Joining the DPC Family

Episode Transcript

Speaker 1 (00:00):
Thirteen ten wib and Full Scope with Wisconsin's Direct Care
doctor doctor Hemkiss and doctor Hempkiss. I'm noticing on Google
this morning a very popular question, is it swifty with
a Y or swifty with an Ie? Taylor Swift dropping
a new album overnight. I did not know this. You
listen now, you got kids.

Speaker 2 (00:21):
So you're implying that I am a swifty then I've
never said that.

Speaker 1 (00:26):
Well, if you're wondering, by the way, it is tie,
not with a y. So just just as that. Maybe
if you bet you've already listened to the album, have
or at least some of it, haven't you?

Speaker 2 (00:39):
Yes, you know, I do like some of Taylor's fast music. Yeah,
you know, but the last album I wasn't a huge
fan of. But I've listened to a few of the
songs in the new one. It sounds like she's switching
things up a little bit, you know, reinventing herself. And
I like a few of the songs that I haven't
listened to the whole thing yet.

Speaker 1 (00:55):
Today I learned I had no idea. Well, it's great
to talk with you this Friday morning, doctor, and we've
got we've got a great conversation that had really informative information.
Of course, with open enrollment coming up, we'll also talk
about about some really cool things in the big Beautiful
Bill when it comes to HSA using HSA funds for DPC.

(01:16):
But before we get to that, let's actually talk a
little bit about direct primary Care and Advocate MD. For
folks that are are new to the program, welcome to
the show, or for folks that have been listening and
maybe still have some questions, let's talk a little bit
about what direct primary care is and what you guys
do at Advocate MD.

Speaker 2 (01:32):
Yes, so direct primary Care is a membership based model.
So when you come in to see us, you pay
a monthly membership fee. Then when you come in for
a visit, there's no copay for that visit. There's no
cost for that visit. Whether it's urgent care, if it's
a mind of procedure we do in the office, if
it's a well visit, there's no cost for any of
those visits. And it is an add on to your

(01:55):
existing insurance. You know, we are viewing insurance as what
insurance was intended to be, which is for catastrophic events.
So we view health insurance as something that you don't
want to use. You want to keep that on the
back burner in case you need it, but you want
to use the direct primary care because that not only
is going to save you out of pocket cost, but
that's going to allow you better access, better quality of care.

(02:18):
So I always I feel like healthcare and health insurance,
those two words are used kind of interchangeably, and they
are not the same thing. So there's a lot of
people out there now that have health insurance that do
not have good access to care or have very expensive
health care, so they kind of avoid going to the doctor.
So in this model, you know, we are trying to
do as much as we can for the patient so

(02:38):
that we don't have to utilize their health insurance. And
that would be for things like if they have to
go to the emergency department, if they need to be hospitalized,
if they need a surgery done. So those sort of
things are why they would still need some sort of
a catastrophic policy. But you know, even this morning, I
was answering an email or talking with one of the
docs and it came up of like, oh, well, this

(02:58):
patient has insurance there not sure whether they need us
or not, And it was like, well, Yeah, ninety five
percent of our patients have insurance. This is not something
that's a replacement for insurance, and it is meant again
to be to fill that gap, not only the gap
in coverage, the gap in access, the gap and quality
of care that people are experiencing now. And we talked

(03:20):
on the program last week about how one of the
local health systems is not even accepting new patients right now.
So unfortunately, the healthcare system has changed a lot in
the last tory years. We've all experienced that personally. So
this model came about to kind of satisfy the needs
that you know that we see for patients right now.

Speaker 1 (03:39):
You know, one of a couple of things for folks
that I've had a chance to visit any one of
the four clinics for Advocate MD, whether it's Middleton location
on the west side right at thirty two or five,
Glacier Ridge east side location here in Madison at one
fifty seven South Farolaks have down in Rock County, Janesville,
North Rock County, southern Dane County area right at ten
twenty one Mineral Point Avenue. Of course, the newest location

(04:02):
thirty two to twenty syin Road right in the little
it's a little nature preserve area, very beautiful area. One
of the things that for folks that have walked in
and bend in that reception area, you notice right away
there's no like what do they call it, like a
scanner for like insurance cards or anything like that. Like
none of that stuff goes on. And we're going to
get into a little bit about about open enrollment other things.

(04:24):
But for people that don't know Direct Primary Care Advocate MD,
you guys aren't running insurance. You're not billing insurance. You're
you're not going through that insured that insured process, are you.

