Good Health Care

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Episode Transcript

(00:08):
Eight six thirteen ten WIBA and fullscope with doctor Nicole A. Hemkiss,
Wisconsin's direct care doctor. You canlearn more about doctor Nicole Hemkiss Advocate MD,
all the doctors at Advocate m Das a matter of fact, all
their locations as well all that greatinformation available to you online at Advocates DPC
dot com. That's Advocates DPC dotcom. The telfold. I'm gonna make

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an appointment to become a member atAdvocate m D six O eight two six
eight sixty two eleven. That's sixO eight two six eight sixty two eleven.
And joining us this morning is doctorNicole Hemkiss. Doctor. How are
you doing this week? I'm doingwell, Sean, how are you?
I'm doing all ri It's Friday,you know, we're in that time of
years. Despite the haze in theair, it's looks like it's going to
be a beautiful day ahead. Anduh, it's a good day to do,

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to do some contemplating thinking. Maybeyou get a little bit of downtimes
thinking about what's important to you whenit comes to you, your family.
If you're an employer, some greatopportunities for your employees as well. And
before we start this week's conversation talkingabout DPC memberships and insurance and you know,
kind of some of the great benefitsof Advocate MD and direct primary care

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for people who don't know you started. When you started here in Dane County,
you were the first direct primary caredoctor in Dane County that was successful.
I know it's been tried here andthere, but nobody ever really had
had the had the fight that youdo talk and you grow your clinic group
from from the one in Middleton totwo now on the east side, and
of course the third down in Janesvillefrom one to two to three to four

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to five doctors and patients and peopleare really responding to what it is that
you do, aren't they. Yes, um, yeah. We have been
very fortunate to be successful in growingand be able to build more clinics to
make it more convenient for patients.And I think just as more and more
people hear about this direct primary caremodel, because there's still you know,

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people at our community or you know, Madison, Dane County and the surrounding
areas that have never heard of directprimary care. So we're hoping that we
can keep spreading the world word andmore people will will find out about this,
and you know, we'll be interestedin that. And I know there's
folks listening that have had a chanceto get to know you and get to
know what you do. And whatI would urge everybody to do this weekend

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as well, is that you talkto people, you see people, let
them know about direct primary care.It's a fantastic benefit, a really amazing
setup when it comes to direct primarycare and how Advocate MD operates. And
that brings us to our conversation thisweek doctor about what you offer with direct
primary care and at Advocate MD.The fact is, there is no such
thing as what you offer with directprimary care in the insured system. It's

(02:53):
just it's just not there for folks, is it. Yes, you know,
I like to in presentations like ifI like to say you can't buy
this with insurance, you know,in quotes, you know, because we
obviously live in a community where youknow, we actually have a large the
most of the population here has insurance, so we are fortunate in that way.

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I also like to say that healthinsurance does not equal healthcare, right,
So there's a lot of people thathave health insurance, but they still
have poor access to healthcare, meaningit's hard to make an appointment with a
doctor. You know, you getinto see the doctor and they don't spend
time with you and all of thosekind of surrounding issues. So so health
insurance doesn't necessarily mean that you havegood health care. But we do live
in an area where there is alot of health insurance and a lot of

(03:37):
HMOs. And I think we're kindof seeing this, you know, morphing
into a thing where you know,people have you know, either high deductible
policies, so it might be inaccessibleto them to see a doctor just because
they're scared of what the cost ofthat might be, you know. I
mean that's something I think we allthink about when, including myself, when
I if I ever have to goto the doctors, I think, man,

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I wonder what this visit is goingto cost, you know, And
then you get your explanation of benefitstwo or three months later from the insurance
company saying, you know, thisis how much the visit was, or
the lab work or the X ray, and then this is what portion of
that your insurance paid, and thisis the remainder is what's left over for
you? Um and and again thatpart is hard because we most of the

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time don't really have much of anidea of what the cost is going to
be heading into that visit or thatprocedure or that you know, lab work
or whatever it might be. SoI think that that also makes access a
more difficult thing. But in thedirect primary care model, you know,
we also have transparent pricing, soyou never have to be concerned about that.
Yes, there are there are definitelymany things that will you know,

