Insurance & Deductibles

Episode Transcript

Speaker 1 (00:00):
Eight oh nine thirteen ten WIB and full scope with
Wisconsin's direct care doctor. Doctor Nicole hemkis, of course, doctor Hemkins.
She comes to us from Advocate MD, the website ADVOCATESDPC
dot com. That's ADVOCATESDPC dot com Telvah making a point
become a member at Advocate MD. Six oh eight two
six eight sixty two eleven. That's six 'h eight two

(00:22):
six eight sixty two eleven. Doctor. How you doing this morning?

Speaker 2 (00:26):
Doing well? Son? How are you?

Speaker 1 (00:27):
I'm doing really well. And we're going to talk about
becoming a doctor at Advocate MD, what goes into becoming
a primary care physician, and a lot of really great
information on that. But before we get rolling on this
week's topic, let's talk about something that we're hearing in
the news. We're hearing all over the place. Open enrollment.
It is coming up and it's coming up quick, and

(00:47):
this is a really good time for folks to be
looking at their at their primary care options, and specifically
looking at direct primary care. Now. I know you're accepting
patients year round, but this is kind of that time
of year where it's on people's radar and other choices,
whether it's different types of insurance policies and things can
be examined. Let's talk about where we are right now

(01:07):
with open enrollment and direct primary care.

Speaker 2 (01:11):
Yes, so many people are obtaining their health insurance through
their company that they work for. I think it's now.
You know, fifty five sixty percent of Americans are getting
health insurance through their employer. So you might be coming
upon this open enrollment period where they're giving you presentations
asking you to make choices as far as your insurance benefits.

(01:32):
You know, one thing that we always kind of recommend
for the vast majority of people is that you consider
a higher deductible policy. Now you can pair that with
an HSA and that the HSA funds can also be
used for direct primary care. But the reason for the
high deductible policy is for the vast majority of us,
unless you are I would say, unless you're in the
circumstance where you regularly visit, you know, multiple specialists. You

(01:56):
know you're going to hit your deductible for example, because
you need a total knee replacement, or you're going to
need some major surgery you know, during the next upcoming year.
Those would be reasons to choose a lower deductible policy.
But if you're a relatively healthy, you know, person that
doesn't go to the doctor a lot of and again
you specialists have specialized medications like injectibles and you know, logics,

(02:22):
those sort of things, then you probably are not hitting
your deductible every year, you know, whether that's one thousand
dollars or six thousand dollars, most of us are not
hitting our deductible. So what that means is that we
are paying every month a premium and then when we
are going to the doctor on those rare times, we
are paying out a pocket for that until we've hit
our deductible. If we need lab work done, if we

(02:44):
need an MRI or an X ray done, we are
you know, paying basically cash until we hit our deductible.
So for many people, if they go to a high
deductible plan and they pair this with direct primary care.
So in our clinic, we're going to try to take
care of as much as we can without having to
send you into the hospital system. Of course, again there
are exceptions, like you need major surgery, you know, people

(03:07):
you know need to be hospitalized, and that that's again
why you would carry an insurance policy for those things.
That are unexpected, very expensive, that involve the hospital system.
For the vast majority of things, though, we're going to
do this in an outpatient setting, we're not going to
utilize your insurance. So if you do have the choice
through your employer to make a decision as far as like,
you know, five hundred dollars deductible versus maybe a three

(03:30):
or four thousand dollars deductible, and if it's saving you,
you know, I don't know, one hundred dollars a month
on insurance caremium. You know, in the end of the year,
you're saving a couple thousand dollars. Again, think of that
as an investment. Think of it as taking that money
and putting it into something. If you have an employer
that is offering a high deductible plan with an HSA,
and they're putting funds into your HSA, that's great, and

(03:51):
you can also use those funds. So that would be
the kind of considerations I would think about when you're
going into the open enrollment.

Speaker 1 (03:58):
It's interesting, guys. We talk with doctor Cole Hemkis of Advocatemty.
It's always interesting to me doctor about about people making
these these kinds of decisions. And and the type of
you know, for like the typical person as you mentioned, obviously,
there are some folks that that have very you know,
intensive healthcare needs and and and at that point, maybe

(04:18):
having certain types of insurance, uh maybe the maybe the
way to go, but for most of us, you know,
like a lower deductible but for most of us that
higher deductible insurance and then pairing it with with direct
primary care is really not only is it is it
much more affordable, but it's also so much more conducive
to good health. Having to having the opportunity to get

(04:40):
in to visit your doctor when you're not feeling well
or get in when you when you when you need
to see your doctor, and less and less expensive is
pretty amazing. And it's always, it's always again very interesting
to me about about the kind of the the financial
side of this is people need to need to really
check out direct primary care and what a great, what

(05:02):
a great window this is right now to do just that,
because wow, what a what a great system, what a
great system it is. And with that, doctor, I think
a lot of folks then wonder, Okay, so we're talking
direct primary care and insurance. There is a there is
a there is a difference there is you guys at
Advocate md IN and direct primary care in general, you
do not build through insurance. Membership covers all of your

(05:24):
all of your visits, all of your appointments, everything like that,
doesn't it?

