Doctor-to-Patient Ratio

Episode Transcript

Speaker 1 (00:00):
Thirteen ten WIBA and full scope with Wisconsin's direct care doctor,
doctor Nicole Hemkiss. You can learn more about doctor Hemkiss
and all of the doctors seven other physicians at Advocate MD,
all online advocates DPC dot com. That's Advocate DPC dot com.
Eight doctors at Advocate MD. Four clinics as well. Again,

(00:21):
great Resource Advocates DPC dot com. Speaking of things that
are just fantastically great, great day to make that appointment.
Become a member at Advocate mdtelvim number six oh eight
two six eight sixty two eleven. That's six oh eight
two six eight sixty two eleven. Looks like about a
perfect weekend, doctor. Are you ready for the weekend?

Speaker 2 (00:37):
Yeah, yes, I am ready for the weekend. I looks
like it was a longer than normal week for some reason.

Speaker 1 (00:43):
Yeah, I agree. It does seem like and I don't
know if it's just that we get later in the
h late in the summer and the days are literally shorter,
and just it just feels like, yeah, we're cramming a
lot of stuff in and it's great to talk with
you this morning. And you know, one of the cool
things about getting a chance to speak with you each
every week is if folks have questions about direct Primary Care,

(01:04):
they can get on the show. I'd love to have folks,
if you're listening this morning, jump on. And if you've
ever wondered about direct primary care, you got a question
about health insurance, we'd love to have you join us
on the show. Sixh eight three two one thirteen ten.
That's sixh eight three two one thirteen ten. Maybe in
listening to the program for a while, and there's a
question I have failed to ask, which is very likely

(01:25):
data ask that question. Six eight three two one thirteen ten.
We'll get you right on the air with doctor Nicole
Hemkiss of Advocate MD. I did mention the website ADVOCATESDPC
dot com, as well as the four locations west side
of Madison, right in Middleton, east Side, right on South
Faroalks Avenue, Janesville, Rock County, Southern Dane County, right ten
twenty one Mineral Point A and the newest clinic right

(01:46):
at thirty two twenty syin Road. All great locations for you,
and real quick before we get this week's conversation to
this week's conversation about about monopolies and what's happened with healthcare.
Let's really quickly talk about direct primary care. Doctor mentioned
the four clinics all very convenience. You have all doctors
on staff at Advocate MD. All of that is very

(02:07):
very intentional. It's all about better care and access, isn't it.

Speaker 2 (02:11):
Yes, you know, we're seeing a big access problem here locally,
and I think it's happening all across the country, but
for some reason, it seems worse in our local area
of Wisconsin here where patients are calling to get an appointment,
they're being told six months, nine months or even that
they can't get an appointment with a primary care doctor.
So in our model, we keep our panels smaller, so

(02:33):
each physician might have four hundred to six hundred patients
in their panel, whereas in the large healthcare hospital owned system,
those docs will have two thousand to three thousand patients
in their panel. And then they do, you know, come
upon a time where they're like, I'm not taking any
new patients. There's actually some systems here locally where I've
heard rumors that they do not allow them to close

(02:54):
their panels, so they continue to take on new patients,
but those new patients just aren't able to ever schedule
an appointment, which is super frustrating. But yes, our goal
is to get patients in. If it's a routine visit,
you know, sometimes it'll be a few days, it might
be tops like two weeks. If it's an urgent care visit,
we get them in the same day.

Speaker 1 (03:13):
So let's talk of you mentioned there that that there
are some clinics here in the area that some like
a local hospital system that's not taking new patients. Doctor,
what's going on there?

Speaker 2 (03:27):
Yes, this has come up a few times just in
the last couple of days. I'm doing these kind of
like pre open enrollment meetings and meeting with some employees
at companies that we take care of their employees as
patients in our practice. And this whole recent recently has
come up where you know, the large health system in

(03:48):
town which you know I there. It starts with a
vowel and it ends with a W. So if you
if you call so. And this also interestingly came up
on a female physicians forum that I'm on Facebook. Somebody
posted and said, my doctor is retiring or leaving, and
I called to make an appointment with a set up

(04:10):
an appointment with a new doctor, and I was told
that we are not taking new patients. And I said
to the lady, well, I'm not a new patient. I've
been a patient in this system for many years. But
the doctor's leaving. They said, oh, well, then you're still
considered a new patient, and so we are not. We
don't have any doctors to assign you to at this time,
and so it's crazy to me. And you know, I like,
of course commented and said, how can you be paying

