Hot Off the Presses

Episode Transcript

Speaker 1 (00:00):
Eighth, six thirteen ten WIBA and full scope with doctor
Nicole Hempkiss, Wisconsin's direct care doctor Online ADVOCATESDPC dot com.
That's ADVOCATESDPC dot com. That is a place you can
learn more about direct primary care. Learn more about Advocate MD.
The doctors at Advocate MD also all four locations including

(00:24):
the West Side and Middleton East Side in Madison, Janesville
in Rock County at ten twenty one Mineral Point Avenue,
and the newest location in Fitchburg right on the Fitchburg
Madison line right at thirty two twenty siin Road.

Speaker 2 (00:39):
Doctor. How you doing this morning?

Speaker 3 (00:41):
I'm doing well, Shaan. How are you?

Speaker 1 (00:43):
I'm doing great. I'm reading the Capital Times right now
and I will quote. I'm going to quote something and
I want to see your reaction to this. Hempkiss is
now the owner and medical director of Advocate MD, a
Madison provider which has grown into one of the largest
direct primary care clinics in Wisconsin, if not the entire country.
Business is booming at Advocate MD. Love seeing that stuff.

(01:05):
How cool is that done?

Speaker 3 (01:08):
Yeah? That's good. I'm not sure about the entire country
part of it. I think I I think I told
him when he interviewed me that we're one of the
largest physician only direct primary care in the Midwest, which
is true, and we probably are one of the largest
physician only direct primary cares in the country because as
we've talked about, most direct primary cares and as you know,

(01:31):
healthcare in general is kind of morphing into have a
combination of physicians and non physicians in their practices. So
we are unique in that way.

Speaker 2 (01:39):
That's and that is that is a big thing.

Speaker 1 (01:41):
And I think sometimes and we're going to talk about
a couple of reasons why uh direct primary care is
in the new is a big one here in Wisconsin.

Speaker 2 (01:49):
To talk to you about that in just a moment.

Speaker 1 (01:51):
But when you mentioned the the physician only model you
use at Advocate MD, a lot of folks may not
fully know this, and it's I think, in like some
of the big health systems, they almost don't want you
to know.

Speaker 2 (02:05):
That is.

Speaker 1 (02:06):
I think as as a lay person, I see somebody,
they're wearing a white coat, they've got a stethoscope, they're
they're taking all sorts of information and use cases some
cases providing uh medications.

Speaker 2 (02:20):
Other things.

Speaker 1 (02:21):
People may be surprised to learn that that that person
may not actually be a doctor. They may be something
like a PA, which, by the way, there is perfect
great pas and they've got great roles, but they're not doctors.

Speaker 3 (02:34):
Yes, you know, so there are other other people that
are part of the healthcare team. You know. I've I've
worked with many nurse practitioners and pas and in various
settings when I worked in the emergency department, when I
worked in the hospital, and many of them are a
great contributor to contributor to our healthcare system. I think
in this particular model of direct primary care, I've always

(02:57):
kind of felt strongly that, you know, we we definitely
need to have the most highly educated, highly trained, experienced
doctors that are taking care of patients in this model
because again, we are trying to take care of as
much in the clinic setting without having to refer people out.
So I think that that part is important, you know.
And I know we've kind of talked about this before,

(03:19):
but yeah, so I think it's it's it's an interesting
thing that a lot of people don't maybe necessarily think
a lot about, but it did actually get brought up.
But when I testified at the Capitol the other day also,
so it's yeah, that's this is kind of an interesting
time because I think partially this article came out because
of the legislation that is now going before the Wisconsin

(03:41):
State Senate and State Assembly, and as listeners to the
program I've now testified, I think this was the third
time in front of the legislature for the same that
we keep trying to pass this bill, and I have
I have mixed feelings. I think this article even mentioned it.
I do have sort of mixed feelings because I am

(04:02):
a kind of small government type person. I do think
that insurance is a perfect example. Right, Sometimes when you
get middle men involved in things, it drives up cost,
it lowers efficiency, it lowers patient care. It just makes
it the process more cumbersome, and it doesn't do anything
to improve the quality of care that we delivered a patient.

