Keeping It In-House

Episode Transcript

Speaker 1 (00:00):
Thirteen ten WIBA in full scope with Wisconsin's directcare doctor,
doctor Cole Hemkiss. Of course, doctor Hemkes. She comes to
us from Advocate MD, a direct primary care practice with
clinics throughout the area. Of course, there's the to Madison
east side on Fair Oaks A westside and Middleton south

(00:21):
side of Madison, so I guess technically Madison, Fitchburg. That's
three Madison locations south side in Fitchburg right at thirty
two to twenty Sien Road, and in Rock County Janesville.
Also able if you're in the southern part of Dane County,
very convenient, the clinic right at ten twenty one Mineral
Point Avenue. You can learn more about Advocate MD Direct
Primary Care at their locations. The eight physicians are at

(00:43):
Advocate MD all on their website Advocates DPC dot com.
That's Advocates DPC dot com. Telphy number six eight two
six eight sixty two eleven. That's six oh eight two
six eight sixty two to eleven. And joining us this
morning is doctor Nicole hemkss of Advocate MD dot com.
How you doing this week?

Speaker 2 (01:02):
I'm doing well, Son. How are you?

Speaker 1 (01:03):
I'm doing really, really good, and we've got a lot
of ground to cover. We've got an important, important conversation
about the costs of specifically things like labs and other
types of work that folks can have done, meds and
all that stuff, and some of the stuff you guys
actually do in the clinic. We'll talk about that in
just a moment, but real quick before we get to
this week's topic and conversation mentioned the four locations of

(01:27):
Advocate MD and I know, doctor, you work really hard.
Part of what makes direct primary care so appealing to
folks is not only access to their doctors, but their
doctors being inconvenient locations at a nearby clinic. And I
know you work really hard when you're trying to find
that perfect place to open up a new clinic. You

(01:48):
really want it convenient for folks to get into, don't you.

Speaker 2 (01:52):
Yes, you know. We try to make it so that
we have some clinics that are in different areas of Madison.
You know, patients that are living on the east side
of Madison versus the west side of Madison. They don't
like to cross across the belt line, I guess, or
go across the Isthmus. So we've always tried to kind
of put our clinics so people are within fifteen or

(02:14):
twenty minutes hopefully, but we do actually have patients that
will drive from you know, thirty forty minutes an hour
outside of Madison because we are the closest direct primary
care clinic for them.

Speaker 1 (02:25):
As we talk about that too in the in the
clinics is obviously you started the first location west side
of Madison, and then you moved to the added not moved,
you added the other one on the east side in
town and then Rock County that type of thing. You've
also added more doctors and there's a there's a reason
why there's eight physicians at Advocate MD right now. It's
really a priority of speaking of access and getting getting

(02:49):
everything convenient for patients is making sure that there's a
that the panels are kept small enough that folks can
actually get in to see their doctor.

Speaker 2 (02:58):
Yes, so in a traditional, a big healthcare system, a
primary care doctor might have a panel of two thousand
to three thousand patients. That's not uncommon. So that's why
it's difficult when you need to call to make an appointment,
you know, you have to wait many months, six months,
nine months, a year to get an appointment. That's why
when you go in to see them, their appointment slots

(03:20):
are usually fifteen minutes, and if if you have a
fifteen minute slot, that probably means you spend about ten
minutes or less with the doctor. So in our system
we have panels usually between four hundred to six hundred
when the physician is full. So our newer docts have
less patients than that. So that's when you call to
get an appointment. Sometimes we can see you and then
the same day, even if it's something not urgent. You know,

(03:42):
it's usually a few days to a week to see
a routine appointment and then urgent care we get them
in the same day.