Speaker 2 (04:35):
That is true. We are completely separate from insurance of
any kind, you know, whether that's commercial insurance like Blue Cross,
Blue Shield courts, or if that's government insurance like Medicare
and Medicaid. That doesn't mean that we don't see patients
that have those insurances. But again the idea of our
model is that when we keep insurance out of it,
we can keep our costs lower, and that translations too

(04:57):
taking more time with the patient, taking better care of
the page. So again, whether we have patients that are
on Medicare, whether we have patients that have private insurance
to their employers. They're paying us the monthly membership fee,
which on average is around seventy dollars a month. It's
different based on ages, but they pass the monthly membership
and then they come in and do all their primary
share through our clinics, and they reserve that health insurance

(05:18):
for the big thing.

Speaker 1 (05:19):
It's really it's really great to talk about getting into
the clinic and not having to worry about what a
bill may come in the future, what's covered, what's not covered.
It's a really fantastic model. You can learn more online
the website ADVOCATESDPC dot com. That's Advocate DPC dot com.
Great data, make an appointment at Advocate empty eight physicians
at Advocate MD, and a great opportunity with enrollment right now,

(05:42):
an opportunity to become a member. I can just give
them a call. Six oh eight do six eight sixty
two eleven. That's six h eight to six eight sixty
two eleven. Let's talk about open enrollment. I know we are,
we are coming up on it quickly. We don't always know.
I don't think a lot of folks really, I'll admit
there's a night tan my part about kind of how

(06:03):
this all works. But let's talk about how how open
enrollment works and how a lot of folks kind of
purchase their insurance. Kind of that process there.

Speaker 2 (06:12):
Doctor, Yes, So open enrollment is that time of year.
It's usually you know, laid October to early January. You
know that sometimes it's a little more restrictive than that.
But typically if you get your insurance through your employer,
through the company that you work for, versus if you
get it through the healthcare marketplace, there's a restriction in

(06:34):
terms of when you are allowed to purchase that insurance
or make any changes. And so it's in this kind
of late fall winter time period, so you will be
asked to make some choices. You know, many people, most
people obtain their insurance through their company. So you're going
to be going to meetings or getting information where typically

(06:54):
they're going to give you a list of choices, maybe
two or three choices, and you're going to have to
figure out, you know, what choice is best for you.
But in many cases, the insurance options will be something like,
you know, a low deductible option. And it's it's important too,
I should take a step back to say to understand
what this terminology is because I'm always a little bit surprised.

(07:16):
And I would also qualify this by saying that, you know,
seven eight years ago, before I started the practice, I
probably was not as well attuned to all the insurance
terminology as I am now. But your deductible is that
amount that you have to pay before the insurance even
kicks in. Right, So throughout the years, that deductible has
gotten higher and higher, but so that basically means you

(07:38):
are kind of paying out of pocket until you hit
that deductible, so you're going to have low deductible options
and high deductible options. The copay is the amount that
you pay when you walk into the doctor's office, whether
that's a primary care, doctor, specialist in er, and urgent care,
all those places you typically will have some copay. And
and then based on how your insurance is set up,

(07:58):
it could be that you have a co pay plan
versus you have a straight deductible plan, which means that
you are paying out of pocket for everything, all your
primary care visits, all your specialist visits, your urgent care
until you hit that deductible. So it's important to understand
those differences. And then there's also the situation where sometimes
even after you hit your deductible, you have this thing

(08:19):
called co jur which means that you have like an
extra ten or twenty percent that you're paying until you
hit your max out of pocket. So there's a deductible
and then there's a max out of pocket, and there's
typically an individual deductible and a family deductible, and same
thing for the max out of pocket. So kind of
understanding what you're getting yourself into. And again, this is

(08:39):
another reason why people do direct primary care and why
I like to explain it in these terms is because
you know, for most people nowadays, you have a higher
deductible insurance policy. So that's four thousand and five thousand,
seven thousand dollars. So of course, you know most people
probably are not hitting four thousand or five thousand dollars

(09:00):
with the medical cost in a year unless you have
something like a surgery, you make a visit to the er.
You know you have something bigger that happens to you.
So what that means though, is that you basically are
paying every month at your insurance premiums and you never
hit your deductible, so you're paying the insurance premiums plus
you're paying out of pocket for everything you're going to
the doctor for. So again this is a reason why

(09:20):
people do direct primary care because it's kind of the
best of both worlds. They can get the better access,
the better attention, the lower out of pocket costs for
things like labs and meds. But then they also have
that insurance policy that's sitting in the background if you
ever have something catastrophic. So we want people to be covered.
If you have a very unfortunate thing happened, like you're

(09:42):
diagnosed with cancer, the cost of that can be you know,
put people to bankruptcy, so we want you to have
protection against that. But again, this is a small minority
of people that have this stuff happen. So we will
hope that we never have to use your insurance, and
we as a clinic won't use your insurance. We hope
that you never have to use your insurance and that

(10:02):
you can come to Advocate and D for almost all
of your health for you.