Speaker 2 (05:28):
That is correct. Yeah, So the big thing that separates
us is that we don't build claims to the insurance system.
That's part of the reason that we're able to keep
our costs lower. So because we don't build claims, we
don't have billers, encoders and high overhead cost. So yes,
we again recommend that patients have some sort of catastrophic coverage,
but when they come in to see us, that's included

(05:49):
in the membership fee. There's no copays, there's no cost
for that, is it? Things like lab work, if they
get medications through our clinic, those would be additional, but
you know, usually pennies on the dollar, you know, ten
fifteen dollars for a couple panels of labs versus you
know four or five hundred dollars in the big system.
So it's a big cost savings there.

Speaker 1 (06:08):
It is amazing and you can learn more online advocates
DPC dot com. That's ADVOCATESDPC dot com also a great option,
not just for you and your family, if you are
an employer or if you're looking to talk to your
HR folks or your employer about direct primarycare, definitely direct
them over to Advocates DPC dot com. That's Advocates DPC
dot com. Again, a lot of great information about Advocate

(06:30):
MD as well as Direct Primary Care. The telfhe I'm
going to make an appointment become a member at Advocate MD
six h eight two six eight sixty two eleven. That's
six 'oh eight two six eight sixty two eleven. And doctor,
I know, obviously with direct primary Care and what you've
been doing at Advocate MD, the patients are coming and
you're hiring more doctors all the time. And one of
the nice things is because of if there is a

(06:52):
benefit to the messed up healthcare system we have right now,
is there's a lot of good doctors out there that
are that are looking to looking to make a change,
looking to work at a place like Advocate MD. And
I know when you have openings, you really get the chance.
And we look at the other doctors at Advocate MD
as well, you really get the pick of the best

(07:12):
of the best, and there is something going on there.
Let's talk about kind of for direct primary care doctors,
why they're coming direct to work at Advocate MD and
do direct primary care. Why are they leaving the system?
Let's talk about that.

Speaker 2 (07:28):
Yes, so, you know, as a family medicine doctor, after
I graduated my training, so after medical school residency, I
worked for about ten years for various health systems. I
worked as a outpatient family medicine doc, as I do
now I'm still practicing and seeing patients. I also worked
in the hospital system as a hospitalist, so that's a

(07:50):
doctor that takes care of people that are admitted to
the hospital or who have surgery and stay overnight in
the hospital. And then I also worked in the emergency department,
you know, I worked in urgent care clinic. So I
did a variety of things. But in terms of working
as a family medicine doc in an outpatient setting, what
a lot of docs experience now that work in these

(08:11):
large healthcare systems, which we have a couple of them
here locally, is that those doctors are typically seeing you know,
usually I would say between fifteen to twenty five patients
in a day. They those visits are typically between ten
to twenty minutes for each patient. You know, they do
not have breaks in between. They if they are lucky,
they have maybe a you know, thirty forty minutes for

(08:33):
a lunch in between. But you know, this is why
it is so hard, you know, to get an appointments.
When you get the appointment, you know, you wait a
long time to see the doctor in the waiting room,
and then they take you back and they you know,
maybe spend ten or fifteen minutes with you. Again, not
the fault of the doctor, I think it is the
fault of the system. But I experienced that briefly, you know,

(08:53):
when I finished my training and I and I kind
of had a rude wake up call of what the
reality of being a primary care doctor was going to
look like for me, you know, And I'm in my
late twenties, early thirties and think, I don't think I
can do this for twenty years. So again a day
in the life of a primary care doc in the
big system. When I moved back. So I'm originally from

(09:17):
Florida and moved back briefly to Florida and I worked
for the large, very large hospital system down there as
a family medicine doc. And so my typical day was
I'd start seeing patients at eight am. I would see
patients from I believe, like eight to twelve. I would
have an hour lunch. But during that hour lunch, I
would drive across the street to the hospital. I would

