Patient Care Experience

Episode Transcript

Speaker 1 (00:01):
Eight oh five thirteen ten, double U, I BA and
full scope with doctor Nicole Hempkiss, Wisconsin's direct care doctor.
You can learn more about doctor Hempkiss, all the doctors,
all the clinic locations as well, and learn more about
direct Primary Care on their website Advocate DPC dot com.
That's Advocate d PC dot com and got a fantastic website.

(00:22):
Great resource to learn more and get more information. Great
thing to do this morning, pick up phone. Gave a
call become a member a patient and advocate Mt six
eight two six eight sixty two eleven. That's six oh
eight to six eight sixty two eleven. And joining us
this morning is doctor Nicole Hempkiss.

Speaker 2 (00:35):
Doc.

Speaker 1 (00:36):
How you doing this morning?

Speaker 2 (00:37):
I'm doing Welsh on how are you?

Speaker 1 (00:39):
I'm doing pretty good? And uh boy uh Now for
folks that don't know you grew up in Florida, we've
had we've had like a Florida couple of days these
past couple lists like Florida in January, isn't it?

Speaker 2 (00:51):
This is like I joke, this is a Wisconsin summers.
It feels like some but yes, this would be cold
for most Florida. And it was funny. I was having
a discussion with my dad. My parents came up a
few weeks ago, and he said, and he's lived in
Florida I think now like fifty five sixty years, And
he told me the lowest recorded temperature he remembers in

(01:13):
Orlando is nineteen degrees. And I remember one time as
a kid seeing a little bit of snow flurries, but
I never actually saw snow until I went away to college.
So I was like eighteen or nineteen years old the
very first time I saw snow.

Speaker 3 (01:26):
Wow.

Speaker 2 (01:26):
And that's but now that's changed a lot.

Speaker 3 (01:30):
Yeahs things are a little bit different that, that is
for sure. And as we have these past couple of days,
I know that kind of brings a little fresh energy
to everybody and kind of gets us moving. I don't
know if there's got to be some kind of scientific
thing to that. But with that, he started thinking a
little bit more about your health. He started thinking a

(01:50):
little bit more about things like access and spending time
to get to know your doctor. Those are some great
features of advocate empty. It's a really good day to
learn more online Advocates DPC. That's ADVOCATESDPC dot com. Four
clinics for Advocate md westside, the original in Middleton right
at thirty two pot five Glacier Ridge, east side of Madison,
Wright at one fifty seven South Fair Oaks. I have

(02:12):
the Rock County location right in Janesville, real easy and
convenient to get to there.

Speaker 1 (02:17):
It's at ten twenty one Mineral Point Avenue. And the
newest localacation right in Fitchburg kind of that right on
that Fitchburg Madison line, right at thirty two to twenty
sign Road, and all the clinics are absolutely beautiful, and
that Signe Road clinic is just not only is the
clinic beautiful, but in that really nice nature preserved again.
You can learn more online ADVOCATESDPC dot com. That's ADVOCATESDPC

(02:39):
dot com speaking of the newest clinic, of course, the
Fitchburg clinic. Doctor Philbin. She's she's going to be starting
there in no time, isn't she.

Speaker 2 (02:47):
Yes. Doctor Philbin starts with us a week from Monday,
so we're very excited about that. Doctor Philbin is a
native Madisonian. She grew up in Madison. I forget which
high school she went to. I can't remember if she
went to East or West, but she went to UW
and then I think lived someplace else but came back
and then worked in Lake Mills for a number of years.

(03:08):
But she still lives on the east side of Madison.
So we're very excited to have her. We already are
hearing from patients of hers from her prior practice that
are wanting to follow her. So we're very much looking
forward to that as we expand our practice, and we're
again hiring for doctors. So if if you are a
doctor or no a family medicine doctor that's looking I

(03:30):
know there's a lot of burnt out and unhappy doctors
out there, so please contact us.