(04:32):
every month for an insurance that that is the network,
that is their network, and the insurance company is owned
partially by the hospital system, which we've talked about how
that creates very perverse incentives there. But how can you
pay every month for an insurance and then when you
go to schedule an appointment with the primary care doctor
that's in your network, they're telling you that they can't

(04:52):
schedule you in appointment. I don't know why people aren't
up in arms about this, like why is this not
you know, everybody always says like why is this on
the evening news, Like why are we not hearing about this?
This is a big deal, right, people can't get in
to see the doctor. Why is this not a big deal?
You know? We hear about it in the political context
of you know, what happens when we have cuts to

(05:13):
Medicaid or Medicare, any of these programs. But but this
is happening right now here, right for people that have
private insurance, if you are part of this large system
that you're being told that you can't get a primary
care doctor appointment.

Speaker 1 (05:25):
What's interesting about some of that is some of the
ambiguity that goes on, and I think that, like, obviously
there's there's a role for the media to you know,
look into this stuff, and it's not always clear, and
I think at the same complexities oftentimes that that patients face.
I think also trying to navigate this stuff for a reporter,
it would be a heck of a story, a heck

(05:46):
of a scoop for somebody to do and to look
into that. But it's it's it seems like it's it's
you know, very unclear to to kind of make things
more difficult for patients. And you know, I think a
lot of folks have experience you mentioned, you know, not
taking new patients. We've talked i know, on the show
in the past. For folks that do actually get an
opportunity to have an appointment with their doctor or somebody

(06:10):
on their doctor's team. More often than not, several several several,
it seems like under many months later they're able to
get in. It's it's it's very very broken that that system.
And it's interesting when you mentioned the insurance thing you're
paying for this. It'd be like, you know, you have
car insurance, you get in a car accident, and you're

(06:30):
insurer saying, yeah, well there's nobody that can fix your car.
Sorry about that. I don't think people would stand for that,
they'd be outraged, but healthcare, for some reason, people just
seem to kind of accept that stuff.

Speaker 2 (06:43):
Yeah, and I think it's a I think you're exactly right.
And I think it's a like a David versus Goliath
type situation where you know, if I'm just a lowly
patient or one doctor, let's say, and I call up
and complain and ask to talk to the supervisor, you know,
whether I call up my insurance plan that's owned by
this hostspital system, or I call up the hospital system
itself and say this isn't right, like I I should

(07:04):
be able to make an appointment with the primary care doctor.
You know, it's me versus this you know, large multi
million dollar hospital system. And you know the in this
meeting I was at yesterday, you know, one of the
employee patients you know, said well, well, how why is this,
like why can they not take on new primary care patients?
And you know, the person that one of the people

(07:27):
that were there was well, they don't have enough doctors.
I guess, like they don't have the number of doctors
to take on more patients. But then my question would be,
you know, instead of spending millions of dollars of your
quote unquote nonprofit money to build new hospital buildings or
to make the existing ones even fancier, why don't you
channel that money, you know into uh, I guess paying

(07:50):
doctors more or recruiting more docs, because if that's the
if that's the funnel, or that's the stumbling block to
being able to take patients and provide patient care, which
is your ultimate mission right of your health system, is
to provide care to patients, then you should be using
more money towards that.

Speaker 1 (08:08):
One of the things that I don't think as patients
we always think about is that doctor that you're seeing,
if it's in the insurance system, is probably burnt out
is probably somebody and I know, you know, we talk about,
you know, all of the work that it takes to
become a doctor, and it's really has to be like,
you know, something that they are truly they are truly
committed to not just I think a lot of folks

(08:29):
they are doctors. They make all the money and and
all that stuff. The reality is it's very expensive, very
time time consuming to become a doctor, and people that generally,
especially people that become primary care doctors and work in
that type of environment, are people that at the end
of the day, it's really about helping people, really about
taking care of people. And that doctor, oftentimes you're sitting with,

(08:49):
is just exhausted. They're doing their best to put on
a positive face, and of course they're concerned and they
want to help you the best they can. Unfortunately, the
system that they're in just does not allow it. We're
going to talk about as we talk about monopolies, there's
another bohemoth player in the world of healthcare. I want
to talk about that in just a moment, but I
do want to ask you doctor to kind of as
we can trast some of this what's going on with

(09:11):
folks not being able to see their primary care physician,
and some of these are their physicians is leaving and
not having an option to see somebody else. There is
an alternative. We talk about what you're able to do
at Advocate MD. You are accepting new patients at Advocate
MD right now, and for folks that are interested, it's
really easy to get into see your doctor, isn't it.

