Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
Thirteen ten WIBA and full scope with doctor Nicole Hemkiss, Wisconsin's.
Speaker 2 (00:08):
Direct care doctor.
Speaker 1 (00:10):
Of course, doctor Amkins comes to us from Advocate MD
online ADVOCATESDPC dot com. That's the website ADVOCATESDPC dot com.
Of course, Advocate MD a directcare primary practice, primary care
practice with offices.
Speaker 2 (00:25):
They got a clinic in.
Speaker 1 (00:26):
Middleton on the west side of Madison, right at thirty
two o five Glacier Ridge Road, east side of Madison,
right at one fifty seven South Fair Oaks Avenue, Jamesville
for you folks in Rock County or in southern Dane County.
Real convenient location in Janesville right at ten twenty one
Mineral Point Avenue. And the newest location right in Fitchburg,
right just at the City of Madison Fitchburg line, right
(00:49):
at thirty two to twenty Sign Road.
Speaker 2 (00:51):
Beautiful, beautiful new clinic.
Speaker 1 (00:52):
All the clinics are absolutely beautiful with fantastic doctors at
all of the clinics for Advocate MD. Again the website
ADVOCATESDPC dot com. That's ADVOCATESDPC dot com. That teleph number
to make a point. 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 eleven. And
again joining us this morning is the doctor doctor Nicole Hemkiss. Doctor,
(01:14):
how you doing this week? And Welsh how a, I'm
doing really good? And uh mentioned the newest clinic in Fitchburg.
And of course as you add patients and you add clinics,
you add doctors as well, and you've got a really
good doctor that's going to be doctor Philman is going
to be starting very soon at the Fitchburg clinic.
Speaker 2 (01:33):
Wow.
Speaker 3 (01:35):
Yes, doctor Philman is starting on Monday. So we're excited
to have her. She comes to us from Fort House.
She was working in their Lake Mills clinic for many years,
so exciting to have her come. And we're already, you know,
having patients that are trying to find out where she's
going to be.
Speaker 2 (01:50):
That's really exciting.
Speaker 1 (01:52):
And of course as we talk with doctor Hemkiss, and
we're going to talk about some interesting stuff in the
news and some of the issues with healthcare and the
system healthcare, especially in some of the ways that folks
are really becoming quite alarmed by some of the behavior
and some of the practices. We're talk with doctor hemkiss
about a couple of stories that have been that have
(02:12):
been in the news recently. We'll get to that in
just a moment. In the meantime, if you haven't had
a chance to check out the website Advocates DPC. That's
Advocates DPC dot com. Check that out online again Advocates
DPC dot com to learn more about Advocate MD and
doctor let's talk about this. This a story that that
has to do with a plastic surgeon who was doing
(02:35):
reconstructive surgery for somebody who had had battled with breast cancer,
doing reconstructive surgery and am I reading this right? And
like during the surgery the phone rings or set this
story up? Let's let's let's talk about this.
Speaker 3 (02:50):
Yes, so the doctor is doctor Elizabeth Potter. She's out
of Austin, Texas, and she's a plastic surgeon that it
sounds like does a lot of breast reconstructive surgery. But
so she posted a TikTok about a week ago where
she had to scrub out of a surgery. For anybody
that has been through surgery or knows about surgery, you know,
it takes that there's a long process to scrub in
(03:11):
and gown up because then you're sterile. So she must
have gotten a call during the surgery, and you know,
they have these text assistants that are sitting in the
r that will take the phone for the doctor. But
it must have been the insurance company that was saying
that they are denying the patient staying overnight in the
hospital due to the billing code, of the diagnosis code
(03:33):
or something. So she had to scrub out of surgery
and go and call the insurance company to try to
justify why she felt that the patient needed to stay overnight.
Surgeries of this type are pretty major, you know, people
can be in the hospital for two or three nights afterwards,
you know, depending on the recovery time. But and then
after that whole process, she posted that as a TikTok
(03:56):
after talking to them, and then the the I part
is that the surgery actually sorry, the stay actually got
denied afterwards, and then United Healthcare came and kind of
tried to threaten her to take down the video and
said that she was lying and that those weren't the facts,
(04:17):
and that if they you know, I don't know if
they threatened what they would do if she didn't take well,
I guess if she didn't take it down, they were
going to pursue some sort of legal action against her,
and they wanted a public apology. So she posted a
second TikTok, and she was kind of like, well, you know,
I'm not going to be intimidated, but I mean, imagine
the largest health insurer in the country saying that they're
going to sue you, and they have retained this prominent,
(04:38):
you know, law firm to do it, and you are
an individual doc. She might be part of a group practice,
but I mean that's still a pretty intimidating thing. You know,
even as an employee doc. You know, hospitals don't want
to get sued either. So she is kind of sticking
to her guns and not backing down because she said
it was factual what she said. And then to get
(04:59):
that letter with you know, the threats and also the
denial of care for the overnight's stay. And you know,
the hard part of all of this is that there's
a lot of doctors that are scared to speak up
because some of these things, like, I mean, they are
just really atrocities against patients when they deny their cancer
treatments or they deny their you know, necessary prescriptions or
(05:22):
you know whatever it might be the surgery that they need.
