Episode Transcript
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Speaker 1 (00:00):
Eight oh seven thirteen ten WIBA and full scope with
doctor Nicole Mkiss, Wisconsin's direct care doctor. Of course. Doctor
Mkiss comes to us from Advocate MD, a direct primary
care practice with four clinics, three here in Madison, one
right in Janesville, the three and Madison of course, got
the west side location in Middleton on Glacier Ridge Road,
(00:20):
a side of Madison, right on South Fair Oaks, south
side of Madison, right in Fitchburg, right at the Madison
Fitchburg line on Syene Road. And of course the clinic
in Janesville for those of you in southern Dane County
and Rock County right at ten twenty one Mineral Point Avenue.
Of course, eight doctors at Advocate MD. You can learn
more online the website ADVOCATESDPC dot com. That's ADVOCATEDPC dot
(00:45):
com and telphen Our make appointment, Come a member at
Advocate MD. Six eight two six eight sixty two eleven.
That's six oh eight two six eight sixty two eleven. Doctor.
Next time I stop in for a visit, I may
need to get an autograph. You are all over the
place these states.
Speaker 2 (00:58):
How you doing I'm doing well, Sean.
Speaker 1 (01:01):
How are you I'm doing great, although I think the
modern equivalent of autographs now are selfies. I think is
what what folks are doing. We're going to be talking
price transparency this morning, which is a very timely conversation
for folks that may have missed it. I know we've
been playing a little little blurb on the news this
morning about it. But you had a chance yesterday to
(01:22):
talk a little bit about price transparency at hospitals, didn't you.
Speaker 2 (01:27):
Yeah.
Speaker 3 (01:27):
This this is a bill that's being introduced into the
Wisconsin Senate, so on a state level, there are legislation currently,
you know, on the federal level, but you know, it
is kind of on the top of my mind because
I had to prepare a little bit of you know,
some talking points that they asked me to do. I guess,
I guess before they introduce a bill, they do a
(01:49):
press conference and then and then it gets introduced. But
so that's the first time I've ever participated in that.
I've testified, you know, at the capital for various things,
but I've never done a press before. Were you nervous,
I guess a little bit, But I mean I was
only I only had three minutes to talk, so it
wasn't like a huge speech or anything.
Speaker 1 (02:10):
You don't you don't seem very flappable. That seems to
be like one of those things that I've I've noticed
about you over the years is you're You're pretty calm,
and I'm guessing it's probably works really well working and
being in medicine is being pretty uh comfortable and cool
even And you know, I think for a lot of folks,
like the idea of having to having to participate in
a press conference, uh makes makes us very nervous, but
(02:32):
UH sounded great. It's great. Great to have you on
with us this morning, doctor, and uh speak of price transparency.
One of the things that that you've that you've shared
and I was shocked by this where the state of
Wisconsin ranks when it comes to prices and people say,
is there a correlation between prices and transparency? I think
a lot of folks also would realize, yeah, there very much.
(02:54):
Is Where do we rank here in Wisconsin when it
comes to two prices for for healthcare?
Speaker 3 (03:02):
Yes, So there's various you know, of course ranking platforms
or websites that do this, but I guess, based on
what I've seen in the last year or two you know,
we're ranking either fourth or fifth in the country in
terms of highest price.
Speaker 2 (03:15):
So that's not a good thing. That's a bad thing.
Speaker 3 (03:17):
So fourth or fifth highest prices, and this is based
on hospital pricing because obviously that's where the highest prices
typically are seen in hospital systems. So so again, it's
funny that you mentioned that because one of the questions that,
you know, there are some press that sit there. I
think there's only two or three press that we're sitting
there during this press conference. But one of the questions
(03:40):
that came up, I think once or twice, was that
they said what they're claiming the Wisconsin Hospital Association, which
of course is against this legislation. Now just think about
that for a second. The hospitals do not want you
to know what they're charging for things.
Speaker 2 (03:57):
Now let that settle in.
Speaker 3 (03:58):
But you know, the excuse that they use is that, oh,
it's going to create additional you know, like costs for
them to have to do this, or administrative costs. And
it's like, well, I'm pretty sure you have enough like
people working at hospitals right now that you could already
do this, plus again if it costs them more, But
then it leads to the patient, you know, of course
(04:20):
getting better prices or more affordable prices. Then it's like, Okay, well,
I guess you're gonna lose a little bit of your
multimillion dollar of profit. But somebody mentioned in one of
the follow up questions was that the Wisconsin Hospital Association
is claiming that they already do all of this stuff
and this is unnecessary legislation. And then my point to that, well,
(04:43):
I actually don't think that that's true. But my point
to that would be, if that is the case, then
why do we have the fourth highest costs the highest
prices in the country. Because we're not Los Angeles or
Chicago or New York, you know, like we are not
these very high cost of living places, right. I mean,
obviously Madison is a higher cost of living than if
(05:04):
you go up to northern Wisconsin someplace, but we still,
as an overall state, we don't have the highest cost
of living in the country. So why are our healthcare
prices some of the highest in the country. And again,
I think that's multifactorial, but I do think that one
of the reasons is because we have multiple parts of
our state, including our local area here of Madison, where
(05:27):
we don't have price competition. So we have one or
two large health systems that are basically almost competing with themselves.