(04:24):
So it always makes me a little bit nervous in
terms of getting government more involved in things. So obviously,
as a physician in any type of medical practice, whether
I practice for a large hospital system, whether I practice
for a private practice that's taking insurance, I am under
I am under certain regulations in terms of my licensing,

(04:46):
the quality of care I have to deliver. We're under
certain consumer protection you know laws. Obviously as a business,
we are under non discrimination laws. All of that stuff
is already happening. This is meant to kind of be
like an added layer to help. The intention would be
to help direct primary care practices stay independent of insurance regulations,

(05:07):
which obviously we shouldn't be under insurance regulations because you know,
I'm not a Blue Cross, Blue Shield or a Courts
or a d and right like, we don't do anything
like they do. You know, it's funny because one of
the questions that came up in this this hearing, so
there was a public hearing on Wednesday that I went to.
There was a Senate and the Assembly. I just went
to the Assembly when I sat there for almost three
hours before I could testify, So at that point I

(05:30):
didn't have any more time to spare. But you know,
this question came up from one of the legislators on
the committee, you know, after someone had described direct primary
care and then they asked again. They were like, can
you just explain to me again why this is not insurance?
And you know, unfortunately, I think the answer that was
given was not a super great answer. But insurance in

(05:52):
and of itself, by definition, insurance is taking on risk, right.
There is a risk pool or share or shared risk
they call it sometimes where you know, you are paying
into the insurance company and then they are paying out
on claims. And you know, again the idea behind insurance
is that many healthy people that don't utilize it are

(06:12):
paying a lot of money into it, right, So then
that the fewer number that the small number of people
who are needing you know, high cost medical you know,
procedures and things like that, they are pulling money out
of that insurance pool. But but again the insurance takes
on a risk, right because they have to have more
people paying into it than are taking out of it.

(06:33):
That is not what we do in direct primary care, right,
We aren't sharing in any risk. What we are doing
is delivering to the patient primary care services within our
office setting. So we aren't you know, taking out your
appendix or delivering your baby in the back room, of course,
so we are delivering to them outpatient primary care services.

(06:53):
And then you know these ancillary services on the side,
you know, which are being delivered at wholesale prices, like
the labs, the x rays, you know, if we dispense medications,
but everything else just involves us in the patient, and
you know, is very low cost. So that's kind of
almost a transactional type relationship. You're paying me seventy dollars

(07:15):
a month, you're getting all your primary care visits included
in that. So it is vastly different than the way
the insurance model operates.

Speaker 2 (07:23):
A gentleman Sam, I do believe. Yeah.

Speaker 1 (07:26):
A gentleman Sam was profiled also in the story of
The Capital Times. He had moved away to Arkansas but
was a member at Advocate MDS obviously told The Capital
Times this so we can talk about it. I talked
about when he first learned about direct primary care, he said,
to be honest, since I thought it might have been

(07:47):
a scam. He said, why wouldn't you take my insurance stuff?
And then he talks about his experience with Advocate MD
and and you know, able to perform blood work for free.
Also he had he had mentioned the story about when
he had COVID nineteen, his doctor would text him every
day to check in to see how he was, and
he said it was very meaningful to me. He says,

(08:09):
I miss my doctor. One of the things he misses
most about living here in Madison is his experience at
Advocate MD. So really really glowing review there. But that's
just one of many examples of folks that really love
what you are doing at Advocate MD. And this with
this bill here and going making its way through the
state legislature here in Wisconsin, obviously nothing is perfect, but

(08:34):
I've got to ask, doctor, is this something that is
necessary here in Wisconsin to kind of codify some of
what's going on with direct primary care.