So if you don't have people kind of bringing light
to this crazy, you know, borderline of legal stuff that
is happening, you know who else is going to call
it out? So I'm glad that she is not backing down.
Speaker 2 (05:38):
It's it's it's it's very bold.
Speaker 1 (05:39):
But and and thank goodness, people like this doctor are
out there to kind of highlight this because as you mentioned,
doctor Hemkiz, there is there is substantial risk is even
you know, you can you can be absolutely right, but
threats of lawsuits and other things, especially when you're dealing
with you know, working for a for a hospital system
of other things. They're they're mediate thinking is going to
(06:01):
be well, we're going to just automatically settle lead to
things like termination and other things, and it can be
very dangerous. And it's it highlights though, what I think
a lot of people have have kind of felt for
a long time is, uh, these insurance companies are trying
to play doctor based on financial considerations, whereas you know,
(06:23):
who would know better about the needs of a patient
than the actual doctor, the surgeon that's that's performing the surgery.
I would guess that she probably has a much better
grasp of what the needs are, especially for recovery of
her patient than than some somebody sitting at a desk
somewhere in another state that's never actually seen the patient,
(06:44):
never talked with the patient, doesn't know all of the
nuances and the ins and outs as well of the surgery.
This stuff gets gets really frustrating doctor, and for people
that that hear these stories and see these stories, it's
it's a really, really kind of sad state of affairs.
I know. One of the great things about direct primary
care and what you're able to do at Advocate MD
(07:05):
with primary care is is you're literally, you know, as
a member, you're entitled to get in to see your
doctor or doctor actually is able to spend time with you.
It's such a drastic contrast. You don't have an insurance company,
you're not billing insurance, so you don't have to go
to war and start that battle. I know, part of
part of the story of how you started Advocate MD
(07:25):
is you worked in those systems and kind of became
quite frustrated with having to having to argue with somebody
about and these are not like really like not don't
know the word complicated, but these are things that are
that are It's it's stand like like talking about a
hospital stay after surgery. An overnight stay is especially if
you're such a such a significant surgery, it's pretty common
(07:48):
sense like probably want to keep them in too, to
at least monitor them and make sure that they're recovering
properly overnight. I mean, it's it's just it's just so
I don't know how to say it, doctor, it's just
so all right, yeah.
Speaker 3 (08:01):
And then the other ironic part of this story was
that that surgery was actually preapproved because of course, like
you know, you can no longer just do surgery without
getting it preapproved by the insurance company, So that that
surgery was preapproved, and I'm assuming that you know, at
that point they knew what the requirement was going to
be for the overnight's stay, and so then they were
kind of like reviewing it again after the person is
(08:21):
like literally having the surgery done, to say like, oh well,
we might actually not cover this overnight stay. That's how
so you know, she kind of starts out this TikTok
to saying like insurance company, insurance companies have just become
so crazy. This is what they're doing right now to
again like spread the word of what is happening, because
I think if you're not in the healthcare field, you
(08:42):
might not know that this kind of stuff happens, and
you might just think, oh, I can't believe that would
ever happen. So I think it's you know, we need
people like that that are kind of like the whistleblowers
on what's going on.
Speaker 1 (08:52):
Are we seeing more and more doctors that are kind
of standing up and kind of not only fighting back
speaking out as well? Again, I mentioned, you know the
bold move you made when you started Advocate MD is
you know being a doctor, you know, working for a
big hospital group, there's there's a lot of security there.
There's you know, you're guaranteed money, you're guaranteed patients, you're
(09:14):
guaranteed the work. You know, all of these things are
like any job, are guaranteed. You stepped out of that
that comfort zone for your love of patients, for the
love of your practice and said I'm going to do
something different. Are we seeing more doctors do things like
you or like this doctor. They're saying, you know what
I'm gonna I'm going to fight for change, whether it's
changing how how the practice operates or taking the time
(09:36):
to speak out and get the word out of what
goes on behind the scenes of some of these with
some of these insurance companies and some of these institutions.
Speaker 3 (09:44):
Yeah, I think it's it's difficult. I'm not sure if
we're seeing it more or if we're just seeing more
doctors get you know, kind of burnt out and then
give up and you know, retire or leave the practice
of medicine because they don't want to kind of fight
an uphill battle. I think a lot of docs are
afraid of you know, retribution or retaliation from their employer.
(10:04):
So I mean, I think there's a lot of times
things that happen within large healthcare systems or hospital systems
where they're not patient friendly, they're not doctor friendly. They
you know, things that maybe are not ethical that doctors
want to speak out against, but again, they don't want
to lose their job, you know. So I think that
happens every single day. So you have to have a
(10:25):
doc that's brave enough to know that when they speak out,
they might lose their job. And you know, then again,
like do you want to pursue legal action. How many
you know, tens or hundreds of thousands of dollars is
that going to cost if you need to hire an attorney.