They don't have to show you the prices of things.
You basically default to going to the same hospital system
for everything because that's where your primary care doctor sends you.
And so they don't have to compete based on value,
which again is price and quality. They don't have to
(05:49):
compete based on that, so they can charge you whatever
they want. So I think that's a big problem. It's
not just a problem in Wisconsin, but I think it's
a big problem here, as I talked.
Speaker 1 (05:57):
This morning with doctor Nicole Hempkiss of Advocate M. Of course,
you can always learn more about direct primary care on
the website Advocates DPC dot com. That's Advocates DPC dot com.
Fantastic resource to learn more about direct primary care as
well as Advocate MD some of the great options for yourself,
your family. If you're an employer looking for fantastic primary
care options to offer your employees, definitely check out Advocates
(06:20):
DPC dot com. That's Advocates DPC dot com. So doctor
people often wonder, and I'm not alone in this, why
exactly it's so hard to uh, you know, to to
have transparency in healthcare. Why is that such a difficult
ask for for the hospitals.
Speaker 3 (06:40):
Yeah, you know, I think that there are certain aspects
of healthcare where it would be relatively simple to have
price transparency. I think things like lab cost, you know,
medication cost, you know, some sorts of sort of radiology costs.
You know, it'd be easy to have kind of a
menu of prices of this is what these things cost.
(07:00):
Where it gets more complicated are, for example, you know,
if you have a surgery or a procedure done, because
then you get into you know, what are the anesthesia costs,
They're they're going to charge you facility fees within that
hospital system. You know, are you going to be are
you going to need to stay in the hospital overnight?
How many days? Again, so some of that also is
(07:21):
determined by the course of of you know, what happens
after you have that procedure or that surgery. But again
that's a that's a relatively small part of healthcare for
most people, right, so most of us aren't having you know,
major surgery or you know, unfortunate things occurring like cancer
treatments and things like that. But I think so, I
think that there's a fraction of healthcare where it is
(07:44):
difficult to quantify the cost because there are variables involved,
But I think for the vast majority of health care
it would be simpler. The other part that complicates it, though,
is because you know, medicine is in some ways it's
almost it's like its own length language, right. It's kind
of like when you read a legal This came up
recently for me, when you read a legal document, and
(08:05):
it's like, well, lawyers talk and these they use this
verbiage that like, I don't know what these words mean.
I mean, medicine and healthcare is very similar, right, So
you know, a patient might say I need to get
an X ray of my my foot or you know,
an mriah or whatever. So it's like, is this the
the dorsal surface of the lateral component? You know? I mean,
(08:26):
like you know, do you know the terminology to be
able to look these things up, you know online? So,
so what this legislation is attempting to do in prior
again federal legislation, is they want hospitals to be putting
all this information in easily accessible areas like the front
page of their website so that people can extract that.
(08:48):
But again, I think there are certain things that that
would be great for, and I think there are other
things where even having that information available, it will be
hard for the patient to find that the correct test
or procedure and to interpret that right. So it's like
is it an MRI with or without contrast? You know,
(09:10):
you know the body parts, you know, knowing the correct terms,
all all of these things. So I think that that
complicates things too in terms of trying to make this
information digestible to like the everyday person that's not a
doesn't have a healthcare or medical background. How do we
make this information digestible? I think there are ways to
(09:31):
do it. There are certain places that have done a
really good job with this. So for example, one that
just comes to my mind, so there's an independent surgery
center and practice in Economoo called Solstice Health and they
do surgeries. And so they have a website where you
you know, you kind of click on the body part
so it's like head and neck, you know, chest, armor, leg,
(09:53):
you know, you click on the body part and then
they have kind of like almost like a menu or
a list of things. So are you do you need
a right knee Arthur scopy, so that's like a right
knee scope, and they have kind of a like you know,
a drop down menu or a list where you can
look at the different services they offer for that particular
body part. Again, I think that that is a really
great way to do it because I that I think
(10:14):
would help people to be able to navigate this in
an easier way. But I think also having some sort
of uniformity to it. So you know, if every single
hospital putting this in a different place on their website,
they're using a different format. They're not using you know,
easy to understand words or common language for body parts
(10:35):
and things like that, which they probably aren't right because
they're going to be using the medical terms. So there's
this thing called the charge master. So every hospital system
or healthcare system has a charge master. In that list,
every single charge they do in that hospital. You know, again,
whether it's a lab, a professional fee, an X ray
at MRI, all, you know, surgery, everything is in this
(10:56):
charge master. And that's that's what they're basically in many
is giving the public access to. But again, if I
have this this document that has thousands of charges, like
how do how do I, as a as a layperson,
like find the thing that I need within that? So
that I think that's the complicating part.