(09:38):
round on my you know, three or four patients who
were hospitalized at that time. I would eat my lunch
in the car. I remember eating my lunch in the
car driving home, driving back to the clinic, and then
I would see patients from you know, one to five,
but of course you're running behind, so maybe that's more
like five thirty six. And then when you leave the
office at six o'clock, you go home and then maybe

(09:59):
eat dinner, and then you do charting from you know,
seven to nine. So I mean, you know, that's a
long days. And that's again because the system is built
in a way that rewards and drives volume. Right, So
like the more patients you can see, the more visits
you can code, the more thorough those notes are, the

(10:20):
more diagnosis codes that are involved in those notes, the
higher the level of building, which again the hospital systems
push this because this is how they generate revenue. So
if you can make the note longer, put more aspects
of the physical exam and the review systems in there,
they can build at a higher level. So again you're
rewarded for having kind of more like detailed notes. So

(10:41):
I realized early on that this is not what I
went into medicine for. I did not go into medicine.
I mean, as much as I enjoy using a computer like,
I didn't go into medicine to sit in front of
a computer for seven to eight hours a day and
actually only talk to patients for maybe you know, a
small fraction of that. Because again, I'm sure everyone experience
going into a doctor's visit, whether it's a primary care

(11:03):
doctor or specialist, and that doctor rarely making eye contact
with you because they're staring at the computer screen. And
again I do not blame doctors for this, because I
I understand it. You know, so much is driven by
the electronic medical record right now and making sure you
capture all those details and things like that. But it's

(11:24):
not It's not a satisfying way to practice medicine for me,
and I don't think obviously patients are are happy with
the way it is going either. So I heard about
this model. You know, nine or ten years into practicing
as an employed physician. Of course, every day, majority of
doctors out there are burnt out. They're all looking for
other other things to do, other types of practices to

(11:47):
go into. You know, there are doctors of course that
are you know, leaving early, you know, retiring early, going
into two different things. But I heard about this direct
primary care model. I had a few colleagues that were
practicing this way in other states. So I started doing
my own research. I joined some of these national groups,
and then I thought, you know, I think I think

(12:10):
I could do this. I'm you know, I'm not necessarily
the most risk averse person. It's a big risk just
taking a leap, you know, It's it's leaving the stability
of an employed job that you have good pay and
good benefits, and you basically are kind of starting over.
But I did want to kind of regain that autonomy
and that joy for practicing medicine. You know, the reason

(12:34):
I went into family medicine is because I like talking
to people. I like taking care of families. I like
being there to help patients. You know, again, my my
motivation was not sitting in front of a computer screen
and enter it like being a data entry person, which
a lot of times I felt that way. So so
for me, the direct primary care model where I could

(12:55):
see four to six patients in a day and take
care of a much smaller panel of patients, almost you know,
like a concierge type model. So you really get to
know those patients, You get to know their families. They
have the ability to reach out to you when they
need something. They're not having to be relayed through, you know,
the the receptionist that relays them through the nurse on
call that relays them through the doctors on call, and

(13:17):
like you actually are talking directly to your doctor, which
is great and very surprising in today's current medical system.
So I liked that we cut out a lot of
the red tape and the bureaucratic you know, stuff that
goes into medicine right now unfortunately. So I started the
practice in two thousand and nine by myself, and at

(13:39):
that point of course, we didn't have any patients in
the beginning, and you know, we didn't have any staff.
So I was the person that sat at the front
desk and answered the phone and answered emails and roomed
patients and Drew Blood and we've been very fortunate, you know,
over the next uh, you know, the last seven years,
to be able to grow to where we have some

(14:01):
wonderful staff. We call them patient care technicians, kind of
like medical assistants. We have wonderful patient care technicians. We
have now a group of eight doctors, including myself, which
I've been very fortunate to find great physicians again that
are still really very much enjoy taking care patients, but
they just didn't want to work in the big health

(14:24):
system anymore.

Speaker 1 (14:24):
Yeah, and I hope people realize as you know, as
we as we you know, I've obviously got to know
you quite well over the years, and for folks that
are that are maybe listening for the first time, what
a bold move it was for you to start. This
is is we talk about about, you know, why why
don't doctors more leave the the insurance system and these

(14:47):
big systems. The reality is, it's a reliable paycheck I
last I check college, especially to become a physician, not
particularly inexpensive. There's a lot of you know, there's a
lot of and stuff that's accumulated, so a lot of
doctors feel very trapped and most of them will will
kind of will suffer that system because they have to.