All of those kind of factors I think come into it.
Speaker 1 (10:40):
It's it's it's I know I've said this a couple
of times on the program, but the stuff I used
to find shocking and now it's like I'm almost like, gosh,
I'm not surprised.
Speaker 2 (10:49):
I'm like, how much lower can they get? These can
these people behave? And it's it's it's really really unfortunate.
Speaker 1 (10:56):
We're going to talk about also when it comes to billing,
how the billing systems work, in the coding and other things,
some really really troubling stuff there. We're going to talk
about that with doctor Nicole Hempkiss in just a moment.
In the meantime, I hope you've had a chance, But
if you haven't had a chance to head on over
the website for Advocate MD. That's ADVOCATESDPC dot com. That's
Advocates DPC dot com.
Speaker 2 (11:18):
Head on over there.
Speaker 1 (11:18):
You can learn more about Advocate MD. You can learn
more about the doctors, the clinics, you can learn more
about options when it comes to whether it's catastrophic or
looking for health share different types of coverages as well,
and of course you can learn more about how direct
primary care works and how affordable it is and how
high quality is with looking for options for yourself, your family,
you're an employer looking for something great for your employees,
(11:40):
definitely check out Advocate MD in their website Advocates DPC
dot com. That's Advocates DPC dot com. More a full
scope with doctor Nicole Hempkiss.
Speaker 2 (11:50):
Of Advocate MD.
Speaker 1 (11:50):
Next here on thirteen ten wib A thirteen ten WIBA
and full scope with doctor Nicole Kiss, Wisconsin's direct care doctor.
You can learn more about doctor hem Kiss actually all
the doctors at Advocate MD. More information on them just
at ADVOCATEDPC dot com. That's Advocates DPC dot com. Tell
(12:12):
me number to make an appointment to come a member
at Advocate MD. Six h eight two six eight sixty
two eleven. That's six h eight two six eight sixty
two eleven. And that last story really touched a nerve
for some folks who have experienced had to have that
surgery and just here as first about what some other
folks going through. And it's it's shocking to hear and doctors.
We talk about the clinics at Advocate MD. One of
(12:35):
the kind of I think neat features that maybe a
lot of folks don't think about is a lot of times,
because of the availability to see your doctor on short notice,
in certain situations, you can avoid having to go to
these places called urgent care. Like let's say you break something,
or you get you know, you have to have a
splinter removed or something like that. A lot of that
(12:56):
stuff can be done and is done right in the clinic.
I want to kind of contrast and compare that with
the story you also shared with me about going into
a hospital and does a you know, for example, removing
a splinter, what does that count as is that is
that a surgical procedure? And if so, what ends up
happening when it comes time to build something like that.
(13:18):
Let's talk about this this one doctor.
Speaker 3 (13:21):
Yeah it was. There was a pretty recent story in
the Washington Post called how Everything Became Surgery, And I
think this is a good example of kind of how
messed up our billing and coding system is. In the
current healthcare model, health insurance model, I should say, we're
basically you know, health insurance and you know, hospital systems
(13:43):
are incentivized to code things to higher levels. You know,
I guess I could say that maybe the health insurance
is not incentivized to do that, but they, you know,
play a part in all of this, and they don't
really help the control costs. But the health system, or
the doctor's office or or the radiology facility or whatever
it might be the goal. And they have people that
(14:04):
work at these places that this is all they do
all day long is to maximize the coding and the
billing for claims. I remember when I used to work
in the hospital as a hospitalist. Now I can't even
remember their names, but I mean what their job title was.
But there are people that would go around and you know,
go through the medical records and try to find diagnoses
(14:26):
that they thought could be like, you know, a level
higher based on you know, the on or based on
you know, the notes that they found from the doctor.
So so that was their job to try to maximize
how much that the hospital was billing to the patient
and the insurance company. And again really the insurance company
whatever they don't pay, they bill that to the patient.
(14:47):
So this interesting article where they're talking about the definition
of surgery, and they give two or three examples of
One of them was a guy who brought his young
son to a pediatrician to remove a splinter, and they
said it took, you know, a couple of minutes. They
got a pair of tweezers out, they pulled out a
little tiny, you know, splinter of wood or whatever out
(15:07):
of the finger. And they got a bill later on
for four hundred and fourteen dollars because it was coded
as a incision and drainage, incision and removal of foreign body.
And so this was I guess a father that was,
you know, trying to advocate on behalf of himself and
his son for this medical bill, and he kind of
tried to get appealed it, and you know it said, well,
(15:30):
there was no incision in drain incision in the finger.
It was just tweezers. And it's as I've said before,
it is nearly impossible to argue with a large health
system about a medical bill. The chances of them changing
it is so minute. I mean, I've tried it myself
that I feel like I'm pretty I'm pretty well versed
(15:50):
in medical coating and billing, and I couldn't even get
them to change something that was very unfairly codd So
these things are difficult to you know, remediate. But there
was another example of a woman that went into her
dermatologists for her annual skin exam and she they found
a skin tag which they used liquid nitrogen, you know,
the freezing spray. And then she later and from what
(16:12):
I can gather, it was one skin tag singular, not plural,
and when she got the bill, it was four hundred
and sixty nine dollars and they coded that as a
surgery destruction of benign lesion. And again, both of those
things that if you came into a direct primary care
clinic like Advocate m B, we would do both of
those things for free. We don't charge anything for those things.