Speaker 3 (08:45):
Yeah. So, basically every time this bill has come up
in the last I think it's been six or seven
years I remember testifying I think right after the practice started.
And every time it comes up, the bill becomes longer,
in a little bit more complixed it and has more
requirements of the physician or the direct primary care practice, which, again,

(09:07):
in some ways that's okay. I understand wanting or needing
to have the consumer protection aspect of it, and we
already do all of this in our patient agreements. Anyways,
you know, I always get a little bit concerned if
we are holding direct primary care doctors to a different
standard than other private doctors in our community in terms
of you know, kind of dictating dictating to them how

(09:31):
they have to practice or you know, some of the
things that this bill has in it. That part concerns
me a little bit, but I think still overall, it's
it's better. There's more positive benefits to it than negative benefits.
You know, it's always interesting when you testify at the
capital and just you know, as you as people know

(09:51):
the legislators that you elect, you know, and these are
legislators from all over the state of Wisconsin. They come
from all different walks of life and professions. You know,
so our businessmens or our you know, teacher some of them,
you know, some of them have never been in the
health care environment or the insurance environment, so you're kind
of having to uh explain things to them in a

(10:12):
way that will make sense. And also they're having to
make decisions about things, you know, that will impact potentially
patients of course, you know, medical practices. So it's it's
always a little bit I guess, uh nerve racking when
when that happens, because it's like you've got to translate
the right message right and you have to make sure

(10:34):
that they understand the significance of these things, and you know,
I kind of spoke about, you know, the three aspects
of healthcare, which we've talked about in the past of
being access, quality, cost right. So we are fortunate in Wisconsin.
In most areas of Wisconsin, we have really high quality
health care accessible to us. Here in Madison, we have,

(10:55):
you know, a large health system that's like a tertiary
care center, so people from all over our state and
sometimes even other parts of the country come here to
see specialists. That is a great resource. But in the
state of Wisconsin, we also have very poor access. So
it's taking people nine months twelve months to get an
appointment with their primary care doctor. We also in Wisconsin

(11:17):
have very expensive health care. There was a report that
came out a few years ago saying the fourth highest
cost health care in the country. This is based on
hospital pricing or health system pricing. But again, you know,
I make the arguments, and I said this to the
legislators when you have high cost care, that in and
of itself limits access right because people are scared to

(11:39):
go to the doctor because they don't know the cost
of the medical care that they will be getting. So
cost and access kind of are correlated to each other.
When you have lower costs you have better access typically,
and our model of direct primary care is a perfect
example of that. When you can keep cost very low,
very affordable, people will access medical care and they will realize, like, oh,
I do actually need to go to a doctor for

(12:01):
these things that I've been ignoring for six months or
a year year's potentially. So I tried to I try
to educate them and talk to them about those things.
And also part of my speech was to dispel some
of the you know, misconceptions about direct primary care, and

(12:22):
those miscons conceptions are that we're trying to replace insurance,
that we are concierge medicine, you know, that we're only
for healthy people. These are based on things I've heard,
you know, brought up in the past. So so yeah,
so that was kind of part of my testimony.

Speaker 1 (12:39):
It's and and as this of course works its way
through the different different committees, and I will definitely keep
up to date with doctor Hemkiss on that and as
we talk about and I hope folks get a chance
to read a little bit more online. It's I always
love hearing too from folks that have had an opportunity.
I know many of you have have contacting me over

(13:00):
the years that our patients at Advocate MD and told
me about your experience and what a phenomenal, uh phenomenal
thing it is when it comes to direct primarycare and
of course Advocate MD. It's a great day to learn more.
Of course, you can go online the website Advocates DPC
dot com. That's Advocates DPC dot com. Great resource to
learn more about direct primarycare and Advocate MD. Telphon number

(13:22):
to make an appointment. Become a member at Advocate MD
six oh eight two six eight sixty two eleven. That's
six oh eight two six eight sixty two eleven. Great
options for you, great stuff for your family. If you're
an employer looking for some primarycare options for your employees,
definitely check out Advocate MD again. You can learn more
online Advocates DPC dot com. That's Advocates DPC dot com.