Speaker 1 (03:49):
Dougas Morning with Doctor Nicole Hemkiss of Advocate, MD. The
website Advocates DPC dot com. That's Advocates d PC dot com.
They're tellthing, I want to make an appointment, become a
member at a and MPT six eight two six eight
sixty two eleven. That's six h eight two six eight
sixty two eleven. Again, if you have any questions, you've
been looking maybe into direct primary care and Advocate EMPT

(04:10):
looking for a great option for yourself or your family.
If you're an employer looking for great options for your
employees when it comes to primary care, definitely add on
over to the website Advocates DPC dot com. That's Advocate
DPC dot com and Doctor. One of the things that's
amazing is what you guys are able to do in
the clinics at Advocate MD. But also when you do
have to use any type of specialized equipment, you are

(04:33):
able to in things that may not be accessible directly
at the clinic. You are able to arrange affordable options
for folks and convenient options for things like like labs, meds,
X rays, a lot of that stuff though in a
lot of stuff you guys also can do in clinics.
Let's talk a little bit about about those services that
you're able to help folks out with.

Speaker 2 (04:53):
Doctor. Yeah, so one of the goals of the clinic
is to be able to provide is many of these
ancillaries services in house. So lab work, you know, if
a patient needs an X ray or an ultrasound, we
can do those in house. We have a mobile imaging
company that comes in. We do a lot of cardiac monitoring.
So many people have probably heard of an EKG or

(05:14):
had one of those done, but we also do things
called halter monitors or event monitors. We do pulmonary function testing,
which is a type of breathing assessment that assesses lung capacity.
And so when we are able to provide all these
services in our clinic rather than referring you out to
you know, whether it's another independent facility or whether it's

(05:38):
a hospital. In many cases, right because if you see
your doctor that's part of the big health system, which
is an insurance based practice, most of the time they
are going to refer you into the hospital system for
all of this testing, cardiac monitoring, ultrasounds, X rays. You're
going to go to a hospital for all those things,
and that's going to be exponentially more expensive. And also

(06:00):
in many cases, you know, the expense obviously is a
big part of it, but just the availability of being
able to get that done and the convenience of being
able to get it done when you're right there in
the clinic and we can do it at that time,
or we can say, okay, come back tomorrow and we'll
do it. So it's not going to be that we're
scheduling you, you know, again months out. So people really

(06:22):
like that And as you know, Sean, we work with
a bunch of different companies, So some of our companies
their employees when they come in to see us, a
lot of those ancillary services are covered that the company
is not only covering the cost of their membership, but
they're covering the cost of the lab work and the
X rays and you know, so all of that is
at a significantly discounted cost, you know, the stuff that

(06:45):
we can do in house and not have to involve
a third party. So for example, an EKG, So we
have an EKG machine, you know, we hook get up
to the patient, we take the tracing, we print it,
we can review that, the doctor reviews that and talks
to the patient about it. Sometimes if we have questions
or concerns, we can send that to a cardiologist through
the telemedicine service and get their second opinion on that.

(07:08):
But that is at no cost to the patient. The
patient gets built nothing for that, not the time that
took the staff to do it, or the interpretation by
the doctor, not not the telemedicine assessment by the cardiologist.
So that is really crazy when you think about it,
because in the big system, you would be getting charged
for each one, each step in that process. But for us,

(07:30):
we do all of that in house. And again the
telemedicine services is outside of us, but we pay for
that service for our patients, so that's not an additional
cost to them. Something like an X ray, for example,
we have a mobile imaging company that comes in and
does those and then they bill us for that. So
then we would build a patient, you know, whatever the
company is billing us. So for an X ray, for example,

(07:51):
it's eighty dollars. For an ultrasound, I want to say
it's one hundred and eighty dollars. But again, for anybody
that's ever experienced an X ray, either an urgent care facility,
not even mentioning an er, but let's say a radiology
facility that's owned by a hospital, or an urgent care facility,
an X ray can be anywhere from five hundred to

(08:12):
one thousand dollars. So an eighty dollars X ray is
a really great price. And ultrasound the same thing, And
ultrasound can be anywhere I would say similarly, maybe five
hundred eight hundred dollars more probably if it's done in
a hospital. So again, one hundreds and eighty dollars. Ultrasound
is a really good price. And then these cardiac monitoring services,