(16:34):
It's it's interesting something that will take you, you know,
thirty seconds to do or sixty seconds to do, and
you get a bill like that. That is really what
again kind of makes patients distrustful of our medical system.
They make you know, patients make it distrustful of insurance
companies and and you know, why are we billing these
(16:55):
exorbitant bills for something like that, even if it was
fifty dollars, right, Like, even if we could attach a
fair price to something like that, maybe fifty dollars is
too much, but definitely four hundred and sixty nine dollars
is too much. So, yeah, it was this idea that
now quote surgery is involving anything that's being done to
the skin basically, like doesn't matter matter if you're using
(17:15):
a scalpel and its sutures. Basically, they are coding anything
as surgery that's being done to the skin. And the
last example they use was a plantar ward that they
went in and got treatment for. I don't know if
this was at a primary care dermatologist or a foot doctor,
but they you know, rubbed some ointment on the planter's
(17:36):
worts and then they again build that as a surgical
procedure and they are looking to see what the actual
it was a three year old child. Oh, they had
for two visits. They had a balance of four hundred
and sixty five dollars because they had to come back
to do it again. But yeah, so what is the
purpose of that. What is the purpose of coding something
(17:57):
as surgery that we all don't really consider that surgery.
That's a billing motivation, right, That doesn't mean that they're
taking better care of you. That doesn't mean that they
are more thorough or higher quality of care. That is
purely billing and kind of manipulating the fee for service
like ICD ten codes in a way that allows us
to rip off patients is great.
Speaker 1 (18:19):
You know, we talk about some of the some of
the benefits of direct primary care and Advocate MD. We
you know, we talk about affordability, we talk about accessibility,
we talk about those things. One of those areas that
that I guess I kind of maybe take for granted
is just not saying I think like like one of
the other benefits is like sanity, like not having to
(18:39):
worry about like what is this appointment going to cost?
How is it going to be built. You mentioned some
of the procedures, and I know we've talked about on
previous programs as well, some of the procedures that you
guys do right in the clinic. The doctors at Advocate MD,
things that you're as a doctor, very well qualified, heavily
trained to do, and and do them very very well.
(19:01):
And you mentioned earlier, you know, like the removal of
a splinter or something that's included with your membership. You
come in, that's just part of the deal. You don't
have to worry about getting built. Just like that sanity
factor alone is priceless. Doctor, I got to tell.
Speaker 3 (19:14):
You, yeah, I think, I mean, we know that people
will avoid medical care if they think it's going to
be too expensive.
Speaker 1 (19:21):
Right.
Speaker 3 (19:21):
I did a presentation of some employers yesterday and we
were talking about access and cost of care. Right. So
in the Wisconsin area, especially in Madison, we have very
poor access and we have very expensive care. And my
argument would be is that in and of itself, having
medical care that is too expensive makes it inaccessible, right,
because people will then not go to the doctor when
(19:43):
they need to go to the doctor, because they're going
to be scared of getting these huge surprise medical bills,
which this is exactly an example of that. This was
a surprise medical bill. They would not have any you know,
expectation that they would have gotten such a large bill
from such a simple, quick, little procedure that was done
in the office. But so again this goes back to
transparency and in the direct primary caure model, as you said, Sean,
(20:07):
anything that we can do in the office that doesn't
involve a third party. So if we're doing a procedure
in the office, any of those procedures that they listed,
whether it's a planter's removing a molar, skin tag and
you know, removing a foreid body or incision and drainage,
all of that stuff would be included at no cost.
The only time we add on costs, and again this
is all something that we talked to the patient about
(20:28):
is let's say we had to remove a mole and
send that to the pathologist and they charge us a fee.
You know, we're going to pass on that fifty dollars
or sixty dollars fee onto the patient, but it won't
be anything like you know, the four hundred five hundred
dollars that they're talking about in this article. So yeah,
that gives you, as you said, Sean, the peace of
mind that you know you can get very high quality,
accessible care and it's not going to bankrupt you. You're
(20:50):
not going to get these exorbitant surprise medical bills in
the mail.
Speaker 1 (20:54):
Great data, make that appointment, become a member at Advocate
MD all I gotta to just pick up phone. Gave
a call six so eight to six, eight sixty two
two eleven, that's six oh eight two six eight sixty
two eleven to become a member at Advocate MD.
Speaker 2 (21:04):
You can learn more online the.
Speaker 1 (21:05):
Website ADVOCATEDPC dot com. That's ADVOCATESDPC dot com. Doctor Hemkiss
is always great chatting with you. You have a fantastic
day and.
Speaker 2 (21:14):
Enjoy the weekend you too, Sean, Thank you. News is
next right here on thirteen ten. Wuib A
Thirteen ten WIBA and full scope with doctor Nicole Hemkiss, Wisconsin's.