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that will go through that will makethe direct primary care model very different than
what you will experience in the insurancebase system. Let's talk about that that
first example, and I think thisis one of those areas that is probably
most immediately noticed by folks when theybecome a member at Advocate MD is is
the way time when it comes tomake an appointment. I think people have
gotten, unfortunately very used to ifthey call their insured doctor in the in

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the in the systems, being toldweeks, if not oftentimes months out before
you can get any type of anappointment, having to maybe compromise and see
on somebody other than your primary caredoctor, oftentimes not even a doctor.
One of the great things about andone of the great benefits of Advocate MD

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and direct primary care is it's easyto make those appointments and to get in
to see a doctor. Is thetimeline is very short? Yes, I
think unfortunately, what we're seeing happeningin the system, like you said,
Sean, is that now if youcall to make an appointment with your primary
care doctor through one of the youknow, the two or three large insurance
based systems here in town, morethan likely it's going to be anywhere from

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six months to nine months or longerto get an appointment with your doctor.
The irony is that you know,if you find a good doctor, that
other people have found that good doctor, right, so that doctor becomes busier
and then it gets harder to seethem. And then the next question you
probably ask is, so what doesthat mean the doctors that your practice aren't
good. No, it means thatin our model we keep just a much

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smaller panel of patients. So it'sit's actually a spin offer kind of based
off of the concierge model. It'sdifferent than concierge, but it has a
similar idea that you know, youkeep a smaller panel of patients for that
doctor and then they are able tohave better access to care and they you
know, the doctor can spend moretime with them and all of that that
you see in the concierge model.So in our practice, you know,

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a doctor might have let's say fivehundred patients in their panel when they're full,
and in a traditional insurance based practice, a primary care doctor, like
a family medicine doc might have twothousand to three thousand patients in their panel.
So that's what's making it so difficultto get in for an appointment to
see that doctor. And we hearthis, you know, almost on a

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daily basis from people that come tojoin our practice. And you know,
again, most of our patients haveinsurance. You know, we encourage you
to have some form of catastrophic coverage. We don't look at ourselves as a
replacement for your insurance policy. Butwhat we think that we insurance should be
used for is really the catastrophic things, so like if you need to be
hospitalized, you need to you havesomething emergency where you have to go through

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the er. Really the high pricethings that involve going to a hospital.
If you have an unfortunate diagnosis likecancer and you're going to need chemotherapy,
and those sort of things that aregoing to be very expensive. That's why
you need insurance. But for theprimary care stuff, you don't need to
have insurance to cover that. Sothat's where the direct primary care model comes
in. And as I was saying, when we have people to join,

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you know, nowadays they're telling usstories about how they called their their primary
their old primary care doctor through thesystem and they were told it was going
to be nine months to get anappointment, but they're offered an appointment with
this other you know, the otherprovider, usually not a doctor that can
see them sooner. But again,then you kind of lose that continuity of
care which is so important in primarycare. To have that continuity with your

(07:57):
doctor. That's an important thing toas you talk about, doctor Nicole,
is when we talk about we talkabout things like continuity with your doctor,
getting to know your doctor, yourdoctor, getting to know you, getting
to know a lot about you inyour lifestyle. It's a great benefit with
Advocate MD and direct Primary Care.You can learn more online Advocates DPC dot
com. That's Advocate DPC dot com. Tell number six O eight two six

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eight sixty two eleven that's six Oeight two six eight sixty two eleven and
talking about seeing your doctor in atimely manner. When you get a chance
to get in and see a doctorat Advocate MD, whether it's you or
doctor Adam Balen, doctor Karen Sholman, doctor Michael Augie, doctor Christina Equality,
where you actually you get in,you make that appointment, You get
in and no time. It's veryquick to get into see your doctor.