(13:43):
We're going to do a conversation with doctor Cole Heem
because of Advocate MD next as Full Scope continues right
here on thirteen ten wu I b A thirteen ten
WUI b A and full scope with Wisconsin's Directcare dot
doctor Nicole hempkis. You can learn more online Advocates DPC
dot com. That's Advocates d PC dot com tel for
number six soh eight two six eight sixty two eleven

(14:04):
to make an appointment and become a member at Advocate
MD again that number six oh eight two six eight
sixty two eleven. And doctor, obviously you having the opportunity
to testify and really help inform lawmakers about the benefits
of direct primary care and what you're able to do
at Advocate MD. I was telling you I'd seen a
couple of stories show up on Reddit, and I don't
know how familiar you are with Reddit, but somewhat related.

(14:26):
But on a separate thing in Wisconsin, somebody had commented
on Reddit or started a post. They said, ken, wisconsinights
who work in the medical field, please explain the long
delays to see doctors and scheduled screenings, et cetera. This
person says a family member needs a neurologist to assess
them for memory loss, and they say the wait is
twelve to fourteen months, and I thought, whoa, and we're

(14:48):
I mean, we're seeing more and more of this And apparently,
according to them, the primary care physicians said, everything right
now is taking much much longer, including things like screenings
for like mammograms and other things. We look at the
healthcare system and some of the significant issues with it,
and then we talk about what you're able to do
with direct primary care. It's pretty amazing. So what is

(15:10):
kind of the next the next steps for this for
this legislation. Is there any hopes that this is the
time that will that'll kind of be the time that
actually progress is made or or what's kind of the
what's kind of the process there?

Speaker 3 (15:25):
Doctor, Yeah, that's a great question. Quickly, I wanted to
go back to what you said, because I think you
made a great point. Is that one of the things
I see happening or this is my general thought about
this is that when you overwhelm primary care doctors and
they only have, you know, five to ten minutes to
see their patients, they triage a lot more patients out

(15:48):
to specialists. Right, So now we have specialists who are
already probably overwhelmed, that are seeing patients for things they
probably shouldn't be, right, So like, not every ration needs
to go to the dermatol, just not every person with
high blood person needs to go see a cardiologist. All
of these things, right, So if a primary care doctor
is overwhelmed and is seeing twenty patients, twenty five patients

(16:10):
a day, they are most definitely going to send more
of those patients to specialists. And so now we have
a situation where specialists can't get to the patients that
actually need to be seen by specialists, like those requiring
you know, specialized medical procedures. They need the expert input
of someone beyond primary care. You know, we are generalists,

(16:31):
So the joke is always that we know a little
bit about a lot of things. Specialists know a lot
a lot about a little bit of things. So I
think that if we could take better primary care of
you know, most people, that would mean we vastly would
cut down on the number of specialists referrals. And also
in our clinic, we do offer a telemedicine specialty service,

(16:52):
so we actually are consulting with a you know, board
certified cardiologist, GI doc, you know, orthopedic, whatever it might be,
and we are sending them our notes, our X rays labs,
and then they're giving us their input. So again that
turnaround time could be a day or a couple of
days versus multiple months. Like you said, I mean, I've

(17:13):
had situations where I do have a patient that needs
to see a specialist, and I don't refer a lot
to specialists, but when I do, it could be six
to nine months to get them in with a specialist,
depending on what the specialty is. Yeah, so will this
pass the legislator legislation. It's it's interesting because last time
this came around two or three years ago. It passed

(17:35):
through both the Assembly and the Senate, and then it
got vetoed by the governor. And this was a very
unfortunate thing. There was one word in the legislation legislation
that somebody took out and then someone else raised alarms
that I don't want to open up this whole can
of worms. But basically they didn't like some of the
language that they worried would contradict or didn't fit in

(17:57):
with non discrimination language. And just so everyone, both in
our state of Wisconsin and in the federal government, we
already have non discrimination laws in place that mean that
any doctor, no matter where you practice in a hospital,
in a private clinic and a direct primary care clinic,
you cannot discriminate against patients based on you know, color, sex, uh,

(18:18):
you know sexual orientation, you know, socioeconomic background, any of
those things. So so those laws already exist, but that
was part of the concern, I guess from the governor,
you know. And it's interesting because, and I said this
during my testimony, this is a non partisan issue. This
is not a Republican or Democrat issue. Both Republicans and