Speaker 2 (00:08):
Direct care doctor.
Speaker 1 (00:10):
Of course, doctor Amkins comes to us from Advocate MD
online ADVOCATESDPC dot com. That's the website ADVOCATESDPC dot com.
Of course, Advocate MD a directcare primary practice, primary care
practice with offices.
Speaker 2 (00:25):
They got a clinic in.
Speaker 1 (00:26):
Middleton on the west side of Madison, right at thirty
two o five Glacier Ridge Road, east side of Madison,
right at one fifty seven South Fair Oaks Avenue, Jamesville
for you folks in Rock County or in southern Dane County.
Real convenient location in Janesville right at ten twenty one
Mineral Point Avenue. And the newest location right in Fitchburg,
right just at the City of Madison Fitchburg line, right
(00:49):
at thirty two to twenty Sign Road.
Speaker 2 (00:51):
Beautiful, beautiful new clinic.
Speaker 1 (00:52):
All the clinics are absolutely beautiful with fantastic doctors at
all of the clinics for Advocate MD. Again the website
ADVOCATESDPC dot com. That's ADVOCATESDPC dot com. That teleph number
to make a point. 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 eleven. And
again joining us this morning is the doctor doctor Nicole Hemkiss. Doctor,
(01:14):
how you doing this week? And Welsh how a, I'm
doing really good? And uh mentioned the newest clinic in Fitchburg.
And of course as you add patients and you add clinics,
you add doctors as well, and you've got a really
good doctor that's going to be doctor Philman is going
to be starting very soon at the Fitchburg clinic.
Speaker 2 (01:33):
Wow.
Speaker 3 (01:35):
Yes, doctor Philman is starting on Monday. So we're excited
to have her. She comes to us from Fort House.
She was working in their Lake Mills clinic for many years,
so exciting to have her come. And we're already, you know,
having patients that are trying to find out where she's
going to be.
Speaker 2 (01:50):
That's really exciting.
Speaker 1 (01:52):
And of course as we talk with doctor Hemkiss, and
we're going to talk about some interesting stuff in the
news and some of the issues with healthcare and the
system healthcare, especially in some of the ways that folks
are really becoming quite alarmed by some of the behavior
and some of the practices. We're talk with doctor hemkiss
about a couple of stories that have been that have
(02:12):
been in the news recently. We'll get to that in
just a moment. In the meantime, if you haven't had
a chance to check out the website Advocates DPC. That's
Advocates DPC dot com. Check that out online again Advocates
DPC dot com to learn more about Advocate MD and
doctor let's talk about this. This a story that that
has to do with a plastic surgeon who was doing
(02:35):
reconstructive surgery for somebody who had had battled with breast cancer,
doing reconstructive surgery and am I reading this right? And
like during the surgery the phone rings or set this
story up? Let's let's let's talk about this.
Speaker 3 (02:50):
Yes, so the doctor is doctor Elizabeth Potter. She's out
of Austin, Texas, and she's a plastic surgeon that it
sounds like does a lot of breast reconstructive surgery. But
so she posted a TikTok about a week ago where
she had to scrub out of a surgery. For anybody
that has been through surgery or knows about surgery, you know,
it takes that there's a long process to scrub in
(03:11):
and gown up because then you're sterile. So she must
have gotten a call during the surgery, and you know,
they have these text assistants that are sitting in the
r that will take the phone for the doctor. But
it must have been the insurance company that was saying
that they are denying the patient staying overnight in the
hospital due to the billing code, of the diagnosis code
(03:33):
or something. So she had to scrub out of surgery
and go and call the insurance company to try to
justify why she felt that the patient needed to stay overnight.
Surgeries of this type are pretty major, you know, people
can be in the hospital for two or three nights afterwards,
you know, depending on the recovery time. But and then
after that whole process, she posted that as a TikTok
(03:56):
after talking to them, and then the the I part
is that the surgery actually sorry, the stay actually got
denied afterwards, and then United Healthcare came and kind of
tried to threaten her to take down the video and
said that she was lying and that those weren't the facts,
(04:17):
and that if they you know, I don't know if
they threatened what they would do if she didn't take well,
I guess if she didn't take it down, they were
going to pursue some sort of legal action against her,
and they wanted a public apology. So she posted a
second TikTok, and she was kind of like, well, you know,
I'm not going to be intimidated, but I mean, imagine
the largest health insurer in the country saying that they're
going to sue you, and they have retained this prominent,
(04:38):
you know, law firm to do it, and you are
an individual doc. She might be part of a group practice,
but I mean that's still a pretty intimidating thing. You know,
even as an employee doc. You know, hospitals don't want
to get sued either. So she is kind of sticking
to her guns and not backing down because she said
it was factual what she said. And then to get
(04:59):
that letter with you know, the threats and also the
denial of care for the overnight's stay. And you know,
the hard part of all of this is that there's
a lot of doctors that are scared to speak up
because some of these things, like, I mean, they are
just really atrocities against patients when they deny their cancer
treatments or they deny their you know, necessary prescriptions or
(05:22):
you know whatever it might be the surgery that they need.