Speaker 2 (09:33):
Yes, we can typically get people in within a handful
of days. I would say one to two weeks, is
you know, the normal amount of time. But you know, again,
in this meeting that I was in yesterday, I had
an employee raise their hands and they said, well, I
went to schedule an appointment and the first available appointment
was in the first week of October. And I was thinking, well,
we're right now in the last week in September. That

(09:54):
sounds pretty darn good to me. And I go, is
this something urgent? Well not really, And I was like, Okay, well,
if you had something urgent, we could definitely get you
in sooner. And I know all of the doctors in
our practice are more than willing to fit people in.
They'll double book themselves, they'll schedule an appointment over their
lunchtime or before they usually start seeing patients. But yes,

(10:15):
the norm for us is one week to two weeks,
which again the bar at the large health system is,
you know, six months or nine months, and that's not unusual.
That's not uncommon. That's the way it's been probably for
the last couple of years. So I feel as though
one to two weeks is a really great Yeah, comparatively,
that is a great amount of time to be able

(10:37):
to get in for a routine visit.

Speaker 1 (10:39):
It's pretty amazing what you're able to do at Advocate MD.
It's a great day to start that conversation, start that journey.
Of course, you can learn more right online ADVOCATESDPC dot com.
That's ADVOCATESDPC dot com. Learn more for yourself your family. Also,
if you're an employer looking for great options for your employees,
definitely check out Advocate MD. They're telful number to make
an appointent become a member six so eight to six eight

(10:59):
sixty two eleven. That's six h eight two six eight
sixty two eleven. We're gonna continue our conversation with doctor
Cole Hempkiss. We'll talk about another big player in the
game and the effect that's going on there, a little
bit of an anti trust law. Soon we'll got some
of those details from doctor Hemkiss. We'll do that next
as full Scope continues right here on thirteen ten WIBI
thirteen ten wi b A and full Scope with doctor

(11:20):
Nicole Hemkiss of Advocate MD. You can learn more about
doctor Hemkiss and all the other doctors at Advocate MD.
You can also learn about direct primary care what makes
it such a great value and such a great service
for you your family. If you're an employer looking for great
options when it comes to primary care, make sure you're
checking out Advocate MD. The website advocates DPC dot com.

(11:41):
That's ADVOCATESTDPC dot com. Tell what I'm making a point,
become a membert Advocate MD six eight two six eight
sixty two eleven. That's six oh eight two six eight
sixty two eleven. Talking this week with doctor Nicole Hempkiss
about some of the troubles with monopolies. Now, the game
may be fun, but the real world of application not
good for concent And I know that one of the

(12:01):
big players in healthcare right up the road here Epic,
they are dealing with an anti trust lawsuit. Right now,
let's talk a little bit about for folks that and
I know here in Madison probably a little more familiar
with EPIC than most are electronic medical records. What exactly
are they and what exactly is kind of their overall
role in healthcare? Doctor.

Speaker 2 (12:23):
Yes, so we call it EHR or EMR, so electronic
health record, electronic medical record. This was something that came
about probably twenty to thirty years ago, and you know,
over the last ten to fifteen years has really blown
up to where companies like EPIC have become sort of
almost dominant not only in you know, health care information,

(12:46):
but they also control healthcare billing, so they have a
lot of power over our healthcare system. And it's also
I was thinking about this before we talked Sean, that
you know, monopolies can come in many forms, and I
would argue that this hospital system that we were just
talking about the source of the validins of the w

(13:07):
you know, they have a monopoly in our Madison area.
You know, so two of the two out of three
of the large hospitals in the Madison area are owned
or have some partnership with this system. So what happens
when you become large like that in many industries, and
I think healthcare is the same. So when when you
develop a monopoly, then you control competition, right, you drive

(13:31):
down competition. And typically when you drive down competition, you
drive up costs. They've done all kinds of studies showing
that when you have one or two hospitals in a
community versus like four or five or six, the cost
of those one or two hospitals is going to be
higher that I mean, it makes sense because they don't
have to compete, right, Like they don't. They have more
patients than they know what to do with, you know,

(13:53):
so they can they can charge what they want. It
also makes access worse, right, and we see that as
what we talking about. So drives down competition, drives up cost,
drives down access. And again, costs and access are correlated
with each other because if you have higher cost you
decrease access to patients. And we know that's happening with

