Shopping By Price

Dr. Hemkes talks about what hospitals, outpatient centers, and other locations charge for different servers and why it pays to shop around.

Episode Transcript

(00:05):
Away thirteen ten WIBA and full scopewith doctor Nicole Heempkiss, Wisconsin's directcare doc.
Of course, doctor Nicole Heempkiss comesto us from Advocate MD, a
direct primary care practice. If you'renot familiar with direct primary carey learn a
whole lot about it online at AdvocatesDPC dot com. That's Advocate DPC dot

(00:25):
com. Not only can you learnabout direct primary care, you can learn
about Advocate MD all at the websiteAdvocate DPC dot com and the telephone number
six O eight two six eight sixtytwo eleven at six O eight two six
eight six two eleven. Make anappointment to become a member at Advocate MD
again their number six O eight twosix eight sixty two eleven. And we've
got phone lines open as well ifyou've got questions about direct primary care.

(00:46):
Love to have you joined us thismorning at six O eight three two one
thirteen ten at six O eight threetwo one thirteen ten. And joining us
this morning, as mentioned is doctorNicolehemkiss. Doctor. How are you doing
this week? I'm doing well,Sean, how are you? I'm doing
really really good. And we've gotsome great stuff to talk about, really
important stuff. A lot of questionsI think sometimes people have about pricing and

(01:07):
price transparency and what the heck isgoing on with that type of stuff Before
we get talking about that though,real exciting news obviously, Advocate MD.
We've been talking about the west Sidelocation in Middleton for a while as well
as the east Side location and Southfair Oaks have your Janesville clinic. Your

(01:27):
south clinic is now open, runningand taking patients, isn't it. That's
right. Yeah, we've been opennow for about a month and a half
and a doctor, Christina Quality,is working down there and she's also working
at our other two clinics. Butyeah, we're seeing patients and it's going
very well. They liked the spaceand we'll be expanding that the hours in

(01:49):
the days that were open down thereas the summer comes along. And that's
right at ten twenty one Mineral PointAvenue in Janesville, and again the other
two locations of Advocate MPT west Sidehere in Middleton at thirty two oh five
Glacier Ridge Road and east Side Madisonat one fifty seventh South fair Oaks Avenue.
Again the three locations to serve you, and of course you can learn
more speaking of locations, website thatcounts to the location these days, I

(02:12):
do believe advocate DPC dot com.That's Advocates DPC dot com. And I
know one of the big parts ofdirect primary care is transparency and of course
the openness of this is what thingscost and working. And I know with
Advocate MD that's partially the word advocate. Where that comes from is being open

(02:34):
with patients and advocating for them aswell. Let's talk about some pricing and
work through some of the examples.I think one of the big questions folks
often asks is why do prices varyso much from maybe one location to another
and m and kind of people seethat discrepancy, they say, wait a
second, why is that such sovaried and what are some of those factors

(02:54):
there? Yes, it's it's somethingthat I would say part of the problem
with our healthcare system is just that, you know, we don't know the
cost of things. We don't knowthe price of something, and it's very
hard, I would say, tocompare prices of things. You know,
it's not like you know, ifyou go into a retail store, if

(03:15):
you go into a restaurant, youknow, there's a menu of prices or
the price tag is right on theitem. You know, in healthcare,
we don't have that situation. Sotypically the situation, the scenario is that
you go in and see a doctorand you know, you you think you
might know the cost of it basedon what your insurance is going to cover,
and you think maybe it's just yourcope. You know, potentially they

(03:36):
might add a different code on there, and so maybe it isn't covered under
your your insurance. So then youget a bill two or three months later
saying, Okay, this is whatyou're responsible for. And you know,
the other frustrating part is that manyof these, you know, the cost
of something or what it actually coststhe hospital the health system to do the
procedure or the test is very differentthan the price. Right so we can

(04:00):
kind of figure out cost of things, but the price that is set by
the health system is very much ina way sort of arbitrary. Um.
You know, so a hospital candecide um. You know, they own
the MRI machine. You know,they are paying a tech to sit there
at the radiology tech to do theMRIs um. They are paying for the
overhead on the building where the thatMRI machine is sitting. So that's kind

(04:20):
of how they could calculate their cost. But the price that they that they
charge you is not really related totheir cost. They're kind of setting that
very high. And you know,then they have all the other additional fees,
like the facility fees, um youknow. So the really frustrating part,
and we use MRIs for some reasonas an example frequently, is that
you know, I remember, priorto starting the practice, you know,