So if you don't have people kind of bringing light
to this crazy, you know, borderline of legal stuff that
is happening, you know who else is going to call
it out? So I'm glad that she is not backing down.
Speaker 2 (05:38):
It's it's it's it's very bold.
Speaker 1 (05:39):
But and and thank goodness, people like this doctor are
out there to kind of highlight this because as you mentioned,
doctor Hemkiz, there is there is substantial risk is even
you know, you can you can be absolutely right, but
threats of lawsuits and other things, especially when you're dealing
with you know, working for a for a hospital system
of other things. They're they're mediate thinking is going to
(06:01):
be well, we're going to just automatically settle lead to
things like termination and other things, and it can be
very dangerous. And it's it highlights though, what I think
a lot of people have have kind of felt for
a long time is, uh, these insurance companies are trying
to play doctor based on financial considerations, whereas you know,
(06:23):
who would know better about the needs of a patient
than the actual doctor, the surgeon that's that's performing the surgery.
I would guess that she probably has a much better
grasp of what the needs are, especially for recovery of
her patient than than some somebody sitting at a desk
somewhere in another state that's never actually seen the patient,
(06:44):
never talked with the patient, doesn't know all of the
nuances and the ins and outs as well of the surgery.
This stuff gets gets really frustrating doctor, and for people
that that hear these stories and see these stories, it's
it's a really, really kind of sad state of affairs.
I know. One of the great things about direct primary
care and what you're able to do at Advocate MD
(07:05):
with primary care is is you're literally, you know, as
a member, you're entitled to get in to see your
doctor or doctor actually is able to spend time with you.
It's such a drastic contrast. You don't have an insurance company,
you're not billing insurance, so you don't have to go
to war and start that battle. I know, part of
part of the story of how you started Advocate MD
(07:25):
is you worked in those systems and kind of became
quite frustrated with having to having to argue with somebody
about and these are not like really like not don't
know the word complicated, but these are things that are
that are It's it's stand like like talking about a
hospital stay after surgery. An overnight stay is especially if
you're such a such a significant surgery, it's pretty common
(07:48):
sense like probably want to keep them in too, to
at least monitor them and make sure that they're recovering
properly overnight. I mean, it's it's just it's just so
I don't know how to say it, doctor, it's just
so all right, yeah.
Speaker 3 (08:01):
And then the other ironic part of this story was
that that surgery was actually preapproved because of course, like
you know, you can no longer just do surgery without
getting it preapproved by the insurance company, So that that
surgery was preapproved, and I'm assuming that you know, at
that point they knew what the requirement was going to
be for the overnight's stay, and so then they were
kind of like reviewing it again after the person is
(08:21):
like literally having the surgery done, to say like, oh well,
we might actually not cover this overnight stay. That's how
so you know, she kind of starts out this TikTok
to saying like insurance company, insurance companies have just become
so crazy. This is what they're doing right now to
again like spread the word of what is happening, because
I think if you're not in the healthcare field, you
(08:42):
might not know that this kind of stuff happens, and
you might just think, oh, I can't believe that would
ever happen. So I think it's you know, we need
people like that that are kind of like the whistleblowers
on what's going on.
Speaker 1 (08:52):
Are we seeing more and more doctors that are kind
of standing up and kind of not only fighting back
speaking out as well? Again, I mentioned, you know the
bold move you made when you started Advocate MD is
you know being a doctor, you know, working for a
big hospital group, there's there's a lot of security there.
There's you know, you're guaranteed money, you're guaranteed patients, you're
(09:14):
guaranteed the work. You know, all of these things are
like any job, are guaranteed. You stepped out of that
that comfort zone for your love of patients, for the
love of your practice and said I'm going to do
something different. Are we seeing more doctors do things like
you or like this doctor. They're saying, you know what
I'm gonna I'm going to fight for change, whether it's
changing how how the practice operates or taking the time
(09:36):
to speak out and get the word out of what
goes on behind the scenes of some of these with
some of these insurance companies and some of these institutions.
Speaker 3 (09:44):
Yeah, I think it's it's difficult. I'm not sure if
we're seeing it more or if we're just seeing more
doctors get you know, kind of burnt out and then
give up and you know, retire or leave the practice
of medicine because they don't want to kind of fight
an uphill battle. I think a lot of docs are
afraid of you know, retribution or retaliation from their employer.
(10:04):
So I mean, I think there's a lot of times
things that happen within large healthcare systems or hospital systems
where they're not patient friendly, they're not doctor friendly. They
you know, things that maybe are not ethical that doctors
want to speak out against, but again, they don't want
to lose their job, you know. So I think that
happens every single day. So you have to have a
(10:25):
doc that's brave enough to know that when they speak out,
they might lose their job. And you know, then again,
like do you want to pursue legal action. How many
you know, tens or hundreds of thousands of dollars is
that going to cost if you need to hire an attorney.