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But when you actually get in tosee them, the appointments. You actually
schedule appointments that are long enough forthe patient and the doctor to talk about
things, which is just it's like, oh my goodness, imagine that.
Yes you So all of our appointmentstypically and Advocate m D are an hour
long, we call them consultation appointments. But so you have an hour long

(09:03):
appointment with your doctor. This iskind of unheard of. The only time
I remember having, prior to this, an hour long appointment with a patient
is when I was going through residencytraining and we had a geriatric's rotation and
yea, sometimes those business would bean hour long because the patients were rather
complicated. But so you have anhour long visit with your doctor and that
really allows us you know, asprimary care doctors, a large part of

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what we're supposed to be doing withpatients is preventive care, discussing lifestyle medicine,
things like exercise, diet, sleep, stress, which are the foundations
of our health. But we don'treally have time in a traditional fee for
service insurance BACE system. I mean, I don't If there are doctors out
there doing it in the fee forservice system, I would like to know

(09:46):
what their secret is. But theydid a study a few years back by
the AFP, the American Academy ofFamily Practice, where they studied the actual
amount of time that a primary caredoctor or family medicine doc spends in the
room with a patient, um,you know, interacting with them, talking
to them, the history, thephysical exam, as opposed to you know,
obviously there's a lot of work thatgoes on, you know, behind

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the scenes. You know, beforethat doctor's walking into the room, they've
received your chart, your recent labs, maybe you saw a specialist. You
know, they've they've done a lotof reviewing, they've put in some orders,
you know, and then there's stuffthat happens after the visit. But
the actual amount of time that theysit in the room with you and talk
to you and examine you. Andwhat they found is it's about seven minutes.
And again, so you know,even though that visit says it's fifteen

(10:28):
minutes or twenty minutes, you're probablynot getting fifteen or twenty minutes with the
doctor. And so you think abouthow much can you actually do in a
seven or eight minute visit, becausethat's not a lot of time, um,
you know. And I like totell people that as a family medicine
doctor, you know, I Iwent into this field. I chose family
medicine because I like talking to people. I like learning about you know,

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their lives, their their children,their work, the stresses they have,
um, you know, and andthen kind of taking it from there.
And in a seven minute visit,I can't learn about all the those things,
you know. I can't um developthat doctor patient relationship with that patients
so that they I know them,they know me, you know, there's
a mutual trust and respect there.I don't know how a doctor can develop

(11:13):
that over a seven minute visit unlessyou've seen that person many many years,
right, So if you've seen thatsame doctor for ten or fifteen years,
you know those seven minutes I'm surehave added up over that time. But
in our clinic, because we seepatients for one hour, you know,
usually after two or three visits,you know, we we have developed some
rapport and and um, that's areally cool thing as a family medicine doctor
to have that. That's one ofthese things too. During you know,

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I know you regularly do open housesat the at the clinics and patients come
in and people that are curious.I know, a couple of weeks ago
you had the grand opening at theat the new Janesville location. Um,
it's it's it's fun to see peoplecoming in and spending time just you know,
seeing their seeing their doctor in thatkind of even that type of setting,
and you know, you can tellright away that there's a there's a

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there's a familiarity there. They oweeach other. It's not like and again
going back to some of the thingsthat you will never experience in the insurance
system, that type of conversation andthat type of setting that will never happen
in the insurance system. And that'sone of the other fantastic things about Advocate
MD is you get to know yourdoctor. Your doctor gets to know you
you get to spend time together,you get to get in to see your
doctor when you need to see yourdoctor. It's an amazing system. We're

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going to talk more about some ofthe fantastic benefits for Advocate MD as mentioned.
If you've been listening to the programfor a while, maybe you are
already a member at Advocate MD.Tell your friends, tell your family,
Talk with your employers as well aboutdirect Primary Care and Advocate MD. Let
them know about the great benefits thatyou hear hear us talking about with doctor
Nicole, and maybe you've experienced yourself, because it is something that is great

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for everybody when you're looking for optionsfor yourself, your family. If you're
an employer looking for some great options, or you want to talk to your
employer about that, tell them aboutAdvocate MTY. You can learn more online
Advocates DPC dot com. That's AdvocatesDPC dot com twelve number six O eight
two six eight sixty two eleven.That's six O eight two six eight sixty
two eleven. What if what ifsomething happens outside of nine to five,

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we'll find out from doctor to colehemkiss you got a question about that,
we'll find out from doctor Nicole.We will do that next as Full Scope
continues right here at thirteen ten WiBaia and full Scope with doctor Colehem Kiss,
Wisconsin's Directcare doctor of course, doctorColhem Kiss and Advocate MD. There's

