All About Direct Primary Care

Episode Transcript

Speaker 1 (00:00):
Eight, six thirteen ten wib You know the music. Time
now for full scope with doctor Nicole Hemkiss, Madison's in
Wisconsin's direct care doctor. You can learn more about doctor
Hamkiss all the eight physicians at Advocate MD, as well
as their four locations the website Advocate DPC dot com.

(00:21):
That's ADVOCATEDPC dot com. West side of Madison, right in
Middleton at thirty two five Glacier Ridge Road, east side
of Madison, one fifty seven South Fair Oaks Avenue on Jamesville.
If you are in southern Dane County, Rock County, doctors
are there for you at Advocate MD at their Janesville
clinic at ten twenty one Mineral Point Avenue and the
newest location right on the Fitchburg Madison line of very

(00:45):
very great location at thirty two to twenty Siin Road
right near the nature preserve there just off the belt line.
If you ever been driving the belt line and Parkstreen,
kind of look to your left, you'll see all that
all that beautiful beautiful area there that is actually where
the clinic is. And it's a really nice, really really
nice place. All four clinics absolutely amazing for Advocate MD.

Speaker 2 (01:06):
Again, you can learn more online the.

Speaker 1 (01:07):
Website ADVOCATESDPC dot com. That's Advocates DPC dot com. Tel
number six O eight to six eight sixty two eleven.
That's six soh eight to six eight sixty two eleven.
To make it a point, become a member at Advocate MD.
All I gotta do is pick a phone, give them
a call. And doctor Nicole Hemkes is joining us this morning. Doctor,
how you doing this week?

Speaker 3 (01:25):
Good? Sean?

Speaker 4 (01:26):
How are you?

Speaker 2 (01:26):
I'm doing really really good?

Speaker 1 (01:28):
And uh, we're going to talk about direct primary care
and get kind of an overview of what it is
a little bit about the history there. Of course, we'll
also talk about the history of Advocate MD as well,
and uh one of the areas and we'll get into
all those all those different facets as well as different
applications of direct primary care. And obviously I always say
something for you your family or business businesses, it's a

(01:51):
great uh, it's a great option to offer your employees.
But uh, real quick, let's kind of start off from
the beginning of Direct Primarycare dot and get a little
bit about the history of what it is. And I
also am curious for you what led you to decide
to open up a clinic and a practice for direct
primary care.

Speaker 3 (02:13):
Yeah.

Speaker 4 (02:13):
So, you know, direct primary care is a model that
you sometimes, I think when people hear about it, especially
in our local area here of Madison, Wisconsin. You know,
for some people, they still haven't ever heard of this
direct primary care model, so when they first hear of it,
they think it's something new, but it's actually been around
for probably twenty years. In various parts of the country,
especially areas like Florida and Texas and Oklahoma and Kansas,

(02:37):
Colorado kind of be scattered, you know, states around the
country that I would say are more free market friendly
and maybe more open to new or alternative models of healthcare.
In some of some cases it's because they have a
larger number of uninsured people. So it was almost kind
of out of necessity that these things came about. But
it is something that has been around for many years,

(02:59):
and there are to the country where it's it's exploded
over the last you know, ten years. Again, I think
that has a lot to do with, you know, how
much of a monopoly the insurance companies have or the
HMOs have in those areas. And so there's other parts
of the country where it's been slower to make its
way in but you know here in Wisconsin it has
grown a lot in the last five to ten years.

(03:21):
So the history behind this though, is that it came
about sort of as a spin off of concierge medicine.
So it is not the same as concierge medicine. Concierge
medicine is something I would say is designed for more
upper middle class, wealthy people, and that was in some
ways it had similar goals. The goal was to provide
people with more personalized care, more time with the doctor,

(03:43):
and kind of that more one on one relationship where
the doctor has a much smaller panel of people. And
the concierge medicine has probably been around for thirty forty
years now. I think it started in the eighties or nineties. Again,
it's interesting as the as insurance became worse and worse, right,
these alternative models have sprung up. So in the concierge model,
you have insurance, you know most people have in many

(04:07):
cases good insurance, and then they're paying this additional membership
fee every month because their insurance isn't giving them access,
it isn't giving them time, it isn't giving them the
ability to call or text their doctor after hours. But
then when they go in and see that concierge medicine doctor,
they are still not only in addition to their membership,
the doctor is still billing for that office visit, that procedure,

(04:28):
that lab work to their insurance company. So that is
different than direct primary care because we don't build anything
through insurance, but we do have similar goals in terms
of the time and the access. And I always think
it's funny. I like to use the example. I think
years ago when I first started the practice, there was
a concierge doctor that reached out to me in California
because they had a family that was sending their daughter

(04:52):
to University Wisconsin, so they wanted to the daughter to
do direct primary care.