(18:38):
Democrats can agree that our healthcare system is broken and
that we have poor access, and that health care costs
too much. So let's take let's make it nonpartisan, right
and just do what's best for patients. And the other
funny thing was I guess that I was going to
bring up was one of the legislators and I don't
I'm not really familiar with her specifically. I don't think
she's from Madison, but actually my assembly person was on

(19:01):
the Health committee. I didn't tell her that I actually
live in her district, and I don't know if that
would have mattered, But one of the assembly women that
was on the Health committee, she kind of kept hammering
at this one point of like, well, who's going to
educate consumers, who's going to educate patients about what direct
premiary cure is, and how do we make sure that
they don't confuse this and think this is insurance and

(19:22):
think that all these things are covered, you know, under
their insurance. But this is an insurance Like Who's going
to provide the education? And so I'm sitting there for
my two and a half three hours like chomping at
the bit, like I want to answer this question. So
when I finally got up there, I'd been taking notes
of all the questions that I've been asked, and I
was like rapid fire, trying to get through this stuff
as quickly as possible. So I said, I want to

(19:43):
answer your question about who educates the consumers? And I said,
you know, consumers educate themselves obviously, you know, if they're
dealing with a insurance broker or if they have an
HR representative that they get their health benefits through their employer,
Like all of these people have to provide education, right,
Like it's not a one person thing. And then plus

(20:04):
this this bill is designed to provide some education and
consumer protections also to patients. But then I kind of
flipped the script a little bit and I said, but
tell me who educates people about their insurance? Because most
of the time when I see patients in the clinic
and I ask them kind of what should be simple
questions like what's your deductible, what's your co insurance, what's

(20:27):
your total maximum out of pocket? You know, ninety percent
of people do not know the answers to these questions,
and many people, you know, understandably so don't know the
basic insurance terminology, you know, like co insurances and all
of those things. So I would make the argument that
the majority of Americans don't understand their insurance benefits. I

(20:48):
don't even understand part of it because it is so
overly complicated. Right, so most of the time, when you
go into the doctor's office, you don't know for certain
if that office visit is one hundred percent paid for,
Are that you're going to get an additional bill of
the mill? Are those labs paid for? Are those going
towards your deductible? Are they preventive care labs? Are they
considered you know, non preventive care labs. So it is
very confusing, and again you have I would say, regulatory

(21:12):
agencies in place that are supposed to be helping with this,
and you know, you could argue that they're not. But
I think that insurance benefits are way more confusing that
direct primary care, and it would be much easier to
explain this model to anyone than to explain insurance.

Speaker 1 (21:28):
I think the only the only hard thing to understand
about direct primary care is how exactly are you able
to do all this? And then when you start to
learn about about all the costs and the insurance system,
and you suddenly realize you go, oh, I see exactly
how the doctors at advoct MD are able to offer
affordable access to primary care and it's an amazing model.

(21:48):
If you want to learn more ADVOCATESDPC dot com. That's
ADVOCATESDPC dot com. Speaking of opportunities for education. If you
know folks, make sure you let them know about direct
primary care and add MD. I know a lot of
you get a chance to listen to doctor Hemkiss each
week and have a pretty good understanding of some of
the great benefits and what makes Advocate MD in direct

(22:10):
primary care such an amazing option for folks. Make sure
you're telling others and sharing that as well. Again, you
can learn more online the website Advocates DPC dot com.
That's Advocates DPC dot com. Today would be a great
day to make an appoint and become a member at
Advocate mdtelphone number six oh eight two six eight sixty
two eleven. That's six oh eight two six eight sixty

(22:30):
two eleven.

Speaker 2 (22:31):
Doctor.

Speaker 1 (22:31):
You have a fantastic day and a great weekend and
we'll do it all again real soon.

Speaker 3 (22:36):
You too, Sean, thank you.

Speaker 2 (22:37):
News is next right here on thirteen ten wib I