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five doctors, Doctor Nicole, doctorAdam Balan, doctor Michael Aggy, doctor
Karen Sholman, doctor Kristrina Quality.Three locations for Advocate MD. West side
in Middleton, right on Glacier RidgeRoad, east side of Madison, right
on South Fair Oaks Avenue, andthe newest location in Janesville ten twenty one
Mineral Point Avenue. You can learnmore about Advocate MD Direct Primary Care,

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the doctors, the different locations ofAdvocate m D, as well all the
website Advocates DPC dot com or phonega McCall six eight two six eight sixty
two eleven. Make an appointment andbecome a member at Advocate MD. That's
six o eight two six eight sixtytwo eleven and doctor Nicole. We are
talking earlier about some of the timethings that the amount of time you're able
to spend with patients, the amountof time, the short time it takes

(14:11):
to get in to see a doctor. One of the other things that you
guys are able to do at directPrimary with direct Primary Care and at Advocate
MD is actually talk with your patientsafter hours, which is again going back
to the overarching theme of this.You can't buy this in any other in
any other system. It just doesn'texist, does it. Yes, you
know. So another unique thing aboutour model and our practice is that when

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you enroll as as a patient memberin the practice, you get a card
that has a number that you cantext or call your doctor if you have
something urgent going on. So weyou know, we don't encourage patients to
use that like just make an appointmentor something. There when they injure themselves
on a weekend or they're very sickand it's after hours and the clinic is
closed, they can use that numberto text their doctor, and it's actually

(14:58):
their doctor who's going to get thatmessage, you know, not the nurse
triage line or not the doctor oncall who's covering for thirty doctors patients,
which is what happens in the bigsystems. So it's a really nice,
very efficient and very patient friendly thingthat you have the ability to communicate with
your doctor who knows your medical historyand knows you, and then that doctor

(15:22):
will help kind of triage like Okay, well I think, you know,
try doing this in this or oryes, I need you to come in,
or you know, go get thisprescription at the pharmacy and I'll touch
base with you in the morning andsee how you're feeling. So that that
is a really cool thing that doesnot exist in the insurance based system.
I don't care what kind of insuranceyou have. I don't know a system
where you're going to have your doctor'scell phone number to call. It used

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to you know, doctor Balin,We joke around, he used to give
you know, in the years ofthat he worked at SSM, he gave
patients his cell phone number because that'sthe kind of he's an old school family
medicine doc. But that does notexist in the current the current time period
right now. So it does existin prime and direct primary here though,
So if you know, and youget into these questions like how much do

(16:06):
you how much is that worth,like having access to a doctor like that,
um direct access, like how doyou put a price on something like
that? You know, if youhave a child too sick on the weekend,
or you injure yourself and and thatallows you to um not have to
utilize an urgent care and er umand you get that kind of immediate feedback
and that you know, kind ofreassurance in some cases. Um. You

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know, it's hard to put aprice on something like that, but I
think it's a really valuable thing.I think too for you know, for
yourself or if you've got kiddos thatand you know that are that are members
as well, and you know kidsjust I'm telling you this, doctor,
I'm kids. Kids just do theweirdest things. You're like, oh my
god, like you know why they'rethey seem to get sick more. I
mean, just have it just anamazing thing. And speaking of other amazing

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things you're able to do. Um, you know sometimes we as we age
or we have an injury, sometimestimes it's very difficult to get out of
the house. And you can actuallydo home visits as well, can't you.
Yes, this is something else thatyou can't buy with insurance, and
I don't I don't know where youcould find that type of service, but

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so you know, it especially isI guess more pertinent you know, newborn
babies or you know older people thathave a difficult time getting out of the
house. Another situations sometimes as ifa patient has been recently discharged from the
hospital and they might have mobility issuesor restrictions which don't allow them to drive
or or to you know, walkeasily. So in those sort of situations,

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we do have the capability and itis an option for your doctor to
do a home visit. It's notsomething that we do commonly, but I
mean I have done them. Ido them maybe a couple of times a
year for a select a number ofpatients that need that. But again,
that's something that we offer that's alittle bit old fashioned, I would say,
like the old country doctor, theold family doctor that used to come

