are you
able to do that?

Speaker 2 (14:35):
Doctor? You know, a lot of it has to do
with the overhead costs.

Speaker 3 (14:40):
And we've talked Sean on the program about how much
of healthcare spending is waste. You know, the non clinical people,
all the healthcare administrators, the billers, encoders, everyone that submits
insurance claims. There are entire departments. I heard a statistic
one time. It was almost mind boggling. I don't know
if it was true or not, and they said something

(15:01):
like for every I think it was like for every
three hospital beds in a hospital, there's one person that's
working in billing and coding that you know. So if
you have a three hundred bed hospital, which is like
a medium sized hospital, there'd be one hundred people kind
of working in their insurance billing coding submitting those claims

(15:21):
to insurance department, which sounds crazy, crazy number to me.
But the idea behind that though, is that there is
a lot of paperwork associated with billing out insurance claims
making sure those are coded properly. You know, hospital systems
will make sure that they are coded to the maximum
extent possible, right because that's how they get paid. There

(15:42):
are people that that's their expertise. I forget the title
of those people that, you know, So there's people that's
that's part of their that's all their job is just
to see how things are coded and see if they've
maximized the level of the visit, the level of the procedure.
And so then you have that whole aspect. You have
the whole aspect of you know, every floor in the

(16:03):
hospital has an assistant, you know, nursing director, a nursing director.
You know, every unit has multiple layers of administration. You know,
the hospital has uh, you know, probably ten times the
number of administrators than it had twenty years ago. And
all these people people make six figures, you know, So
the level of bureaucracy has changed a lot. And it's

(16:29):
kind of like it's it's similarly functioning to government. Right,
So the bigger government gets and the more people you
have in these administrative positions, these people probably don't vote
themselves a salary decrease. They probably don't say, hey, you know,
let's lay off half of the administrators here and you know,
make this just function more efficiently. Probably not right. You know,
they're not going to call for their own firing. So

(16:50):
the same thing happens in hospitals. You tend to get
more and more vps and CFOs, CEOs and all of
these things. And because it's not viewed necessarily. You know, again,
if you if you looked at a business, like a
business and a different industry than healthcare, they are much
more driven on you know, efficiency practices. How can we

(17:11):
get lean or you know, how can we do the
same job with with less employees or less administrators? You know,
do we need all these people? But in the healthcare arena.
There's a lot more waste, and again I think that
if they're not making the profit that they want to make,
they kind of increase their prices. You don't have as
much competition, you don't have the transparency you have in

(17:33):
other industries, so they just keep increasing their prices year
after year. Insurance premiums go up year after year, and
you the patients or the consumer, the healthcare consumer pays
the brunt of that or the employer. So that's kind
of the big difference between you know, healthcare economies and
other industries.

Speaker 1 (17:52):
Tellian's one with talking to Nicole hem because of Advocate
MD online Advocates DPC dot com. That's Advocates DPC dot
com a great opportunity to head on over the website
learn more about Advocate MD and direct primary care. Obviously
a big part of what they do at Advocate MD
is transparency, understanding costs and prices. It's all laid out
membership costs and everything and doctor That's one of the

(18:14):
as to kind of wrap this this week's conversation up.
One of the things that is really important is is
on the on the direct primary care side and at
Advocate MD, I definitely could charge a whole lot more
for the services you offer at Advocate MD. But but
keeping prices affordable and being completely transparent, that is also
at the core of what you do, isn't it.

Speaker 3 (18:37):
Yes, you know, I think that it's it's really important
for people to know what they're spending on healthcare, know
what they're getting.

Speaker 2 (18:44):
You know, we don't in the insurance based healthcare system.

Speaker 3 (18:48):
We don't know those numbers until we get the bill
and the mail, you know, months later. In the interesting
part again this came up during this meeting I was at,
is that employers don't know what they're spending. I mean,
they know what they're insurance premiums for their employees are,
but they do not get the claims data for their employees,
which is mind boggling. But when they have a fully
insured plan, the insurance company does not. They're not legally

(19:10):
required to release to them to their claims data. So
imagine that's kind of like you know, paying for something
and not getting a receipt or you know, a breakdown
of what all those charges are. But that's all legal,
So why do they do that Because they don't want
you to know the prices of things and they don't
want you to be able to shop around for things.

Speaker 2 (19:28):
So if you could see a hospital A.

Speaker 3 (19:30):
And Hospital B are similar levels of quality, same access,
but you know at hospital B everything is ten times
more than at Hospital A, So why would I continue
to go there? But they don't want you to be
able to do that, so they keep all the claims
data hidden other than with some exceptions they show like
their high cost claims. But again it's crazy to think

(19:52):
that they could be paying for something and they will
not show them what they're paying for.

Speaker 1 (19:56):
That is absolutely crazy. And we talk about the transparent
and see at Advocate MD and what they're able to do.
If you head on over to the website Advocates DPC
dot com. That's Advocates DPC dot com can see spelled
out in black and white what it will cost to
become a member at Advocate MD. It's a great day
as well. As we're talking with doctor Hempkiss this morning
of course gets the opportunity to speak with with business

(20:18):
leaders and others. Not only is this a great option
for you and your family, if you are a business
leader a business owner looking for great options for your employees,
they've got great stuff for you at Advocate MD again.
You can learn more online the website ADVOCATESDPC dot com.
That's Advocates DPC dot com. Even better. Great day to
pickup phone to become a member at Advocate MD. Six
oh eight two six eight sixty two eleven. That's six

(20:40):
'oh eight two six eight sixty two eleven. Doctor hempkiss,
It's always great chatting with you. You enjoy this great weekend
and we'll talk soon to thank you. News is next
here on thirteen ten dough Will you Iba