(04:44):
many of these things I just assumedwere very expensive. You know, things
like MRIs I assumed were expensive becauseyou know, as a doc employed in
the system and the insurance based system, you know, if I had to
order an MRI on a patient,you had to jump through all these hoops
you had to get, you know, prior authors from the insurance because they
would deny the claim. And youassume the reason that they're doing all these
additional steps is because this test mustbe very expensive. And the irony of

(05:08):
it is that, yes, dependingon where you go for that MRI,
it might be very expensive, butit also could be inexpensive or less expensive
if you choose to go to adifferent facility. So in the MRI example,
if you choose to go to ahospital to get the MRI. You
know, you could easily be lookingat you know, five or six thousand
dollars. So for many of you, maybe you have a five thousand or

(05:31):
ten thousand dollars deductible, So that'sgoing to go towards your deductible until you
meet it. But let's say youchoose not to go to a hospital and
instead you go to an outpatient imagingfacility, then that MRI could be five
or five hundred or six hundred dollars, so you know, a tenth of
the price of in the hospital system. And you say, again, why

(05:51):
is there so much of a differencehere between if I go to an outpatience
or something located outside of a hospitalversus something inside of a hospital. So
I can feel pretty confident in sayinganytime you have something, any sort of
service done in a hospital, it'sgoing to cost you more. There's there's

(06:11):
many reasons for this, and youknow, the hospitals argue that the cost
of them doing business is more expensiveto run the hospital, and they have
a lot of overhead costs and youknow, all of that maintenance of a
building like that and things like that. But honestly, again, there's a
lot of things that that you know, we could be doing in an outpatient
setting that we do in a hospitalsetting. And again that that goes back

(06:33):
to who's referring you into they setting. So is it your primary care doctor,
is it the specialist? Is itjust because that's the place you've always
gone because of your insurance that yougo into the hospital for these things.
But if we can keep things outof the hospital, we can make them
much more affordable. So if wecan do that MRI at an outpatient facility.

(06:53):
For example, Image Imaging is acompany out of Milwaukee that is just
in the next two weeks opening afacility in West Madison or I think it's
technically Middleton, so they will havean outpatient imaging facility, which is a
great thing for you know, ourlocation, our community here, that we
have that option again to help peoplesave on those costs. Yes, it's

(07:16):
it's very difficult to navigate these things, and most people, including myself,
you know, before I understood allof this, you know, if I
went back five or six years,I didn't realize that these options even existed.
It is amazing and it's I thinkfor a lot of us. We
obviously, I think one of themistakes we always make is one insurance companies
are looking out to get us thebest price, and we also assume that

(07:41):
the price is what it is isbecause it's very you know, obviously not
that cmris are inexpensive, but obviouslythere's some costs and we think, okay,
well this has got to be expensive, and as patients we think that
way. But then I think alsoto learn that that doctors also don't always
realize some of the markup and someof the stuff that goes on with these

(08:01):
with these things for patients, it'spretty eye opening. And when we talk
about the differences between the hospital settingversus an outpatient setting and getting through that
stuff, it's it's really I thinkmakes us very very aware of a lot
of bloat and a lot of wastein that those in those insurance systems,
those healthcare systems. Of course,we've talked with doctor n Colhem Kiss,

(08:22):
Doctor Colhem Kiss and the doctors atAdvocate Empty. They do not bill insurance.
Again, they are a direct primarycare practice. Amazingly affordable options,
high quality healthcare for you your family. If you're an employer looking for primary
care options for your employees. Definitelycheck out Advocate MD and Direct Primary Care.
Learn more online Advocates DPC dot com. That's Advocates DPC dot com.

(08:45):
Telephone number to make an appointment itbecome a member six O eight two six
eight sixty two eleven. That's sixO eight two six eight sixty two eleven
to make an appointment to become amember at Advocate MD and doctor. I
think one of the areas too thatas a patient we often get confused by
is trying to navigate through this stuffand try and figure out, um,
you know, what is out there. So knowing that these things are out

(09:07):
there is one thing. Um kindof navigating and figuring out what our best
options are those are. Those arecan be complicated as well, can't they?
Yes, Um, you know,I think if this is improving.
You know, you've probably heard alot of stories in the news over the
last you know, probably last threeor four years, even when President Trump

(09:28):
was in office about pricing transparency.He was really trying to push through a
lot of legislation that would require hospitalsystems or these large health systems to show
their prices to consumers again, whichwould allow them to be you know,
better educated and informed, um.You know, healthcare consumers that they could
decide, Okay, well, youknow, if I need this surgery,