(17:56):
and visit you at your home.But that is, yes, the service
that we offer as part of thedirect primary care. Does Fisher Price still
make those little medical kids with thelittle medical bag because I wonder if kids
these days when they when they getthose for their birthday, if they're like,
what kind of doctor carries around stethoscopeand things in there in a bag?
But that is that does go onstill, and you guys are able

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to do that with direct primary care. It goes on in that environment.
Another environment, but it's it's prettyamazing that that what you're all you're able
to offer. And before we wrapup this week, the other area too
that I think is is really importantis what you guys are able to do
in your offices. And for folksthat have had a chance to visit and
see the clinics they are, theyare really really nice, and you actually

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have a lot of equipment and areable to do a lot of different services
and procedures right in the office.Yes, you know part of the goal
of this. You know that they'reon the one hand, as family medicine
docs were trained to do a lotof procedures and things that we don't have
time to do in the system.Again in that seven or eight minute visit,
so thing like dermatologic procedures, removinga mole um, you know,

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it's joint injections, gynecologic procedures.So a lot of primary care doctors that
are in large insurance space systems,if they're seeing twenty five patients a day,
you know, unfortunately that doesn't allowthem to add on a lot of
extra things. So if you comein for one particular thing and you you
know, want to have something elseaddressed. You know, likely they might
refer you to a specialist or say, Okay, well you're gonna have to

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make another appointment to come back andsee me, and that visit might be
six months from now unfortunately. Butin our system, again, we have
the time because we have these hourlong visits, and we have the training
and the ability to do a lotof things that again we we just don't
do in the system because you knowthat it's not it's not incentivized to do
those things. So we're happy todo skin procedures, you know, not

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just removing moles, you know,freezing things, um, things like removing
cysts, suturing, you know,acute care stuff like splinting and casting.
And then you know, I mentionedwe do joint injections. Doctor bail And
does something called prolotherapy. And thenbesides what the doctor's services and procedures,
you know, we try to offerkind of a very broad range of services

(20:08):
that I think is not necessarily typicalof a family medicine primary care office.
Again because in the insurance based system, there's no incentive for your family medicine
doctor to do a lot of theseservices that the health system is. It
would rather the family medicine doc sendyou into the hospital to do these things.
Right, So if you need ahalter monitor or an event monitor for
your heart, they're going to sendyou to the cardiac diagnostic center. They're

(20:30):
going to charge you exorbitant fees forthat. You know, if you need
an X ray or an ultrasound.Again, there's no reason why a family
medicine doc would do that in theiroffice other than if they would like to
save the patient money so that they'regoing to send you to the hospital again
for those things. So we takecare of all of that in the office
setting, including pulmonary function testing.I mentioned the cardiac monitoring, vision and

(20:55):
hearing screenings. I mentioned that wedo X rays and ultrasounds. We have
mobile imaging company that comes in sowe can offer that to our patients.
So it's really comprehensive care that wecan do. We of course do lab
work, it's we also dispense medication, so we try to make it as
much of a one stop shop aswe can, and patients tend to like

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that. That doesn't mean that ifa patient said to me, you know,
no, I prefer to do thistest at the hospital, or I
prefer to see this specialist to removethe mole. That is completely up to
the patient. But you know what, in our experience, we find that,
you know, ninety nine percent ofpeople would rather have us do it
in the office. It's much moreaffordable, We do a good job,
and it's much more efficient because thenthey don't have to wait, you know,

(21:37):
three months, six months to seethe specialists. So we try to
do as much of that as wecan. And again that's part of that
direct primary care model. It isabsolutely amazing what you guys are able to
do. When as we talk aboutall these great benefits direct to direct primary
care and Advocate MD, it's alsoaffordable. So as we talk about this
stuff really affordable, I would definitelyencourage you this morning to check out Advocate

(21:59):
MD and learn more online Advocates DPCdot com. That's Advocates DPC dot com.
Share this information with your friends andfamily as well, and then pick
up phone, give him a call, make an appointment, become a member
at Advocate MD. Six O eighttwo six eight sixty two eleven. That's
six O eight two six eight sixtytwo eleven. Doctor Nicole, you enjoy
this fantastic day and weekend and we'lltalk real soon, you two. Thank

(22:21):
you. Certified Financial Planner Tracy Antonjoins US next year On thirteen ten, WIBA