All of those kind of factors I think come into it.
Speaker 1 (10:40):
It's it's it's I know I've said this a couple
of times on the program, but the stuff I used
to find shocking and now it's like I'm almost like, gosh,
I'm not surprised.
Speaker 2 (10:49):
I'm like, how much lower can they get? These can
these people behave? And it's it's it's really really unfortunate.
Speaker 1 (10:56):
We're going to talk about also when it comes to billing,
how the billing systems work, in the coding and other things,
some really really troubling stuff there. We're going to talk
about that with doctor Nicole Hempkiss in just a moment.
In the meantime, I hope you've had a chance, But
if you haven't had a chance to head on over
the website for Advocate MD. That's ADVOCATESDPC dot com. That's
Advocates DPC dot com.
Speaker 2 (11:18):
Head on over there.
Speaker 1 (11:18):
You can learn more about Advocate MD. You can learn
more about the doctors, the clinics, you can learn more
about options when it comes to whether it's catastrophic or
looking for health share different types of coverages as well,
and of course you can learn more about how direct
primary care works and how affordable it is and how
high quality is with looking for options for yourself, your family,
you're an employer looking for something great for your employees,
(11:40):
definitely check out Advocate MD in their website Advocates DPC
dot com. That's Advocates DPC dot com. More a full
scope with doctor Nicole Hempkiss.
Speaker 2 (11:50):
Of Advocate MD.
Speaker 1 (11:50):
Next here on thirteen ten wib A thirteen ten WIBA
and full scope with doctor Nicole Kiss, Wisconsin's direct care doctor.
You can learn more about doctor hem Kiss actually all
the doctors at Advocate MD. More information on them just
at ADVOCATEDPC dot com. That's Advocates DPC dot com. Tell
(12:12):
me number to make an appointment to come a member
at Advocate MD. Six h eight two six eight sixty
two eleven. That's six h eight two six eight sixty
two eleven. And that last story really touched a nerve
for some folks who have experienced had to have that
surgery and just here as first about what some other
folks going through. And it's it's shocking to hear and doctors.
We talk about the clinics at Advocate MD. One of
(12:35):
the kind of I think neat features that maybe a
lot of folks don't think about is a lot of times,
because of the availability to see your doctor on short notice,
in certain situations, you can avoid having to go to
these places called urgent care. Like let's say you break something,
or you get you know, you have to have a
splinter removed or something like that. A lot of that
(12:56):
stuff can be done and is done right in the clinic.
I want to kind of contrast and compare that with
the story you also shared with me about going into
a hospital and does a you know, for example, removing
a splinter, what does that count as is that is
that a surgical procedure? And if so, what ends up
happening when it comes time to build something like that.
(13:18):
Let's talk about this this one doctor.
Speaker 3 (13:21):
Yeah it was. There was a pretty recent story in
the Washington Post called how Everything Became Surgery, And I
think this is a good example of kind of how
messed up our billing and coding system is. In the
current healthcare model, health insurance model, I should say, we're
basically you know, health insurance and you know, hospital systems
(13:43):
are incentivized to code things to higher levels. You know,
I guess I could say that maybe the health insurance
is not incentivized to do that, but they, you know,
play a part in all of this, and they don't
really help the control costs. But the health system, or
the doctor's office or or the radiology facility or whatever
it might be the goal. And they have people that
(14:04):
work at these places that this is all they do
all day long is to maximize the coding and the
billing for claims. I remember when I used to work
in the hospital as a hospitalist. Now I can't even
remember their names, but I mean what their job title was.
But there are people that would go around and you know,
go through the medical records and try to find diagnoses
(14:26):
that they thought could be like, you know, a level
higher based on you know, the on or based on
you know, the notes that they found from the doctor.
So so that was their job to try to maximize
how much that the hospital was billing to the patient
and the insurance company. And again really the insurance company
whatever they don't pay, they bill that to the patient.
(14:47):
So this interesting article where they're talking about the definition
of surgery, and they give two or three examples of
One of them was a guy who brought his young
son to a pediatrician to remove a splinter, and they
said it took, you know, a couple of minutes. They
got a pair of tweezers out, they pulled out a
little tiny, you know, splinter of wood or whatever out
(15:07):
of the finger. And they got a bill later on
for four hundred and fourteen dollars because it was coded
as a incision and drainage, incision and removal of foreign body.
And so this was I guess a father that was,
you know, trying to advocate on behalf of himself and
his son for this medical bill, and he kind of
tried to get appealed it, and you know it said, well,
(15:30):
there was no incision in drain incision in the finger.
It was just tweezers. And it's as I've said before,
it is nearly impossible to argue with a large health
system about a medical bill. The chances of them changing
it is so minute. I mean, I've tried it myself
that I feel like I'm pretty I'm pretty well versed
(15:50):
in medical coating and billing, and I couldn't even get
them to change something that was very unfairly codd So
these things are difficult to you know, remediate. But there
was another example of a woman that went into her
dermatologists for her annual skin exam and she they found
a skin tag which they used liquid nitrogen, you know,
the freezing spray. And then she later and from what
(16:12):
I can gather, it was one skin tag singular, not plural,
and when she got the bill, it was four hundred
and sixty nine dollars and they coded that as a
surgery destruction of benign lesion. And again, both of those
things that if you came into a direct primary care
clinic like Advocate m B, we would do both of
those things for free. We don't charge anything for those things.