(09:50):
if I need this procedure done,if I need to see this specialist,
I'm going to choose hospital A versusHospital B because the cost is going to
be you know, a third ofthe price. Um. And again,
you know, when we talk aboutvalue in healthcare or I guess in other
things, we're looking at both thecost but also the quality. So a
combination of those two things. Andyou know, we've we've mentioned before that

(10:11):
the cost of something in healthcare hasno bearing or the price has no bearing
on you know, what the qualityof that is. There's a really good
website that I encourage people to goto that's through the Wisconsin Hospital Association,
and in some ways, Wisconsin,ironically we have some of the highest healthcare
costs in the country, but wehave been a little bit ahead of the
game compared to other states. Notall other states, but we have had

(10:33):
a pricing transparency website for a numberof years called price Points. So you
can google, you know, WisconsinHospital Association price Point, and it's going
to bring you to this website whereit's going to allow you to compare the
cost of you know, whether it'sa mammogram, a colonoscopy, a knee
surgery. In some cases, they'llrequire you to type in something called a

(10:54):
CPT code, which you can justgoogle like CPT and type in, you
know, whatever the procedure is you'rehaving done. Sometimes it gets a little
complicated, But the interesting part isthat you can look up, you know,
let's say, various hospitals in ourarea of southern Wisconsin, and we
you know, we can compare theprice of those things. And as I
mentioned, you know, let's saythe smaller hospital that maybe doesn't have the

(11:16):
world renowned surgeons, you know,their cost for a knee replacement might be
you know, three times higher thanthe large academic medical facility that has a
really good reputation. So again,I don't want people to think, because
we talk about more affordable cost,that that means that we're trying to send
you to a doctor or a facilitythat's lower quality, because that's completely not

(11:39):
the case. But I think thatthat's a really cool website to be able
to look up some of these things, and you will also kind of from
that be able to tell the dramaticdifference in price from one hospital to the
next for the exact same thing,so the exact same X ray that you
know, if you needed a biopsy, if you needed a colonoscopy, these

(12:01):
prices very dramatically. It is prettyeye opening when you see that and checking
out that website, it is prettyit is pretty amazing just how the variance
of costs and then what a costto have these procedures done. Talking this
morning with doctor Nicolehemkiss of Advocate MD. The website Advocates DPC dot com.
That's Advocates DPC dot com. Youcan learn more about Advocate MD. You

(12:24):
can learn more about doctor Nacolehemkiss,doctor Adam Balen, doctor Karen Shulman,
doctor Michael Augie, doctor Christina Quality, and all the locations of Advocate MD
all on the website Advocates DPC dotcom. Also learn more about Direct Primary
Care. To make an appointment tobecome a member at Advocate MD, I
get Here's give a call six Otwo six eight sixty two eleven at six
O eight two six eight sixty twoeleven looks into your conversation with doctor n

(12:46):
Coolhemkiss. Talk a little bit moreabout some of the challenges when it comes
to pricing transparency. We'll get thedetails on that next as full scope continues
right here on thirteen ten WIBA twentythree thirteen ten WIBA chatting this morning with

(13:07):
doctor Nicole Hempkiss of Advocate MD.You can learn more about doctor Nicole Hempkiss
all the doctors well, is thedifferent locations of Advocate MD, some of
the services, and the great thingsabout direct primary care offered. You can
learn all about that on the websiteAdvocates DPC dot com. That's Advocates DPC
dot com. The telephon I'm makingan appointment to become a member at Advocate

(13:28):
m D six O eight two sixeight sixty two eleven. That's six O
eight two six eight sixty two eleventalking this week about pricing, transparency and
doctor Before the break, we kindof started to kind of scratch the surface
a bit about some of the someof the cost and some of the some
of the variations in costs for somefor some kind of specific procedures. Talking

(13:52):
about MRIs, what about things likefor example, hips and I know one
of the great things about modern medicineis things like hip replace ments, and
other things that can go on.Um, simply getting an X ray of
a hip can can the cost canvary pretty significantly depending on where you go,
can't it? Yes? Um?And you know, I think we've

(14:13):
mentioned before that we have a mobileX ray company that comes into the office,
so we can get these X raysat an extremely low price. UM.
And you can't even compare it toany of these facilities that we also
have an ultrasound They also do ultrasounds, but kind of just for curiosity.
And also, you know, becausewe have the new clinic down in Janesville,
and I was kind of calling aroundto some of the local hospitals to

(14:35):
get their price on on X rays. UM. You know there's one in
particular just right across the streets fromthe clinic. UM. The other the
other frustrating part is, you know, me as a doc and I do
this every day, so I havea lot of knowledge of what the price
of something should be or kind ofwhat it you know, comparable prices,
UM. And I I have youknow, I understand that they add on