Speaker 3 (04:56):
And it's always funny.

Speaker 4 (04:57):
It's like, so I'm charging this kid, you know, forty
four or sixty six dollars a month, and I looked
up with the sky charges and it was something, you know,
it was something like eighty thousand.

Speaker 3 (05:08):
Dollars a year.

Speaker 4 (05:09):
So there are people out there paying eighty thousand dollars
a year, and this I probably has a panel of
I'm just guessing he might have less less than fifty patients, right,
because when you're paying that much, you don't needs to
have a lot of patience. But again, it's all kind
of on a spectrum, right, like a continuum of how
much time and attention.

Speaker 3 (05:27):
Do you need from the doctor.

Speaker 4 (05:29):
And maybe you don't need a doctor that you can
call every week and they kind of do a rundown
of everything going on in your body and your mental health.
But for most people, you do need a doctor where
you can have access when you are sick or when
you have questions, you know, and you have you need
somebody where you can go into that visit and sit
down with them for an hour and talk through things.

Speaker 3 (05:50):
You know.

Speaker 4 (05:51):
Again, the system right now is it's so broken in
the large health systems where you get in for your
own appointment and you have ten or fifteen minutes to
talk to that doctor. I mean, there's no way you can.
I mean even in a pretty healthy person like myself
and maybe I have a couple questions I want to
have is this normal?

Speaker 3 (06:08):
What should I be doing? You know?

Speaker 4 (06:09):
Tell me what preventive health things I'd like to talk about,
lifestyle medicine. There's no way you have you can even
start that conversation in ten or fifteen minutes and develop
that doctor patient relationship. So that was the history of
how direct primary care started was that you know, people
needed kind of in more access, better care, but also

(06:30):
weren't able to pay the prices of concierge medicine. So
this this came about as okay, so we're going to
cut out insurance. Once we cut out insurance, that is
going to eliminate you know, by most estimates, thirty to
fifty percent of our overhead cost. It's a massive amount
of overhead when you need billers and coders and these
people that will go through and tell you how to
upcode or you know, to maximize your coding. So in

(06:54):
most offices, and then you know, you need a very
sophisticated electronic medical record, which we are and all know
what that one is. It So once you take out
all of those people, the additional cost of that EMR,
the additional cost of the two to three you know,
staff members per doctor that you need in the office,
which is I'm not even exaggerating that is true. You
need an additional probably three staff members for each doctor

(07:18):
as opposed to an R model where we usually have
like one staff member per doctor. So once you eliminate
you know, thirty to fifty percent of your overhead costs,
then you can charge a patient. You know, we charge
the patient and average of around seventy dollars a month
when you average out our age ranges. So for seventy
dollars a month, you come in and there's no copays,
there's no charge for that visit, and we sit down

(07:39):
and talk to you for an hour. That's how much
waste there is in the current system.

Speaker 1 (07:44):
It's pretty and when you start to break it down
that way, it's it starts to make sense why it
costs so much, why health and care is so expensive.
And then and then you're like, why does it have
to be? And one of the things that you know
you mentioned, you know, people kind of confusing direct prime
care with concierge care and service and how they do

(08:04):
different also very much how they're similar, and I understand
how people may get the two confused.

Speaker 2 (08:10):
I do think for a lot of folks.

Speaker 1 (08:11):
Kind of the thing I always like to think about
in something that you know, you and I have talked about,
is it reminds me of the way it used to be,
like back when we were younger, or maybe when our parents.
What our parents remember as far as when they'd go
to see the primary their primary care doctor, it was
very personal, it was very caring. It was very much
about welcoming you in, spending time with you, and it

(08:34):
was kind of that one on one stuff. It still
exists with direct primary care, and that's some of the
amazing stuff that you're able to do. And let's talk
then about Advocate m D specifically. And you started out
a single doctor and a single clinic. Since expanded, you've
got you've got four clinics total, eight doctors on staff
at Advocate m D. People really have responded to this

(08:55):
model and what you guys are doing at Advocate MD.

Speaker 3 (08:59):
Yeah.

Speaker 4 (09:00):
So I was a physician. I'm a family medicine position.
I worked in many different systems. I worked for physician
owned groups but also large hospital systems. Kind of realized
that I quickly realized that I didn't, you know, really
want to work in a system where I was having
to see twenty twenty five patients a day and spend
fifteen minutes with each of them.