Speaker 1 (11:16):
And I want to ask too, is as we talk
about how how that can be very complicated and very
difficult to interpret and understand what what we're looking at
doing and how some of this may be resolved as
we talked this morning with doctor Nicole Hempkiss of Advocate MD,
the website advocates DPC dot com. That's Advocates DPC dot com.
Of course, doctor Hempkiss shares great information with us each
(11:38):
and every week right here on thirteen ten WIBA also
a lot of great information up on that website advocates
DPC dot com. Great data. Make it a point and
become a member at Advocate M detail form number six
oh eight two six eight sixty two eleven. That's six
soh eight two six eight sixty two eleven. We'll talk
a little bit about this bill, what exactly it says
ways to combat some of these some of these transparency issues.
(12:00):
We'll get to that in just a moment. As full
scope with doctor Nicole Hempkiss continues right here at thirteen
ten WUI b A thirteen ten WIBA and full scope
with doctor Nicole Hempkiss, Wisconsin's direct care doctor. You can
learn more about doctor Hempkis. You can learn more about
all of the doctors at Advocate MD, all eight of them,
all four locations as well. You can also learn about
(12:22):
direct Primary Care, what makes it so unique? What a
great option it is? All online the website ADVOCATESDPC dot com.
That's Advocates DPC dot com. Great data. Make an appointment to
become a member at Advocate MD. Six eight two six
eight sixty two eleven is their telephone number again, that's
six oh eight two six eight sixty two eleven. Talking
about price transparency and healthcare and doctor I know when I,
(12:44):
you know, I get out to eat once in a
while and you'll go to a restaurant and maybe they've
got seafood on the menu and it'll say MP for
a little market price, and you're like, okay, I can
ask the waiter, what, waitress, what what the current rate
is on certain things? Then give me an answer. Now,
it's a very complicated system that goes into the pricing there,
but you know the wait staff can figure that stuff out.
(13:04):
Why can't a hospital figure that stuff out and exactly
when it comes to billing or at least transparency, How
does this ultimately with this with this bill that's going
to work its way through the legislature here in Wisconsin,
what does this bill say and kind of how does
how does it attempt to address this problem?
Speaker 3 (13:23):
Yeah, I think you know, one of the things that
it's attempting to do, it's it's attempting to make it
easier for both healthcare consumer's patients, but also employers within
our state. So many employers, if they're larger employers, they
are something called self funded, so they're paying out their
own claims. So if they can look at this data
and be able to tell for example, you know, let's
(13:45):
say orthopedic procedure like a total knee replacement is fifty
thousand dollars at hospital A, and it's twenty five thousand
dollars at hospital B. And again that as we've talked
about Sean, the cost or the price for a particular
you know, medical service has nothing to do with the quality.
In some cases, we find that the lower price is
(14:08):
actually a higher quality doctor or somebody that does more
of these procedures. So there's no correlation between price and quality,
but they're trying to make it you know, what they
call shoppable for elective services. So this doesn't mean, of course,
if you have an accident and you need the emergency department,
you're not going to pull up and you know, the
website and be searching on there and where can I
(14:28):
go for the lowest emergency department price. It's not for
that sort of thing, but it is for things like
you know, major elective surgeries, you know, radiologies, stuff like
MRIs that can be extremely expensive, but if you do
them in an outpatient setting, they're very affordable. So so
those sort of services, and the part that I think
that is good of what they're trying to do is,
(14:49):
you know, again because this is very complicated, and you know,
in some cases, in most cases, you know, people have insurance,
they have a certain rate through their insurance that the
hospit is giving, and as we've talked about Sean, that
rate might actually be more than what the cash price is.
But so what they're trying to do is have like
a highest price and a lowest price that that hospital
(15:10):
charges for this particular service, which is probably going to
be shocking when people can see that you know when
they can see the discrepancy of those things and so
so again the cash price might be someplace in the
middle or towards the bottom. But so they're trying to
give that data to the to the patient, to the
healthcare consumer, to the employer and allow them to be
able to compare. Again, if you have that information, you
(15:33):
can compare, and employers have the resources to be able
to do this kind of more broadly and say like, okay,
well it seems like hospital ABC is really giving us
a better value than hospital X, so that we're going
to try to shift most of our employees into this system.