Speaker 1 (03:35):
And so really you mentioned too, of course adding doctors
to Advocate MD as you get more patients, more doctors,
to make sure that people always have access to the doctors.
And one of the things I get a little glimpse
on is when I when I stop out for open
houses and other visits, I know you and the rest
of the doctors at Advocate m D really love what
you're doing and are a fun are a fun bunch

(03:57):
as well. So if you know you mentioned doctors that
are maybe in that system feeling the insurance system feeling
burnt out, want to go to a really, really great
environment and really actually have an opportunity to do what
you love. Advocate MD such an amazing an amazing place
to work, and of course a great place to be
a patient as well. Doctor coming up here at eight thirty,

(04:18):
we're going to be talking about retirement planning, and one
of the things that often comes up is pe and
talking a little bit about about money, and we're actually
going to be talking about private equity in a context
of healthcare, which just feels very very strange. Let's talk
about private equity and what it's kind of done to healthcare.

Speaker 2 (04:41):
Yeah, you know, it kind of prompted me. I get
these different journal articles and stuff by email, and I
saw an article pop up about the title from JAMA,
the Journal of the American Medical Association, which is probably
one of the most prominent journals in this country. The
title was changes in Patient care Experience after private equity
acquisition of US hospitals and this was very recent, so

(05:03):
it kind of got me thinking. And to me, the
results of the study were not surprising. But you know,
I think if you ask most people, and I mean,
I'm curious your thoughts too, Seane, If you know what
was your health care experience like five years ago, ten
years ago, twenty years ago, you know. I mean most people,
I would think would answer that their medical experience, their

(05:26):
health care experience now is worse than it was many
years ago. And again I think there's that's kind of
multi factorial. There's many things that feed into that. But
when you think about it, it's like, healthcare today is
much more expensive, we have better technology, we have more resources,
we have you know, beautiful facilities, hospital systems. So why

(05:47):
is the care that patients are receiving in their perception
of that care worse than it was twenty years ago?
And I think that again, there's there's many reasons for that,
but I think a lot of it comes down to
the lot of the practices that now healthcare systems as
they've become larger, and all the mergers and acquisitions and
private equity acquisitions of health systems, we've transformed healthcare into

(06:11):
almost like a business practice practice. Of course, it is
a business, but I think a lot of the the
business processes that we use for for you know, retail
or you know, uh, manufacturing, those don't necessarily translate to healthcare.
Some of them might, but but there to me is
a little bit of a difference. That's why I always

(06:32):
don't like to talk to call patients customers. Patients are patients.
Customer is a separate thing, right because my number one
priority is taking care of that patient. So I think that,
you know, when you look at all these these business
practices that now a lot of hospitals are implementing are
large healthcare systems, so like the Lean six sigma and
all these like lean processes that they try to implement,

(06:53):
it's like, yeah, there are inefficiencies in the system, but
there's this kind of human component that you have to have,
you know, you have to it can't just be this
kind of cold box that people are walking into and
they taught you know, like type on a computer screen,
and when people are entrusting you with their medical care,
there's something a little bit extra that you have to

(07:14):
do for that. So I think we've really lost that
in many cases, we've lost that, you know, kind of
trust in the healthcare system. The doctor patient relationship has
changed a lot in the last twenty years. Doctors don't
spend as much time with their patients, they don't listen
to their patients as much. Again, some of that's because
they don't have the time. But again that's what in
our direct primary care experience, direct premorary care model, we

(07:37):
seek to change all of that.

Speaker 1 (07:39):
You know, I think a lot of folks may be
familiar with the frog and a pot and metaphor with
the frog the pot that's slowly adding heat and doesn't
realize that that there's a problem until it's too late.
And I think for a lot of people with that
healthcare system, it's kind of been these these incremental changes
for the worst that they've got reached to this point
now and they're like, wait, what's happened? And it's been

(07:59):
something that's been slowly building for years and years and
years and very very unfortunate about that.

Speaker 3 (08:05):
Real quick too.

Speaker 1 (08:06):
By the way, you mentioned profit, and then some people
may have heard you mentioned the word prophet say well, well,
my healthcare system is not profit not for profit. I
like that you left explain why that's maybe a bit
of a misnomer. Doctor.