Speaker 3 (09:22):
So I did work as a hospitalist.

Speaker 4 (09:23):
I did emergency room work, and I found out about
the strict primary care model. I had a colleague and
a friend who was doing it in another state and started,
you know, peaking my interest in this. So I started
doing research and I joined some of the national organizations
of physicians that do direct primary care and kind of
thought to myself, Yeah, I had no business backgrounds. You know,

(09:46):
as a doctor, you don't really get a lot of
business or accounting training or anything like that.

Speaker 3 (09:51):
So I thought, is this something I could do?

Speaker 4 (09:53):
You know, I'm a little bit of a risk taker,
you know, I thought, you know, what's the worst that
can happen, the worst that can avenue that doesn't work?
Can I go back to being an employee doctor. But
for me, it was really kind of escaping a system
that I didn't feel like not only wasn't satisfying for
me to practice in, but also I couldn't take care

(10:14):
of patients the way that I would like to.

Speaker 3 (10:17):
So it was it was, you know, a great change
for me.

Speaker 4 (10:21):
I mean honestly, I tell other doctors when we interview
them or hire them that I had never practiced medicine
in this way, and including in my training, you know,
medical school residency. This is the way I kind of
envisioned it would be. But you know how in a
lot of and a lot of times you get out
of school and you get your first job and you're.

Speaker 3 (10:39):
Like, this isn't what I thought it was going to
be like.

Speaker 4 (10:42):
But in medicine, you work for so long to get there,
you know, you have so many years of school to
get to that point. It's really disheartening when you get
there and you're like, Wow, this is not you know,
this is not good.

Speaker 3 (10:54):
I don't like it.

Speaker 4 (10:55):
So for me, it was it kind of saved my
medical career to be able to practice this way and
to enjoy practicing and to really be able to talk
to my patients, because that's why I went into family medicine,
because I liked talking to people, and I like learning
about their families and their stressors and how jobs going,

(11:15):
and can't do that in a ten or fifteen minute visit.
So I think for many doctors it's kind of a
salvation to go into direct primary care. So yeah, so
started the practice. We started planning for the practice in
twenty eighteen, opened the doors in twenty nineteen January, and
at that point was just me. I had no staff,

(11:37):
So I was the one that answered the phones. I
roomed the patients and did their vitals.

Speaker 3 (11:42):
I drew blood.

Speaker 4 (11:43):
You know, I did not have anybody working with me.
It was slow in the beginning, and then as we
grew started to hire staff. We hired doctor Balen with
the first doctor that joined me about a year and
a half afterwards. And so now fast forward, we're in
our seventh year and now we have eight physics including myself. Yeah,
and I think I started doing the radio show right

(12:03):
then too. We have eight physicians, we have four clinics.
You know, we're very fortunate to have multiple companies that
work with us now. I think my last time I checked,
we have about fifty five companies ranging in size from
like five employees to a thousand employees. Is our largest
company right now. So it's been something really great to

(12:28):
you know, almost you have to pinch yourself sometimes to
think like that, you know, you could you could create
something and it could grow to this point where people
are really grateful that you're able to, you know, offer
them this this benefit.

Speaker 1 (12:43):
It's really amazing what you're able to do at Advocate MD,
and really amazing the services offered as well. I'm going
to talk with doctor Hamkes about the different services and
the reasons why direct Primary Care and Advocate MD is
so important. About the amount of visits. When it comes
to I want to to visiting a doctor, most of
the stuff takes place is able to be taking place

(13:04):
at a at a primarycare clinic. Unfortunately, in the insurance
system a lot of times that doesn't happen. We're gonna
get the details from the doctor on that. We'll also
talk about business owners, about the services offered at Advocate
MD and how that works. We will do all of
that next as Full Scope with Doctor Nicole Hemkis and
Advocate MD continues here on thirteen ten WIBA. If you
haven't had a chance yet, head on over to the

(13:25):
website ADVOCATESDPC dot com. That's ADVOCATESDPC dot com. You can
learn more right online again that website ADVOCATESDPC dot com.
Delphy number six oh eight two six eight sixty two eleven.
That's six oh eight two six eight at sixty two eleven.
More of our conversation with doctor Nicole Hemkiss next here
on thirteen ten wib A thirteen ten WIBA and Full

(13:47):
Scope with Doctor Nicole Hempkiss Wisconsin's directcare doctor talking with
doctor Hemkiss this week about direct primarycare, What.