(08:32):
so things like alter monitors and event monitors. So that's
a cardiac monitor that you're wearing underneath your clothes and you're,
you know, going about your day, and then we're you know,
they're either monitoring that on telemetry and seeing what's happening
in real time, or you're giving us back the monitor
and then we're downloading the recording, and then they're the
company is interpreting that. And again sometimes we will we

(08:55):
will always interpret it ourselves in the clinic, but then
also sometimes we might send that to a cardiology but
in those cases, the cardiac monitoring company is billing us
for that service, so then we're passing on the cost
of that to the patient. So for example, a Halter monitor,
I want to say, is around one hundred dollars. Again,
if you had that done in a hospital system, it's

(09:16):
probably going to be like one thousand dollars. And similar
to an event monitor. An event monitors is very similar,
but you wear it for a longer period of time.
So ours are about two hundred dollars for an event monitor,
and again that would probably be a thousand plus in
a large healthcare system for those things.

Speaker 1 (09:35):
You know, doctor, when you were talking there, you mentioned
I don't know if people picked up on that you
had mentioned, like for folks that insured system months and
that's not an exaggeration. Some of these some of these tests,
some of these procedures, getting in to see not even
necessarily your very own primary care doctor, but any doctor,

(09:56):
anyone that's recently tried to do that in that system.
It's it is months and months out for those for
those opportunities you talk about, the things that you guys
are able to offer right at the clinics for Advocate MD,
and the fact that they're available to folks. Not only
are are they available as part of the membership and

(10:16):
also available at very reasonable costs. They're literally available when
you need them, which is which is a really big
benefit of direct primary care and what you're able to
do at Advocate MD.

Speaker 2 (10:29):
Yeah, it's extremely frustrating, you know, as we talked about,
and I think I gave the example a few weeks
ago of trying to get my daughter an appointment with
a pediatrician in one of our local large systems here
and finally them telling me that it was ten months
to see the pediatrician, and that's not out of the
norm right now, shockingly, I mean it's so you know,

(10:53):
ironic when you think about it, and also you know,
irritating that you pay for health insurance, you know, every month,
or most people pay for health insurance. I personally have
a health share. But so you pay for this health
insurance every month and it's not cheap, and then when
you actually need to utilize it, you can't get an appointment.
So it's like, what actually are you paying for? I

(11:16):
remember sitting at a health fair a couple of years
ago for a company that we take care of their employees,
and I remember an employee coming by and talking to me,
and she was so angry because she said, I just
want to do you guys, I just want to do
advocate m D. I don't even want to have health
insurance anymore because every time I buy health insurance and
I need to use it, either I can't get an

(11:37):
appointment or the health insurance pays for none of the visits.
So what am I saying every month for? And I
totally understood this woman's frustration, and I agree with her.
Of course, the caveat is that We always recommend that
people have some form of catastrophic coverage because if you
have something unfortunate, you know, these unpredictable, very unfortunate things
come about in life, where someone's diagnosed with cancer, where

(12:00):
you have you know, you need a major surgery like
your appendix, your gall blet aer taken out, you you know,
you know need to go into the emergency department for something,
and those things will be extremely expensive unless you have insurance.
For most people, you know, ninety ninety five percent of
their medical needs we can take care of in our clinic,
so that you know, most of that is going to
be covered under your membership. Again with the exception of

(12:23):
these things like labs and X rays and things. But
so for for most people, health insurance is kind of
like a scam. You know, you're paying for this thing
where most people are not utilizing it, and when they
do go to utilize it, they haven't met their deductible yet,
so they're actually paying out of pockets. The other part
that I always try to remind people about is that