(14:13):
patients that have high deductible insurances. But yes, this article
that I will i'll post on the website later that
just came. Within the past month or so, there's been
a lawsuit that EPIC was being sued by a company
called particle health. Now I forget I think they're out
of New York. Yeah, they're a similar healthcare EHR health

(14:35):
information company that's out of New York that is suing
EPIC for basically anti trust you anti competition type practices.
And I think again back to that analogy with the
hospital systems, it's it's kind of a David versus Goliath
type situation here. I mean, anybody that's visited the EPIC

(14:56):
campus can see that they are not hurting, they are
doing very well. I can't imagine the team of attorneys
that they have representing them. But let's say you're a
little healthcare startup company, you know, you probably aren't going
to challenge the largest EHR company in the in the country.
So I mean, I'm glad that this is happening because
we need this. And right now, I think EPIC, the

(15:18):
last I checked, I mean, they have I think sixty
percent they might even have two thirds of the electronic
medical records in our in our country, and now they're
in multiple countries. So I think it'd be hard to
argue against the fact that that's monopoly when you control
two thirds of health information, and then you can you know,
again you know, we've heard this with you know, back

(15:38):
in the day, with Microsoft and all of these tech
companies that had kind of anti competition practices where they
tried to make things so that everything was very proprietary
and you had to use them for everything so they
could drive out their competitors. Epic has done similar things
to that. They basically market themselves to you know, healthcare

(15:59):
system as like, well, we you know, we are the
EHR company here in town, so you have to use us.
If you don't use us, then you know, you won't
be able to communicate your data with all of these
other health systems locally because everyone else is using us.
And again, you know, there are ways in which they
could make that more. They could have more reciprocity or

(16:20):
you know, interchange of information, but they don't. I don't
think that they're motivated to do that, right, even though
the argument, it's interesting, the argument that they always use
is that they're protecting patients privacy exactly like privacy concerns.
But they were involved in a lawsuit. I think we
talked about this on the radio, I don't know, six
months a year ago, where they had some some data

(16:42):
breach or some something was being sold to a company
that was taking people's health information. But but it is.
It is interesting because it's hard to use that privacy
argument when you know, part of the role of an
EHR is to allow for access to patients health information.
For example, if they're in a little rural hospital in

(17:04):
you know, Upper Wisconsin, or you travel, you know, out
of state and you have an accident, earner injury, you know,
you want people to be able to bring up your records.
And so if EPIC doesn't allow that, again that that
affects patient care, and that's part of the reason for
having access to electronic medical records. But I definitely would

(17:26):
argue that EPIC holds a monopoly not just in Wisconsin
but in the United States.

Speaker 1 (17:32):
It's what what is to me, like one of the
one of the glaring things too is if I remember right,
the whole point of like electronic medical record records was
to make it so we are able to able to
be like ease of you know, like if if a
doctor in one city needed your medical records, like it
was all digitized now be easily transferred. And it sounds

(17:54):
like that's not going on where unless they're in the
right the right system. Uh they're not. They're getting quick
access to those records or any access at all. It
is Uh boy, that is that is quite the as
as Ned Flanders would say, quite the dilly of a
pickle for with doctor hevkis doctor bevgus. I know, I

(18:15):
know that there's a you know, of course there's we
talk about great options. And one of the cool things
too about Advocate MD is is the way you're able
to to cut out the middleman, get the insurance companies
out of that out of that h office where it's
just the patient and the doctor. I know that that's
a great thing that you're able to do at Advocate MD.
Another great thing you're able to do is we talk

(18:36):
about options for people and for the families employers. You
are able to work very closely with employers to offer
some really great benefits as well when it comes to
direct primary care and Advocate MD. And I urge folks
with with businesses or if you're in a position or
if you've been listening to the program and say I'd
love to have that in my office, talk to somebody
in HR, talk to somebody in management about direct primary

(18:58):
care and Advocate MD, because uh, it's a it's a
really cool benefit. Doctor. I know, uh, I know, you're
a very very busy person on a Friday. Thank you
so much for taking the time to hang out this morning,
and we'll talk real soon.

Speaker 2 (19:09):
Thanks Shanie too.

Speaker 1 (19:10):
And again that website advocates DPC dot com. That's Advocates
DPC dot com. Telph number six so eight two six
eight sixty two eleven. That's six oh eight two six
eight sixty two eleven. Carl Winter WKWHNL twenty seven sports
director joins us. Next right here thirteen ten WYBA