Speaker 1 (10:06):
It's pretty amazing too. We talk about the access that
that you receive with Advocate MD to get in to
see your primary care doctors and actually see your doctor.
That's it's pretty amazing what you guys are able to
do at Advocate m D. As you mentioned, of course,
members at Advocate m D typically do carry some type
of insurance coverage, whether it's catastrophic or a health share

(10:28):
for those gosh forbid you ever have to experience it.
But some of those significant health issues, hospitalizations, big time treatments,
those kind of things you've you're covered with your insurance
for that, and then your your regular stuff, your checkups,
your I've got a cold, I cut my finger, I
need to get some I need to get some stitches,

(10:48):
or I you know, I've got I've got a question
about Hey, doc, what is this? Those type of questions,
They're there to answer it for you and then get
you in real quick. At Advocate m D and doctor.
One of the things I think a lot of people
wonder so as we go through this insurance is providing
what exactly to me?

Speaker 2 (11:07):
Yes, yeah, I remember being in a meeting one time
with one of our groups and somebody raised their hands
and they were just angry. They were like, I'm paying
every month for this insurance, and then when I go
into the doctor, I have to pay even more, Like
what is the point of having the insurance forge other
they're getting kind of riled up. But yes, you know,
I think it's it's really supposed to be for the
catastrophic things, and it's kind of morphed over the last

(11:30):
ten or fifteen years into something where people feel that,
you know, they have to use their insurance card for everything.
You go into the doctor, you get blood work done,
you go in and you get your blood pressure checked.
We use the analogy of car insurance and say, you know,
all of us have car insurance. You need that, but
we aren't utilizing our car insurance to get our tires

(11:50):
rotated or to get our oil change. We're paying out
of pocket cash for those things, right, because if your
car insurance was all inclusive of every single possible thing
that could happen your car, it would become probably you know,
a multitude more expensive than what it is now. And
it's not necessary, right because those things are cheaper if
we take cash. So we can look at healthcare in

(12:11):
a similar way. Obviously big differences between cars and people.
But you know, I think we use that analogy which
is kind of helps people understand how the direct premierescare
model were it is.

Speaker 1 (12:22):
It is a great illustration of it and as we
talk with doctor Nicole Hemp. Because of Advocate MD. It's
a great opportunity this morning to learn more. If you've
been wondering about direct Primary Care and Advocate MD. You've
got a great resource and a great website to do
just that. All I got to do is head on
over to Advocates DPC dot com. That's ADVOCATESDPC dot com.
Fantastic data, make an appointment, of course, looking for yourself,

(12:44):
maybe something a great option for your family. If you're
an employer, definitely check out Advocate MD. I got to
just give them a call, make an appointment six eight
two six eight sixty two eleven. That's six O eight
to two six eight sixty two eleven. As we're approaching
open enrollment season, definitely should be top of mind. Advocate
MD Direct Primary Care again their telph number six eight
two six eight sixty two eleven. That's six h eight

(13:04):
two six eight sixty two eleven. Something we often talk
about on the financial shows, are your HSA funds? Well,
some great news if you have an HSA a health
savings account, you can actually use that money for something fantastic.
We'll get the details from doctor Nicole Hemkiss. We will
do that next as full Scope continues right here on
thirteen ten WUI B A thirteen ten Wui b A

(13:25):
and full Scope with Wisconsin's direct care doctor doctor Coole Hempkiss.
You can learn more about doctor hempkists the seven other
physicians at Advocate MD, eight total at Advocate MD and
their four locations, all online ADVOCATESDPC dot com. That's ADVOCATEDPC
dot com. We were talking earlier, of course with open enrollment,
and of course with folks who are looking to join

(13:46):
Advocate MD. Some complimentary whether it's a high deductible plan
or or health shares. A lot of great information about
just those right online. ADVOCATEDPC dot com. That's Advocate to
DPC dot COMTELFH number, make a point become a member
six eight two six eight sixty two eleven. That's six
eight two six eight sixty two eleven and doctor My

(14:08):
financial people love HSA funds. Apparently they are quite useful
for a number of things. But that H and HSA
stands for health and UH. And with some good news
and some new legislation, HSA funds can be used or
will be able to be used for DPC. What do
we need to know there.

Speaker 2 (14:28):
Yes, so many people have hsas through their employer. Again,
you know, it's typically tied to a health insurance plan.
Other than there are other other forms of savings accounts
like hrs and FSAs, which have slight differences, but specific
to hsas. In the past, this was somewhat of a
gray area or a concern because there was some language

(14:51):
in the IRS tax Code regarding use of HSA's to
pay for health plans. And again there was there was
some discussion or debate as to whether a DPC is
considered a health plan because we are not insurance. As
people know, we don't you know, build anything through insurance.
We're completely separate. But there were some people that weren't
comfortable with the language in terms of having an HSA