(14:56):
you to these facility fees, andsometimes there's a radiologist fee that they add
on separately. But for a consumeror a patients. It's hard to know
all of this stuff. So evenif I am calling this hospital billing department
and asking them for the price again, unless you know, maybe you listen
to the program a lot, youwouldn't really know to ask all these questions.
So I called this, you know, let's say this hospital, and

(15:18):
I'm asking them. I wanted toget some examples of prices on the X
ray, so I, you know, I asked them about a hip X
ray and at first the girl onthe phone with me comes back with a
price of a thousand dollars and Igo, A thousand dollars for a hip
X ray? I said, I'venever heard of a price that high.
Are you sure? Can you doublecheck that please, because we can get

(15:41):
an MRI for that price, right, And and then I said, does
that include the cash discount? Sowhen you are paying cash a hospital system
health system will discount that price anywherefrom twenty five percent to the biggest I've
heard is like sixty six percent,So sometimes they're taken off two thirds of
the cost of it if you're payingcash. In some cases they will require

(16:03):
you to pay it the day ofservice, but in most cases they do
not so that's actually a really gooddeal if they're you know, taking off
fifty percent of the bill because you'repaying cash in this case. You know,
she said, yes, that thatis that is the cash price,
and again you have to then makesure, okay, does that include the
facility feed, does that include theradiologist fee and all of these things.

(16:25):
So then I had them compare thatfor me, that was to have it
done in the hospital, and thisparticular hospital system has an outpatient facility where
they do X rays that's ten minutesaway. So I asked them what the
price would be at that at theoutpatient facility one hundred dollars, So one
hundred dollars versus a thousand dollars foran X ray. And again, like
these things just kind of blow yourmind because people think like, no,

(16:48):
this can't be right. Like you, I've had people say to me this,
this should be on the news,Like why aren't people talking about this
on the news every night because they'reyou know, I don't want to say
the people off because this is alllegal what they're doing, but um,
but yeah, So it's that kindof dramatic of a price difference that that
you know, it's kind of shockingit is. It is like it's almost

(17:11):
to the point of like, it'sso unbelievable that people I like, wait
from a thousand to a h it'sjust like it's it's so hard sometimes to
comprehend how I think people say,well, how how does this get to
this point? How can how canthere's be such a difference and able to
get away with it and doc Aswe kind of work through some more specific
examples, things like colonoscopies and obviouslyvery important vital medical tests. Um,

(17:37):
there's there's a variance there as wellwhen it comes to costs, isn't there
Yes, So most people, ifthey have insurance, any form of insurance,
if it's a high deductible or alow deductible, you're screening colonoscopy will
be covered. So so you mightmake the argument, do I really care
how much it cost because my insuranceis covering it? Um? Well,
I would say yes, you shouldcare, um because there is this little

(18:00):
known thing that can happen where ifthey're doing your colonoscopy and they find a
polyp, then they switch the billingover to a diagnostic colonoscopy rather than screening.
This is completely legal. It's I'veposted about it on social media before,
and then therefore once it once it'sa diagnostic, it is no longer
covered under your insurance. You haveto pay it until you meet your deductible.

(18:21):
But anyways, you know, oneof the local health systems. Again,
it's part of our job with AdvocateMD is that we help patients navigate
this. So, you know,whatever their situation is, whether they have
insurance, they have a health share, they have a high deductible insurance,
we try to present them the optionsand explain all these things to them.
So we will say, you know, this is covered with your insurance,

(18:41):
but you know, if they findsomething and they switch it over to a
diagnostic, then it's not covered.Do you still want to go to this
place? So one of the localhospital systems that we send a lot of
patients to that seems to be sortof expensive, you know. So it's
it's fifty five hundred dollars for acolonoscopy, assuming that the patient is paying,
you know, they give a thirtypercent cash discount. But if we

(19:03):
send that patient to a cash basedfacility, we can get that colonoscope for
fifteen hundred dollars. If they wantto drive a little bit further, they
can actually get the colonoscopy for ninehundred dollars. So again it's the idea
of this nine hundred dollars versus fivethousand dollars. You know that that makes
people think, Like for most ofus, including myself, like, yeah,

(19:26):
I'll drive an extra hour to saveyou know, two or three grands.
I mean, like, come on, this is not a hard decision
to make, and it also kindof empowers you in a way. For
me personally, I would rather knowthe cost of something and not feel nervous
that, you know, depending onhow they code this. You know,
if they find something, you know, I'm going to potentially be on the
hook for multiple thousands of dollars.Like to me, I would just rather