Speaker 2 (08:23):
Yeah, So twenty years ago, we had a lot of
private hospitals, for profit hospitals, and then we had a
few non for profit or nonprofit hospitals. Quickly, hospitals caught
on because right they've got smart people working for them,
smart accountants and financial advisors, that they should change their
status to nonprofit. I believe that years ago that meant

(08:46):
more than it does today in terms of how that
hospital gives back to the community. I believe that, you know,
it used to mean that they gave a certain percentage
of their profits, of their earnings, you know, back they
did a certain percentage of charity, all of these things
which I think have basically fallen by the wayside in
my opinion. So now the vast majority of hospitals I

(09:07):
can't remember I read the statistic recently. It's you know,
seventy eighty percent of hospitals are nonprofits, right, so it
doesn't mean very much anymore. They do make a profit,
and then they transfer that profit into building new facilities,
purchasing equipment. You know, they can pay their executives more.
They don't have shareholders, right, so they're not like a
publicly traded corporation. But that does not mean that they

(09:29):
cannot make a profit. And that also doesn't mean that
they cannot charge exorbitant prices. And then when their patients
can't pay their bills for their cancer treatments, or their surgery,
that they don't take them to collections because that happens
every single day and it happens here locally in Madison.
So I do think that, like you said, Sean, sometimes
there's a misconception that because the hospital is a nonprofit

(09:51):
that somehow that means that they're working for free or
they're breaking even of course that's not true. We can
all see the beautiful facilities they can building, and you
build those facilities, right, You build those facilities through your
insurance premiums and your payments to that hospital for everything
you get done, and all your copays and all your
deductibles you pay for that facility. So yes, I think

(10:16):
that unfortunately, that's kind of taking a turn and they
use those tax advantages to their benefit.

Speaker 1 (10:21):
Talking this morning with doctor Nicole Hempkis of Advocate MD.
The website Advocates DPC dot com. That's Advocate DPC dot com.
A great option for primarycare. For looking for something for yourself,
your family, or an employer looking for options for your employees,
definitely check out Advocate MD and Direct Primary Care. The
website Advocates DPC dot com. That's Advocates DPC dot com.

(10:43):
You mentioned kind of the how cold and sterile and
kind of just very not very welcoming. It's just doesn't
feel like the old healthcare systems used to. What's going
on there? I mean, it's it's it is like you
walk into these very sterile facilities and they've got you now.
And I mentioned the frog in the pot earlier, they've

(11:04):
got in these in these facilities, they've got you doing
like even like the check in work. Now we're back
in the day. At least you be greeted by somebody.
That stuff is generally out the window these days as well.
What's going on there?

Speaker 2 (11:15):
Doctor, Yeah, that came to my mind too, Sean, as
we talked about that. Now one of the large, the
largest health system here locally is doing this self rooming,
and it was kind of made me laugh because you
know when when big health systems do things like that,
then the smaller systems see what they're doing and try
to replicate it, thinking this must be a great idea,

(11:36):
because one of the small, very small systems I used
to work at that's near the Dells is doing a
self rooming also. So so yes, so basically, not only
now do you walk into a medical clinic that's either
inside of a large hospital or owned by a large hospital,
and now you are responsible. You know, maybe they give
you a number kind of like when you're at a
restaurant and then you have to go find your room

(11:57):
through a maze of hallways and you know, sit in
the empty room for you know, fifteen minutes or however
long until somebody comes in. But yes, I mean the
way again I look at healthcare is that many people
I would say, maybe even venture to say the majority
of people have some apprehension when it has you know,
when it comes to going to the doctor, either they're

(12:19):
nervous about a medical condition that's going on. You know,
they don't go to the doctor a lot. You know,
they maybe have a slightly distrust of the medical you
know community, there's many reasons. But but you know, when
they enter into a medical clinic or a hospital, you know,
it's probably not something they're looking forward to doing. For
most people, you know, it's not like kind of like
going to the dentist. Right. So, so I think that