(15:14):
qualified health plan and then utilizing a direct primary care clinic.
But the good news is that, you know, when the
big beautiful bill was passed, again not saying that everything
in the bill was wonderful, but for us, the DPC
portion was wonderful. So when this was past, I guess
that was a few months ago. But what it says
now is that it specifically calls out direct primary care

(15:36):
and says that this is not a health plan, it's
not a health insurance, so there's not restrictions in terms
of people that have health insurance that has an HSA
participating in a direct primary care clinic or direct primary
care membership. And then it goes even further to say
that you can actually use your DPC, use your HSA

(15:57):
funds to purchase a DPC membership. Again, this was also
not really clarified previously. Some people were already doing this,
but it was a great area. And so now if
you have money, again, some companies are putting money into
your AHSA or matching the HSA funds each each month
or each year, and so now you can take those
HSA funds and use that to pay for a direct

(16:20):
primary care membership and also anything that you do within
our clinic, a direct premiary scare clinic. So you get
blood work done again at a much lower cost, you
get generic medications, you get an X ray. You can
use your HSA funds to pay for all of those
ancillary services too.

Speaker 1 (16:36):
That's really amazing and great to have clarification. It does
show how deeply ingrained the insured system is in every
aspect of life. Cause you think about what you do
at Advocate MD is this is nothing as far as
for primary care. Nothing new. It's different compared to modern times,
but this is really traditional. I think for a lot

(16:57):
of folks, as we talk about what you guys do
day in and day out at Advocate MD, it reminds
a lot of folks to the way medicine used to
be and when you actually have to go through and update,
update and clarify laws to to to make sure that
that DPC is properly included or or or or acknowledged
in that you're like, wait a second here, it shows

(17:18):
you kind of how much how much poll like the
insurance lobby has that that that type of stuff would
have to be clarified because you think about, you know,
the if you it's if you're talking about healthcare, what's
what's more important as far as healthcare than than checkups
and you know, getting in to see your primary care doctor.

Speaker 2 (17:35):
Uh.

Speaker 1 (17:36):
Doctor, we've got a couple of minutes left. I did
want to ask you. We kind of started our conversation
this week off talking about direct primary care. Let's talk
specifically about Advocate MD. I mentioned eight physicians. You've got
four clinics, at Advocate MD. It's a great experience and
I know you get the opportunity to get out and
talk with with different organizations and businesses as well about

(17:56):
what you can do. And I think that's a big
thing as we talk about, you know, looking towards open
enrollment and other things. You work directly with a lot
of area businesses and provide services and for folks that
are that are in those positions of making those type
of decisions, you'd love to talk with them and kind
of help them understand what direct primary care and what
you guys can offer at Avacamity, wouldn't you.

Speaker 2 (18:19):
Yes, So, as you said time, we work with individuals, families,
and then businesses, you know, all the way from small
businesses that have five or ten employees all the way
to very large businesses that are self funded and anything
in between. So if you are a business owner, an
HR person, or someone that is just an employee that

(18:39):
wants you know, better care, better access to care, I
think this is something you should bring up with your
HR people, your business owner, the leadership that makes the
decisions because they can offer direct primary care to their employees,
they can pay for the membership. There's many financial benefits
for the employer to do this. There's also, obviously, you know,

(19:00):
employee satisfaction benefits if you can provide them better access
to healthcare, if they have an easier time getting a
doctor's appointment, they have better quality of care. There's big
benefits to that for employers too. So we're happy to
talk with anyone who owns or represents a business and
to tell them more about how we can work with
them and doing the primary care.

Speaker 1 (19:21):
I know one of the biggest challenges businesses face right
now is recruitment and retention. And you think about being
able to tell your perspective hires or your employees, we've
got this. We've got this relationship with Direct Primary Care
and Advocate MD. If you were your kiddo's need to
get in to see a doctor, you can get in
to see your doctor right away. It's something that you
know as a business you can present all the great

(19:43):
benefits to your employees and what a great tool that
is for bringing in the best and brightest, and of
course you've already got them on your team. You can
keep them around longer as well, because this is a
fantastic option and it's not just a great option for employers.
If you're looking for something for yourself, for your family,
looking to get in to see a doctor, when you
want to see a doctor, an actual doctor, your doctor,
the doctor, not just some you know, random person. It's

(20:05):
actually getting in to see your doctor. Direct Primary Care
and Advocate MD is a fantastic option. Learn more online
Advocates DPC dot com. That's Advocates DPC dot com. More importantly,
today is today. To make it a point become a
member at Advocate MT six h eight to six eight
sixty two eleven. That's six soh eight to six eight
sixty two eleven. Doctor Hemkes, it's always fun talking with you. You
enjoy this great day and have a fantastic weekend.

Speaker 2 (20:26):
Thank you, thank you, and.

Speaker 1 (20:28):
Again the website ADVOCATESDPC dot com. That's Advocates DPC dot com.
We'll be talking Parade of Homes next here on thirteen
ten wiv I