Speaker 2 (13:54):
Makes it so special, what makes it such a useful.

Speaker 1 (13:57):
Option for you, your family, if you're an employer, great
option for your employees when it comes to direct primary care,
and why it's become so very popular. You can learn
more online the website Advocate DPC dot com. That's Advocates
DPC dot com Telpha number. To make it a point,
become a member at Advocate MD six SOH eight two
six eight sixty two eleven. That's six h eight two

(14:18):
six eight sixty two eleven. And doctor I know you
get a chance to speak with business groups and business leaders.
You also get emails from time to time as well
from business owners asking some questions. Let's talk a little
bit about a recent email you receive from a business
owner asking some questions and kind of how it really
does a great job of illustrating what you're able to

(14:39):
do with Advocate MD when it comes to businesses and employees.

Speaker 4 (14:45):
Yeah, so, as I mentioned, we work with businesses all
the way from small to very large, you know, and
all the way from you know, businesses with less than
fifty employees where they're not required to provide insurance. So
sometimes they offer direct primary care you know, as opposed
to offering nothing, you know, so they don't offer insurance,
and then the employee can pay for their own insurance,

(15:06):
go through the marketplace, you know, and see if they
can get a subsidy in that way. But we do
have a lot of employers where they're offering us in
addition to a high deductible health plan. So right if
they are offering an insurance that has a four thousand
or five thousand or eight thousand dollars deductible, there's going
to be that gap there where basically for most people,
unless you have a catastrophic event, you're going to be

(15:27):
paying out a pocket until you hit your deductible. You know,
for most people, that could be lab work, office visits,
you know, x rays, radiology. So if you give them
a direct primary care membership in addition to that high deductible,
you fill that gap for the employee, and then if
we need to use the insurance, you know, we can
still use that for the very expensive things if they

(15:48):
need surgery, if they need you know, MRI or something
like that. But then we also have large employers, you
know that have over one hundred employees that are self
funded and they're hanging out their own claims, so they
when an employee comes in to see us, the company
is covering everything they do in the office. So you know,
if they get lab works, if they get medications, anything

(16:11):
that we do in the office, the company is paying
for that. So we have the whole kind of spectrum.
But it was interesting because I had actually a business
owner that currently offers US to their employees, and she
was kind of emailing asking me, giving me three specific
examples of like, okay, so, well, this employee takes these medications,
this employee needs let's say, for example, a specialist, a visitor.

(16:33):
You know, can you guys cover all of these things?
And what's the cost of all of these things? And
it's it's an interesting question, and it kind of goes
back to understanding the basic premise behind direct primary care, right, so, like,
do we take care of everything that a person is
ever going to need in their whole life, of all
their medical needs. No, we can't do that, right in
the same way that your family medicine doctor. Now that's

(16:54):
part of you know, hospital ABC or you know whatever.
They don't take care of all your medical needs, right, So,
but the idea behind this is that we're going to
try to take care of as much as we can
in the clinic, and then if you needed something beyond
our clinic. You need a referral to a specialist for
a colidoscopy, you need a mammogram, you need these things
again that we can't perform in our office setting, then

(17:16):
we help you figure out where to go for those things.
You know, this person had also asked about very expensive medication.
So we do dispense many medications. You know, hundreds or
thousands of generic meds we can get and it dispends
those and they will probably cost I would say, three
to five dollars a month. But you know, things like insulin,

(17:36):
things like very very specialized injectible medications. You know, there's
a ton of them now that you hear about, you
know in the media. Those we do not carry because
those again are a brand name and we you know,
they would cost us the same amount to purchase them
as what they're charging. But we would also help patients
figure out okay, well that one you can order directly
from the manufacturer. Okay, this one we could send a

(17:57):
prescription to Canada. We can get that at you know,
a third of the cost of get it from Canada. Okay,
this one has a drug discount program that you might
that you're going to qualify for, so will help you
figure out how to do that. So we do help
patients navigate those things that are beyond our clinic. But
I find it a little bit funny sometimes because I
think it's almost like, you know, sometimes you'll get people
emailing you and it's like, well, unless you can take

(18:18):
care of all of these things, you know, the patient's
not interested. It's like, okay, So the alternative to us
is that they have nothing. Right. The alternative is that
when you get sick, you go to the emergency department
and you spend four thousand dollars versus you pay seventy
dollars a month, and we can take care of ninety
percent of your medical needs and then we help you
figure out what to do for the other things. But yes,