(12:41):
you know, when you are greeted by somebody and they
smile at you and they say hello, miss Jones, and
they take you into a room, they sit with you,
they talk to you like a human being. That's a
lot different experience than walking up to a computer screen,
you know, trying to fumble through what you have to
put in there, and then it doesn't accept your insurance information.
It asks you to update all these things and you

(13:01):
get you know, I personally get really frustrated when I
have to do that stuff. And then and then you
kind of sit down, you room yourself. That is a
very different experience. And there is nothing about that that
is patient centered. And I would love to argue with
somebody as to how that is better patient care. The
only reason for that is financial, because you have done
away with staff to be able to greet that person

(13:24):
and to take them back to a room. So so
that part is kind of one aspect of it, you know.
And so this JAMA article they were doing ratings of hospitals.
And again, now when we think of hospitals, when you
think of a hospital, you can almost think of everything
that's included in that because you know, hospitals now own
primary care doctors, they own the specialists, they own the

(13:47):
surgery center, they own the you know, the radiology facility,
and much of that is you know, within the doors
of the hospital building. But they own all the external
things too. So they look at these things called h
cap scores, and some people might be familiar with this
another one that's called presciyany, but age caps are specifically
for patients that are going into a hospital for either

(14:09):
a surgery or a procedure, and so they give they
send that patient typically in the mail, a survey, you know,
weeks later. I used to work in a hospital for many,
many years, so I'm familiar with these because you know,
they would talk to us about these age cap scores.
But so they they look at a variety of things,
and they asked the patient a question about how how

(14:30):
if they felt like they were treated courteously by their doctor,
did the doctor listen to you, did the doctor explain things.
They ask them things about the environment of the hospital,
whether it was clean, whether it was quiet at night.
They ask about the nursing staff, you know, whether the
nursing staff helps them enough, whether they were given their
medication on time, whether the nursing staff was responsive, if

(14:51):
they you know, put their call light on how what
they're the process was like for checking and for leaving
the hospital, you know, whether they were you know, if
they had to be discharged to another facility. And then
the final question is, you know, how do you rate
this hospital and would you recommend this hospital to your
friends and family. So they looked at all these scoring

(15:12):
and they were specifically viewing it for sorry, seventy three
US hospitals that had been acquired by private equity. You know,
and again we've talked about on the show, you know,
mergers and acquisitions and how now the majority of hospitals
are owned by bigger health systems that might be part
of private equity, but they've purchased hospitals spanning multiple states,

(15:33):
and most likely that headquarters is not in your state
that you live in. It's in a different state. So
they compared those hospitals, and then they had some control
hospitals where they were not purchased by private equity, and
they looked at this from two thousand and eight to
twenty nineteen, the three years preceding the acquisition of that hospital,
in the three years following the acquisition of the hospital.

(15:56):
Excuse me. What they found was that the patient experience
got worse when a hospital was acquired by private equity,
and it seemed to get worse the further out it
was from that acquisition, so three years following was worse
than like right after it was acquired. And the specific
things that got worse were patients, the question about whether

(16:18):
or not they would recommend that hospital to friends and family.
You know, that answer became no in more cases. And
then also the responsiveness of the staff. And then I
think something stayed neutral in terms of process and environments.
And then you know, things again like the experience of
whether the doctor listened and stuff like that I believe

(16:39):
also became worse. But it's not surprising to me. Right.
So again, when we translate a lot of the medical
processes into more business processes and view healthcare and medical
delivery as a business one hundred percent of business, and
we take out that human component of it, as we

(17:01):
were talking about, Sean. So what that means is you
look at everything and see how you can cut in efficiency.
So let's let's have less staff, Let's have less nursing staff.
Let's have doctors take care of more patients. You spend
less time with them, but that's okay. The nurse is
taking care of you know, six patients at any given
time rather than three. Well, so I mean, it's going
to be harder for her to respond to the call

(17:22):
lights if she has six patients rather than three. It's
interesting because in many states this is regulated in terms
of how many patients and nurse can have at any
given time, and also depending on the acuity of those patients,
like if they're ICU patients versus you know, post op
patients and things like that. So some of this is regulated,
and legally they have to stay within those standards, but again,

(17:44):
I think private equity will push the boundaries of that, right, Like,
so if they look at this as like, how can
we get the most juice out of this lemon, or
you know, how can we squeeze this for as much
as it's worth, they're going to try to utilize their
staff to the to the highest in terms of their capacity,
and they're gonna again maybe cut out the things that involve,

(18:05):
you know, spending more time with patients and being able
to kind of do that a little bit going above
and beyond for that patient, because you don't get paid
for that necessarily, right, So, so I just found it
interesting that they've been able to kind of objectively demonstrate
this through this study.