(12:44):
you know, even if you have a health insurance that,
let's say so some people have copay plans and some
people have you know, deductible plans where everything goes towards
their deductible versus you know, it's twenty dollars when I
go in and see a primary care doctor for a visit,
it's forty dollars when I go and see a specialist.
And of course those numbers keep going up the copays.
But even when you pay that twenty dollars and go

(13:05):
and see the primary care doctor under the vast majority
of health insurance plans now unless you have an extremely
good one, which are rare nowadays, when that primary care
doctor at that visit orders you to get lab work
and X ray whatever it might be, all of those
ancillary services are going towards your deductible. So if you
have anything, you know, one thousand dollars two thousand and

(13:26):
five thousand plus dollar deductible, you will be paying out
of pocket for all of that at full price, full
hospital price, until you hit your deductible. So just keep
that in mind when you see that, and most people
already know this because they've experienced it, is that you know,
you pay that twenty dollars, He's like, Oh, that's not
too bad, I can see the doctor for twenty dollars. Sure,
you know, So you pay that twenty dollars, but then

(13:48):
the doctor orders you to get three or four different
lab tests done, and then all of a sudden that
the lab test cost four or five hundred dollars. Again,
that's not out of the ordinary. And so now you
have the twenty dollars copay and the five hundred dollars
lab test. And that again is what draws so many
people to the direct primary care model because not only

(14:09):
is there no cost for a visit, there's no twenty
dollars forty dollars copay for the visit, but you know,
the cost of everything ahead of time. The labs are
not included, but the labs are a fraction of the cost.
So for example, if we order those three or four
lab panels, let's say the cost is going to be
twenty dollars total for all of it. And again if
you go through the big system, it's five hundred dollars.

(14:31):
So most people, just in the savings that they get
from their lab work in a year with US, will
more than pay for their membership, you know, again, even
if they're not high utilizers. You know, I always stress
to people because it is a hard concept to wrap
your brain around of I have health insurance, and the
health insurance includes primary care, So why am I paying

(14:51):
this extra membership fee for primary care? I don't understand that,
why should I pay more? And isn't this redundant? And
aren't the services the same? But they're actually not. And
of course, as we talk about all the time, Sean,
the the access is not the same. You know, you're
going to get appointments much easier. But when you have
a primary care doctor that you can access and you're

(15:12):
not scared of what the cost of testing and things
will be, it really allows you to take better care
of yourself because you know, it's not like you're having
to make decisions like well, I don't know if I
should get that lab done because it's so expensive. You
can get the lab work done. You can you know,
get the X ray done if that's what you need,
you know, and get your preventive health screenings and things.

(15:32):
So I just like to remind people that this is
not this is an add on to your insurance. It's
not a replacement. So because you have insurance doesn't mean
that you don't need or shouldn't look into direct primary care.
This is going to be a very different level of
care and and the vast majority of people again nless
you're one of these rare unicorns where you have a

(15:52):
zero dollar deductible, you know, zero copay plan, if you
have any sort of deductible associated with your insurance. Most
people are going to save out of pocket costs if
they come to us.

Speaker 1 (16:04):
And the great thing is if you're wondering for folks
that are wondering about membership, what the costs are? I know,
one of the big points of Direct Primary Care and
specifically what you guys do at Advocate MD is being
completely transparent about everything and all that information membership, costs,
costs for procedures, all of that stuff you can actually
see online the website ADVOCATESDPC dot com. That's ADVOCATESDPC dot com.

(16:28):
What a great thing to do for yourself, for your family,
a great opportunity. Also, if you are an employer, I'm
looking for a great benefit to offer your employees, make
sure you check out Advocate MD and Direct Primarycare. The
website ADVOCATESDPC dot com. Tel forh number six oh eight
two six eight sixty two eleven. That's six' oh eight
two six eight sixty two. Eleven we haven't talked about.
Medications we will do that and more as we continue

(16:50):
our conversation with Doctor Nicole hempkiss next with full scope
right here on thirteen TEN WIBA a twenty five thirteen
TEN wiba talking Doctor Nicole hamkiss Of ADVOCATE. Md the
WEBSITE advocatedpc dot. Com THAT'S advocatedpc dot. Com you can
learn more about Direct Primary Care ADVOCATE. Md there are four.