(18:40):
there are definitely, you know, people that are on you know,
very expensive medications. And then there are people that know,
for example, like oh, I'm going to need to have
this surgery. I know I'm going to need to have
my knee replaced in the next year. Those sort of things,
and those are very expensive things. So like, for there
are a minority of people where I say you should
have some you know, everybody should have some form of

(19:00):
insurance for catastrophic, but there are people where they probably
need a lower deductible insurance, right because then you know,
if you pick a ten thousand dollars deductible, you're going
to pay ten thousand dollars. So we help people also
figure out those things. But I just thought it was
a little bit funny and interesting that, you know, sometimes
in our model we try to do a lot, but
we can't do everything for every patient, of course, but

(19:23):
we do have a network of independent and cast base.
Some of them are independent and they still take insurance.
Some of them are independent and they only deal with
you know, non insurance cash. But you know, things like
radiology facilities, surgery centers, specialists, And it's kind of being
an educated consumer and allowing the patient to make the

(19:44):
choice when you give them all the options to say, okay,
are you willing to drive forty five minutes if that
test is going to be one thousand dollars versus five
thousand dollars, if that was if that question was asked
to me, I'd be like, heck, yeah, I'll drive forty
five minutes. I've driven an hour to get a mammogram
because the mammogram is one hundred and forty dollars as

(20:05):
opposed to eight hundred dollars. Yeah, I'll drive for that,
and I'm not. You know, these are things that maybe
you're doing once a year, once every two years. If
it's an MRI, hopefully you're not having to do that
every year. If it's a colonoscope, you're doing it every
ten years for most people. So again, it's kind of
looking at all of these things as a sort of
trade off. But we know that the system is ripping
people off. So we are so entrenched and ingrained into

(20:29):
the system that we in many cases it's hard to
see anything beyond it. But the system, as long as
you are continuing to go into the big hospital system
for all of your needs, you are getting ripped off.
There is no doubt about that. I don't even need
to know what test you're getting, or what lab you're getting,
or what.

Speaker 3 (20:46):
Procedure you're getting. You are charged.

Speaker 4 (20:48):
You are getting charged ten to tend to one hundred
times more than what it would be someplace else. So
you have to kind of in some cases be willing
to look outside the box and be willing to take
I don't know if it's taking a chance or not.
It's just basically being able to kind of see an
alternative and try it out, and you know you're not

(21:09):
like locked into this for a year or ten years.

Speaker 3 (21:11):
You know, you try it out, you see if you
like it.

Speaker 4 (21:14):
If you're a business owner, this is you know, an
alternative you can offer to your employees. Pair it with
a high deductible health plan. It's going to offer them
way better access. You're going to save on your insurance premiums.
Your utilization is going to go down, so your loss
ratio and your insurance broker talks to you about that
that's going to go down. So I think it's it's
really beneficial to the people that can, you know, be

(21:36):
a little bit creative.

Speaker 1 (21:37):
You think it would be great if people thought and
focused as much about what they're getting out of their
insurance as they do when they're looking to make a change,
because I think I know a lot of folks that
become members at Advocate MD had to try and use
their insurance for things that they needed and they end
up realizing had they thought about it beforehand, they would

(21:57):
have known this right away that it's not as useful
or beneficial as as they may want to want to
cut and I'll use this word ignorantly believe that it's
somehow some kind of thing that's going to cover things
that ultimately they learn all this was not what I
thought it was, and then they end up coming to
Advocate MD. If people would just sit down and think
about what exactly or look into what their ensured system

(22:21):
provides right now, they very quickly go all this isn't
much value at all. As a matter of fact, what
am I exactly paying for? The great thing about direct
primary care everything's black and white. Access to your doctors.
You can learn about all the things that are covered.
As doctor Hempkiz points out, ninety percent of things can
be done right in clinic. It's pretty amazing what they
can do at Advocate MD. And whether you're looking for

(22:41):
some of yourself, your family, your employees, some great options
to offer at direct primary care at Advocate MD. You
can learn more online the website ADVOCATESDPC dot com. That's
Advocates DPC dot com, TELF number six so eight two
six eight sixty two eleven to days to day, make
that phone call. Become a member at Advocate MDA again
the telephone number six oh eight two six eight sixty

(23:02):
two eleven and learn more online ADVOCATESDPC dot com. That's
Advocate DPC dot com. Doctor Hagus, Enjoy this fabulous weekend
and we'll talk real soon.

Speaker 3 (23:12):
Thank you, son, thank you.

Speaker 2 (23:13):
News is next here on thirteen ten WI b A