Speaker 1 (18:23):
It's kind of sad when Taco Bell has better customer
service than the hospital there said Taco Bell. If I
don't want to use the kiosk, I can go up
to a person and order that way.

Speaker 3 (18:33):
It is.

Speaker 1 (18:34):
It's it's unfortunate. And as as we get more studies
and more data and more information on on it, I
think anyone that's experienced the current healthcare system, they're probably
you're probably in your car right now, not in going
yep yep. I know exactly what doctor Hemkiss is talking about.
We think about Advocate MD patients. They are the priority.

(18:55):
It is a great day to become a member at
Advocate MD. You can learn more online Advocates DeepC dot com.
That's Advocates DPC dot com even better. Today's to day,
make that call become a patient, become a member at
Advocate Mdtel forh number six oh eight two six eight
sixty two eleven. That's six oh eight two six eight
sixty two eleven. We'll continue our conversation with doctor Nicole
Hempkiss of Advocate MD. We will do that next as

(19:16):
full scope continues here on thirteen ten Wi B A,
thirteen ten Wi B A and full Scope with doctor
Nicole Hemkiss, Wisconsin's directcare doctor. Thewebsite ADVOCATESDPC dot com. That's
Advocate DPC dot com. Tel Number six oh eight two
six eight sixty two eleven. That's six oh eight two
six eight sixty two eleven. Let's compare and contrast, and

(19:39):
as we were talking in that last segment about what's
been going on in healthcare and especially with the hospital
systems here in the added state, let's compare that doctor
to direct primarycare a bit of an overview about what
direct primarycare is, what it isn't why it's obvious and
I know this answer, but why it's become so popular
here in Madison and Dane County and across the country

(20:01):
as well. Let's talk just a little bit about what
DPC is.

Speaker 2 (20:06):
Yeah, so direct primary care is a model where we
separate out primary care from the rest of healthcare. So
we view primary care as something that can be kept
very affordable when we take it out of a hospital system.
When you see your doctor for your preventive care, visits,
your chronic disease, follow up, urgent care, minor procedures in

(20:26):
the office, all of those things we can do in
an outpatient setting, you do not need to go to
a big health system to do that. And when we
pull primary care out of the rest of healthcare and
we do not use our health insurance for that, that
makes it more affordable, more accessible. So it's a monthly
membership fee that you pay at averages around seventy dollars
a month. This is an add on to your insurance

(20:49):
because you still need some sort of insurance, some sort
of catastrophic coverage in case you need to be hospitalized,
you need major surgery, you have a very unfortunate diagnosis,
I can't or you want to be covered for that.
That could be a high deductible insurance policy, that could
be a health share. There are many options. But again
the idea behind this is that when you see your

(21:10):
primary care doctor, you don't want to be seeing a
primary care doctor that's part of a large health system.
They are then going to refer you back into that
large hospital system for everything, and that's going to become
much more expensive for you, for your employer if you
have employer paid for benefits, and it's just not a
sustainable model for our healthcare system to continue on that trajectory.

Speaker 1 (21:32):
Talking this morning with doctor Nicole Hemkiss of Advocate MD
as we talk about the direct primary care model. It's
a monthly fee, it's it's a really really amazing setup,
no cost for your visits. There are great options for
insurance and health shares that it pairs very well with.
You can get information about all of that online Advocate
DPC dot com. That's Advocates DPC dot com. Doctor Hempkiss,

(21:56):
it's always great chatting with you. You have a fantastic
weekend and we'll talk again very soon you too, Sean,
Thank you. News comes your way next here on thirteen
ten Wi b A