(17:10):
Locations there are eight, doctors, yes actual, doctors getting into
see your primary care physician when you need to see
your primary care. Physician it's an amazing. Model you can
learn all about it. Online the WEBSITE advocatedpc dot. Com
that's ADVOCATES dpc dot. Com telp number six eight two
six eight sixty two. Eleven that's six eight two six
eight sixty two. Eleven we're going to talk about prescription

(17:32):
medications and meds in general in just a moment with the.
Doctor but, first we were talking that last segment about
about some of the different procedures and different things that
they're able to not only do At ADVOCATE, md but
also they're able to offer at at very very very
low cost. Comparatively, Doctor let's talk about some of the

(17:55):
some of the for, example lab work you guys are
able to provide for folks when a laboratory some of that.
Testing people would be amazed at how much more affordable
it is At ADVOCATE md compared with some of the
big clinics and big places here in.

Speaker 2 (18:11):
Town, YES i like to give the example from my
own experience that happened to me a few years. Ago
this was prior to starting the. Practice because, now of
COURSE i just get my labs drawn in the practice
AND i don't have to worry about all this. Stuff i'm.
Lucky BUT i remember having insurance at that, time AND

(18:34):
i would, go you, know once every six months or
once a, year And i'd have a lab drawn called
A tsh thyroid stimulating. Hormone this is a very common
lab and at that time HAD i had an insurance
which had a lab. Copey, again that's getting more rare,
nowadays BUT i THINK i had a twenty dollars lab draw,
cope and SO i was used to, that AND i

(18:56):
was going to the local academic hospital and so one
TIME i just happened to be on a different side of,
town same same hospital, SYSTEM i, mean the same hospital
system owned the, clinic same doctor was ordering the labs
exact same. Lab THE tsh had it drawn at a
different lab that's owned by the same, system AND i

(19:17):
got a bill in the mail for two hundred and forty,
Dollars so twenty dollars two hundred and forty, Dollars so
of course you open it. Up, well of course there's a, mistake,
right they build this. Incorrectly they didn't submit it to my.
Insurance something. Simple SO i contact them and they, go, oh,
no this is not a. Mistake, well the first time
you had it, drawn or when you usually have it,

(19:39):
drawn you go to a place that's owned by the,
foundation and this other place is owned by the health.
System you know. Something AND i might be reversing those,
two But i'm pretty sure it was the. Foundation you
don't have a facility fee, charge but at the health
system lab you do have a facility fee. Charge and
keep in, mind neither one of these labs are inside
of a. Hospital these are all free sta and you, know.

(20:01):
Buildings SO i argued with them about. It i'm, like
there's nothing posted saying. THAT i wasn't aware of. That
nobody told me there was going to be an additional.
Charge OBVIOUSLY i wouldn't have done the lab IF i
knew it was going to be an additional two hundred
and twenty. Dollars oh, no we know we're not going
to adjust. It that was. Correct so and again this
is with using my. Insurance so guess how much that

(20:24):
lab is to have it drawn in our. Clinic THE tsh, sean.

Speaker 3 (20:30):
Let's go forty dollars six, Dollars so six dollars so
for so for a lab that's a twenty lot of
lab cope that then they added on this two hundred
dollars twenty dollars facility.