(15:09):
You know, they've they've they're not willing to take that risk,
take that bold move. And that's why I hope people
realize what a bold move it was. Now clearly now
that now how long Advocate MD, how long has the
practice been? Has it been ten years now?

Speaker 2 (15:24):
So we're finishing up our seventh year, going into our
eighth year.

Speaker 1 (15:27):
Yeah, yeah, and so and obviously now if it's like, oh,
that's absolutely it's fantastic, doctor, look at you know, eight
physicians and you got the you got the four clinics,
and how great is people? I don't know that people
realize that that day one, that that bold move that
you made to open up that first clinic in Middleton,
that was a big step. And it's it's definitely obviously
as we see now, patients are responding, doctors are responding again.

(15:51):
And we talk about the physicians at Advocate m D.
Eighth physicians for you four locations west side right in Middleton,
east side right on one point fifty seven South Fair
Oaks have Southside Wright in Fitchburg, right at Madison, Fitchburg,
right in that beautiful, beautiful nature preserve at thirty two
twenty Sign Road and for those of you in southern
Dane County and Rock County, Jamesville location ten twenty one

(16:13):
Mineral Point Avenue. All great facilities, great doctors for you
at Advocate MD. You can learn more online ADVOCATESDPC dot com.
That's Advocates DPC dot com. Now is the time. Today
is to day to make the appoint 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. I'm going to continue our conversation with doctor
Nicole Hempkiss of Advocate MD as full scope continues right

(16:35):
here on thirteen ten wib A twenty six thirteen ten
WI b A and full scope with doctor Nicole hem
Kiss of Advocate MD, Wisconsin's direct care doctor mentioned that
website Advocates DPC dot com. That's Advocates DPC dot com.
Great day to learn more about Advocate MD. Even a
better day to make an appointment become a member six
oh eight two six eight sixty two eleven. That's six

(16:57):
oh eight two six eight sixty two eleven. I mentioned
the eight eight doctors and four clinics at Advocate MD,
and of course talk about the humble beginnings, the initial
one clinic, one doctor, we've really seen more patients come
along and you are a lot more patients. And one
of the great things about direct primary care and how
you operate is you keep those patient panels small, and

(17:20):
that means that as the as doctors panels fill up,
which is the number of patients that they could see,
you bring on new doctors. And that means that there
are opportunities right now, great opportunities for folks to become patients,
become members at Advocate md' You've got doctors that are
accepting new patients at the clinic right now, aren't you.

Speaker 2 (17:41):
Yes, Currently, of our eight physicians, four of those physicians
are still taking new patients. So doctor Christina Quality, who's
now primarily in the Janesville clinic. Doctor Julia Danz, who
works out of three of our clinics. She's mostly in Middleton,
but she also works out of Fitchburg in Janesville, Doctor
Gina di Giovanni, who also works more in Middleton, but

(18:04):
also in Fitchburg and Janesville. And then lastly, our newest
doctor is doctor Jennifer Philbin, who is mostly at our
East Madison clinic, but she also spends time in Fitchburg
and Janesville.

Speaker 1 (18:15):
That's pretty a pretty great opportunity. Pretty good, you know,
you think about good opportunity to find a great doctor.
What a what a unique experience. Direct primary Care is
an Advocate emty. Great day for you to of course,
pick up phone, give McCall, become a member member at
Advocate md augets, give a call and make that appointment
six oh eight two six eight sixty two eleven. That's
six so eight to six eight sixty two eleven. You
can also get to know the doctors, learn more about

(18:37):
the clinics, and learn more about direct Primary Care all
on the website Advocates DPC dot com. That's Advocates DPC
dot com. Doctor Hemkiss, it's always great chatting with you.
You enjoy this beautiful day and we'll talk real soon.

Speaker 2 (18:49):
You too, Sean, thank you.

Speaker 1 (18:50):
And again that website Advocates DPC dot com. That's Advocate
d PC dot com, telphn or make appoint become a
member at Advocate emty six eight two six eight sixty
two eleven. That's six eight twenty six eight sixty two eleven.
Your twenty seven storm track forecast from meteorologist Emma hippis
Ma says mostly cloudgey day with a few showers a
high of seventy six. Night cloudy with showers a low

(19:11):
of fifty eight. For tomorrow Saturday, it's partly sunny with
scattered showers a high as seventy three, and for Sunday,
cloudy with scattered showers a high of fifty nine. Currently
it is fifty eight here. Thirteen ten WIBA. There's more
of Madison in the morning. It comes your way next
thirteen ten WIVA News Times eight thirty two