(19:49):
do it at a facility where I'mgoing to know the cost of it and
it's not going to change no matterwhat they find. So in the case
of a cash based colonoscopy, itdoesn't matter if they find a or not.
That cost is going to stay thesame. That is that is I
mean, I think about I think, and obviously I know I think most
people who listen to the show regularlyknow, Um, you know that that

(20:11):
you're somebody that that that one likesto expose the truth and and also expose,
um, some of the things outthere that are a bit deceptive,
and of course like to fight fightthose who may be deceptive or maybe uh,
you know, taking advantage of offolks that may not fully understand UM,
all their options out there. You'retalking about thousands and thousands and thousands

(20:33):
of dollars and savings in some casessimply by by going up the road a
little bit and and and looking aroundfor these things. As we talk with
doctor Nicole heem Kiss, one ofthe really cool things too, as we're
talking this morning about pricing transparency.One of the big parts of Direct Primary
Care and Advocate MD is pricing transparency. When it comes to UM, what's
it going to cost? Was thecost to become a member at Advocate MD,

(20:56):
UM, what does it cost asfar as any type of procedures that
you may need, things that canbe done in clinic. It's all spelled
out in black and white, andit is amazingly affordable. Check them out
online Advocates DPC dot com. That'sAdvocates DPC dot com. After you do
that, you're going to want togive them a call and make an appointment,
become a member, because it's justthat amazing six or eight two six
eight sixty two eleven. That's sixo eight two six eight sixty two eleven

(21:18):
one final thing. And I knowthere's we could do examples all day,
but I know something fairly common differenttypes of biops season and there are some
pretty significant differences in costs for biopsies, aren't there. Yes, So again,
if we have a patient in ourpractice, for example, that either
you know, we have an ultrasoundof their thireid, they have a nodule

(21:41):
and they need a biopsy of theirthiraid. Another example would be a breast
biopsy if they have a cyst intheir breast that it is potentially suspicious or
something. We call it a complexsyst. So we can send these patients
to an interventional radiologist and the costdifference of that biopsy, again, if
they haven't done through UW, thecost last night check of a thyroid biopsy

(22:02):
is around five thousand dollars. Abreast biopsy is eight thousand, five hundred
dollars. This is the pathologists charge, the radiologist charge, the facility fees.
If we send them to this interventionalradiologist, you know, he charges
around four hundred dollars depending on thetype of biopsy it is. They can
take their pathology back to us andwe send it to our pathologists, which

(22:25):
charges forty five dollars to the pithology. So we're talking about, you know,
less than less than five hundred dollarsfor a thyroid biopsy. That would
have been, like I said,over five thousand dollars in the system.
And these are the kind of thingsthat kind of just drive you crazy.
And again, it's one of thesethings where you know, if you if
you say, well, I havea thousand dollars doctor, well, I
don't really care. It could beit could be thirty thousand dollars. Who

(22:45):
cares because I'm not paying the restof it. But in a way,
really I think we all should care, right, because this is just contributing
to these exorbitant healthcare costs. Whatit's also doing is that it's increasing your
insurance premiums for the following year becausethey're going to look at all your claims
data and say like, oh,look, we paid out X number of
money on you this year, sowe're going to increase your insurance next year.

(23:06):
You know, so in your company'sinsurance, I should say so.
I think it is important to careabout these things. And also just you
know, why feed the monster ifwe don't have to. So I think
if you can find alternatives that arefair affordable prices at a good value,
high quality, then we try tosend people to those places. And again,
it all starts by learning more aboutdirect primary care. And of course,

(23:27):
if you're looking for great options foryourself, your family, if your
employer looking for some great options forprimary care for your employees, check out
Advocate MD. Can learn more aboutdoctor Nicole and all the doctors at Advocate
MD and learn about their different locationsas well as how direct primary care works.
All you gotta do is head onover the website Advocates DPC dot com.

(23:48):
That's Advocates DPC dot com. TellPhil number to make an appointment and
become a member at Advocate MD.Six O eight two six eight sixty two
eleven. That's six O eight twosix eight sixty two eleven. Fantastic website,
great resource, Doctor Nicole. Itis always eye opening talking with you,
and thank you for all the greatwork that you and your doctors do
at Advocate MD and I look forwardto seeing you real soon. Thanks Sean,

(24:12):
you too, and again the websiteadvocates DPC dot com and the telephone
number six O eight two six eightsixty two eleven at six O eight two
six eight sixty two eleven. Newsis next here on thirteen ten wi BA