Speaker 2 (20:42):
Charge that is a six dollar. Lab so again you
in this, case you're paying more for using your. Insurance
and there's so many examples similar to. That AND i
also like to give the example again going from labs to.
Imaging so things LIKE, MRIs which you KNOW i always
assumed MRIs have got to be super, expensive Right, like

(21:04):
every Time i'd ever experienced AN mri and gone through,
insurance it's five thousand, dollars six thousand dollars to get
AN themri. Done and again these are not inside of
a hospital that's an imaging. Facility but SO i remember
not too long ago having an experience WHERE i had
a patient that needed AN. Mri so we are so
used to now within our, practice our direct primary care,

(21:25):
practice we send them to an independent imaging. Facility and
in this, case the patient wanted to utilize her insurance
BECAUSE i think she thought she's going to meet her.
Deductible there's some reason that she wanted to use the.
Insurance SO i needed to send it to the local
community hospital, here and so they sent back the order
and they said they were requiring me to do a

(21:47):
prior authorization or pre. Certification SO i filled that, up
and then they sent back the order again and they
were requiring me to fill out this like patient safety
form or. Something AND i called them back AND i,
GO i, mean in twenty plus years of practicing, medicine
HAVE I i have never had to fill out a
patient safety questionnaire to to send somebody to do AN.
Mri i'm, like why don't you guys do? This you're

(22:08):
the ones operating THE. Mri, Anyways so then after filling
out all these paperwork and THEN i think they denied.
It AND i said to the woman on the, phone
which AGAIN i try not TO i understand that people
are doing their jobs and they're just cogs in the
wheel of the system that's very, broken and it's very it,
doesn't you, know take care of patients the way it.
Should SO i try not to take out my frustration on,

(22:30):
people but it is difficult. Sometimes SO i said to the,
LADY i was, like you do realize That i'm having
to do all this additional work and paperwork for a
patient to have AN mri done at your, facility where
you are then going to charge her ten times more
so what she would pay IF i sent her to
the INDEPENDENT mri facility down the. Road so she's going
to pay ten times more for THE mri or the

(22:51):
insurance is going to submit it that, way and THEN
i have to do twenty to thirty minutes extra of
paperwork and calling back and forth to get this thing
upon WHICH i don't even remember but actually ever didn't get.
Approved but and you, know and the woman's response was
just like she'd ACTUALLY i don't think she said, anything
but this is the irony of this really broken system

(23:12):
that we.

Speaker 1 (23:12):
Have it is it is completely. Ironic and the great thing,
is AND i, know one of the things that folks
need to remember is there are. Alternatives there are options
for you and your family and your. Employer direct primary.
Care imagine not having to jump through all of those.
HOOPS i imagine getting in to see your actual doctor
when you need to see your. Doctor imagine knowing what

(23:33):
things are going to cost, upfront knowing that that your.
Doctor and not to say that doctors in the insurance
system aren't this way, either but they're able to actually
offer you the proper treatment at a fair. Price and
that's one of the great things about direct primary, care
real quick, doctor just a quick mention as we talk
about different things that are offered at the. Clinic pharmaceuticals as.
Well you are able to get very very good pricing

(23:56):
for folks on a lot of different, medications aren't.

Speaker 2 (23:59):
You, Yes so anything that comes in a generic, form
so any whether it's diabetes, meds, thyroid hyph blood, pressure, cholesterol,
antidepressants you, know dermatologic, creams anything that's a generic medication
that's not an injectible, medication we can get that in the.
Clinic and it's USUALLY i would say the difference of

(24:20):
ninety day supply being five dollars versus maybe twenty or
thirty dollars for a ninety day, supply so you're saving
some money and most of our patients do prefer to
get it from us rather than from the retail.

Speaker 1 (24:30):
Pharmacy pretty amazing stuff that they're able to do at
direct At ADVOCATE. Md Direct Primary care today is to.
Day get on the, website learn more or even, better
pick up phone gimmick call making a. Point become a
member At ADVOCATE. Md the number six oh eight two
six eight sixty two. Eleven that's six 'oh eight two
six eight sixty two. Eleven. Again you can learn more
Online advocate D pc dot. Com That's advocates D pc dot. Com,

(24:54):
doctor it's always great chat with. You have a fantastic.

Speaker 2 (24:57):
Day thank you, Too.

Speaker 1 (24:59):
Sean i'll get new next year on thirteen. Ten doble
U i B i