(16:34):
It's it's interesting something that will take you, you know,
thirty seconds to do or sixty seconds to do, and
you get a bill like that. That is really what
again kind of makes patients distrustful of our medical system.
They make you know, patients make it distrustful of insurance
companies and and you know, why are we billing these
(16:55):
exorbitant bills for something like that, even if it was
fifty dollars, right, Like, even if we could attach a
fair price to something like that, maybe fifty dollars is
too much, but definitely four hundred and sixty nine dollars
is too much. So, yeah, it was this idea that
now quote surgery is involving anything that's being done to
the skin basically, like doesn't matter matter if you're using
(17:15):
a scalpel and its sutures. Basically, they are coding anything
as surgery that's being done to the skin. And the
last example they use was a plantar ward that they
went in and got treatment for. I don't know if
this was at a primary care dermatologist or a foot doctor,
but they you know, rubbed some ointment on the planter's
(17:36):
worts and then they again build that as a surgical
procedure and they are looking to see what the actual
it was a three year old child. Oh, they had
for two visits. They had a balance of four hundred
and sixty five dollars because they had to come back
to do it again. But yeah, so what is the
purpose of that. What is the purpose of coding something
(17:57):
as surgery that we all don't really consider that surgery.
That's a billing motivation, right, That doesn't mean that they're
taking better care of you. That doesn't mean that they
are more thorough or higher quality of care. That is
purely billing and kind of manipulating the fee for service
like ICD ten codes in a way that allows us
to rip off patients is great.
Speaker 1 (18:19):
You know, we talk about some of the some of
the benefits of direct primary care and Advocate MD. We
you know, we talk about affordability, we talk about accessibility,
we talk about those things. One of those areas that
that I guess I kind of maybe take for granted
is just not saying I think like like one of
the other benefits is like sanity, like not having to
(18:39):
worry about like what is this appointment going to cost?
How is it going to be built. You mentioned some
of the procedures, and I know we've talked about on
previous programs as well, some of the procedures that you
guys do right in the clinic. The doctors at Advocate MD,
things that you're as a doctor, very well qualified, heavily
trained to do, and and do them very very well.
(19:01):
And you mentioned earlier, you know, like the removal of
a splinter or something that's included with your membership. You
come in, that's just part of the deal. You don't
have to worry about getting built. Just like that sanity
factor alone is priceless. Doctor, I got to tell.
Speaker 3 (19:14):
You, yeah, I think, I mean, we know that people
will avoid medical care if they think it's going to
be too expensive.
Speaker 1 (19:21):
Right.
Speaker 3 (19:21):
I did a presentation of some employers yesterday and we
were talking about access and cost of care. Right. So
in the Wisconsin area, especially in Madison, we have very
poor access and we have very expensive care. And my
argument would be is that in and of itself, having
medical care that is too expensive makes it inaccessible, right,
because people will then not go to the doctor when
(19:43):
they need to go to the doctor, because they're going
to be scared of getting these huge surprise medical bills,
which this is exactly an example of that. This was
a surprise medical bill. They would not have any you know,
expectation that they would have gotten such a large bill
from such a simple, quick, little procedure that was done
in the office. But so again this goes back to
transparency and in the direct primary caure model, as you said, Sean,
(20:07):
anything that we can do in the office that doesn't
involve a third party. So if we're doing a procedure
in the office, any of those procedures that they listed,
whether it's a planter's removing a molar, skin tag and
you know, removing a foreid body or incision and drainage,
all of that stuff would be included at no cost.
The only time we add on costs, and again this
is all something that we talked to the patient about
(20:28):
is let's say we had to remove a mole and
send that to the pathologist and they charge us a fee.
You know, we're going to pass on that fifty dollars
or sixty dollars fee onto the patient, but it won't
be anything like you know, the four hundred five hundred
dollars that they're talking about in this article. So yeah,
that gives you, as you said, Sean, the peace of
mind that you know you can get very high quality,
accessible care and it's not going to bankrupt you. You're
(20:50):
not going to get these exorbitant surprise medical bills in
the mail.
Speaker 1 (20:54):
Great data, make that appointment, become a member at Advocate
MD all I gotta to just pick up phone. Gave
a call six so eight to six, eight sixty two
two eleven, that's six oh eight two six eight sixty
two eleven to become a member at Advocate MD.
Speaker 2 (21:04):
You can learn more online the.
Speaker 1 (21:05):
Website ADVOCATEDPC dot com. That's ADVOCATESDPC dot com. Doctor Hemkiss
is always great chatting with you. You have a fantastic
day and.
Speaker 2 (21:14):
Enjoy the weekend you too, Sean, Thank you. News is
next right here on thirteen ten. Wuib A
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