And again, if nobody knows the price or the cost
(15:55):
of any of this, then you know, they can basically
charge whatever they want. You know, brought up multiple times
during this press conference that healthcare is the only industry
that you know, I can think of, where you commit
to paying the price. You commit to paying for something
before you actually know what the cost of it will be.
(16:16):
So you walk into the you know, whether it's you know,
your surgery, your doctor's visit, your labs. You know, they
make you sign a consent to treat They will not
treat you unless you sign that with the exception being
the emergency department, which they have to treat you, but
you're the consent to treat. And then in the fine
print there somewhere it's saying that you are going to
pay your bill, not knowing what that bill will be,
(16:38):
and if you don't pay it, they can send you
to collections, they can you know, you know, hound you
for that money. So it's the only industry where you
are committing to pay for something without knowing the cost
of that. And that's crazy when you think about it,
especially because healthcare costs could be tens of thousands of dollars.
You know, it causes people to go bankrupt. So that
shouldn't be the case. We should be giving people the
(17:01):
cost of things, the price of things, I should say,
ahead of time. And the other interesting part about this
is that some of our local systems here they do
this estimated cost, which I think the idea behind it
is a great thing, like they're telling you, okay, I
don't know if you've ever experienced this genre. You go
in for the visit and ahead of time, maybe a
(17:22):
week ahead of time or something, they send you the
estimated cost. I think this happened to me for physical
therapy or something, and so they'll say the estimated cost
is two hundred dollars. But the ironic part of that
is that they don't have to stick with that estimated
cost at all, so that visit could actually be six
hundred dollars.
Speaker 2 (17:41):
So you said, oh, two hundred dollars, okay, I guess
I can do that. That's okay. So that's more than
I want to spend, but okay.
Speaker 3 (17:46):
And so then when you actually get the bill two
or three months later, it's six hundred dollars, and you
call them up and you go, but you told me
the estimated cost was two hundred dollars.
Speaker 2 (17:54):
Why is it six hundred dollars? Oh, I'm sorry. You know,
that's just what it ended up being.
Speaker 3 (17:58):
That's the way they coded the visit it or that's
what and you have zero recourse to get that changed.
Speaker 1 (18:03):
Wow, it's it's it's it's frustrating.
Speaker 2 (18:09):
It.
Speaker 1 (18:11):
The more you learn, the more you go, oh my goodness,
and the more folks experience you think about mad Yeah,
what about is? I think a lot of folks, until
they've encountered it, believe that like the insurance company should
be like an ally of theirs and then they realize not, really,
is there a role here for for insurance to to
put put a little pressure on more transparency or is
(18:33):
that not at all in their interest or something that
they would probably never get involved in.
Speaker 3 (18:39):
I think that when you think of it conceptually, you
think that they should be doing that, you know, because
obviously you would think that they have an incentive to
want to also keep costs down. But you know, ironically,
like we've talked about, you know, on the program many now,
we have an environment, especially locally here, where the hospital
(19:01):
system also owns the insurance company. So again this creates
perverse incentives to not necessarily want to keep costs down,
right because they're paying themselves, so the insurance company basically
passes those additional costs onto the consumer to the patient,
so there's not really that incentive to contain costs.
Speaker 1 (19:22):
And we'll obviously follow this bill as it makes its
way through and get some updates. And one of the
great things about getting the chance to talk with doctor
Hamkes each and every week is getting updates on this stuff,
but also learning more about direct primary care. I know
you've probably been excited. It's a great, great option for you,
your family, your employees. Today's a great day to take
that action. Pick up phone, give a call, make an
(19:42):
appointment at Advocate MD six h eight two six eight
sixty two eleven. That's six h eight two six eight
sixty two eleven. Learn more online the website ADVOCATESDPC dot com.
That's ADVOCATESDPC dot com. Also with this knowledge, make sure
you're sharing it with your friends and family. I talk
to folks nearly every week about to Advocate MD and
about what doctor Hemkiss and the other eight physicians add
(20:04):
to Advocate MD are doing for folks. Again, very affordable
between seventy eighty dollars per month as far as membership,
your your visits are included. It's a really phenomenal model. Again,
you can learn more online ADVOCATESDPC dot com. Doctor Hemkiss,
you enjoy this great weekend and we'll talk again real soon.
Speaker 2 (20:20):
You too, Sean, thank you, and.
Speaker 1 (20:21):
Again that website ADVOCATESDPC dot com. More of madis in
the morning. It's next year thirteen ten. Wiba