The Ethics of Healthcare Pt. 1

Episode Transcript

Speaker 1 (00:00):
Eight oh five thirteen ten wyby and ask the experts.
As a matter of fact, it's a full scope with
doctor Nicole Hemkiss, Wisconsin's directcare doctor. You can learn more
about doctor Hemkiss online. The website for Advocate MD ADVOCATESDPC
dot com. That's Advocates d PC dot com. Great website
to learn more about doctor Hemkiss, all the doctors six

(00:22):
soon to be eight physicians at Advocate MD. Also, you
can learn more about Direct Primarycare learn about all four
clinics at Advocate MD. Also, if you are an employer
or maybe somebody that works in HR and that type
of decision making and you're looking for some great options
for your employees, definitely check out Direct Primary Care and
Advocate MD.

Speaker 2 (00:43):
Again.

Speaker 1 (00:43):
The website ADVOCATESDPC dot com. That's Advocates DPC dot com.
Delphon number six oh eight to six eight sixty two eleven.
That's six oh eight two six eight sixty two eleven.
And joining us this morning is doctor Nicole Hemkiss of
Advocate MD.

Speaker 2 (00:56):
Doctor. How you doing today?

Speaker 3 (00:59):
I'm doing great? How are you?

Speaker 2 (01:00):
I'm doing really good.

Speaker 1 (01:01):
It's fantastic to talk with you, and we've got a
got a conversation I had about some of the uh some.

Speaker 2 (01:08):
What do they call him? Screlly Awards?

Speaker 3 (01:10):
So yeah, I'm not exactly sure how to pronounce that.
I think that is correct?

Speaker 2 (01:14):
Yeah?

Speaker 1 (01:14):
Is that was that named after Martin Screlly. I'm gonna
I'm gonna guess who is the farmer brow I'm gonna
make I.

Speaker 2 (01:20):
I uh I.

Speaker 1 (01:21):
But I what I do know is as you sent
me this story earlier, and I'm like reading through some
of these things, like I'm even shocked, and I've I've
become a bit a bit numb about some of the
some of the stuff that goes on in healthcare because
it's sadly this type of stuff is so common. We're
going to talk about that this morning. But first mentioned earlier.

(01:43):
Uh six soon to be eight physicians at Advocate MIT.
You've got two new doctors joining the practices and uh
and it's such a fantastic thing. People say, well, why,
you know, why is doctor Hamkes always adding new doctors
whilst they're always adding new patients. And before we talk
about the two new doctor that's a priority for you,
right is making sure that each doctor and every patient

(02:05):
has the opportunity to see their doctors. You keep those
those panels very small, don't you, yes, you know, and.

Speaker 3 (02:13):
The traditional insurance based system, those family practice primary care
doctors might have two twenty five hundred patients in our practice.
Our doctors usually have, you know, somewhere between four hundred
to six hundred patients and their panels, so you can see,
it's you know, a quarter of the size, a fifth

(02:33):
of the size of a traditional practice. And that's what
allows us to see patients much more timely, and to
spend more time with them and to be available to
them if they need something, you know, after hours.

Speaker 1 (02:45):
And let's talk then about as we as we see
the growth of Advocate MD now with four clinics and
eight physicians, two new doctors. Let's talk about doctor di
Giovanni first. And she's she's coming on board right now.

Speaker 2 (02:58):
Isn't she.

Speaker 3 (03:00):
Yes, So doctor Gina di Giovanni, and patients call her
doctor d G sometimes. So she is a native of
Prairie to SoC and she her dad is a retired
general surgeon, her mother is a retired nurse. So grew
up in the community, went to Edgewood High School. So

(03:20):
she's a very local gal, very you know, knowledgeable doctor, compassionate,
great personality. Patients really enjoy working with her. So she
started with us last month, has only been with us
for about a month. And then we have doctor Jennifer Philbin,
who was part of a Fort Health in the Lake

(03:41):
Mills clinic for many years. And she is also a
native of Madison. I believe she went to East High
School and might have gotten that wrong, but she went
to u W Madison, and so she's been in Wisconsin
for most of her life, also in practicing as I mentioned,
on the east side. And and now she will be

(04:01):
joining us. Just a few weeks, three or four weeks
before she starts with us, I.

Speaker 1 (04:05):
Asked doctor Filman what a per golder is and we'll
find out if she's a Madisons East a lumber.

Speaker 2 (04:11):
Now that purple and gold I think is.

Speaker 1 (04:14):
What the purroller is for, but yeah, I don't We'll
have to find out for sure. Doctor Hemkiss, you know
we talked to about adding more doctors for clinics, and
you started out, of course, on the west side in Middleton,
right on Glacier Ridge Road. Then he added the second
clinic on the east side on fair Oaks Ave Jansville
for folks in Rock County. You've got the clinic right

(04:35):
on Mineral Point Avenue right across from the hospital there
at ten twenty one Mineral Point Avenue, and then the
newest location at thirty two to twenty Syin Road right
on the Madison Fitchburg line that is. And I had
the chance that have come out for your open house,
and I'd been out in that area previously, and it's
not only is it a beautiful clinic, but that's really
a nice setting. I know you probably appreciate it as well,

(04:57):
getting a chance to kind of look out those windows
and kind of seeing that beautiful nature area, that little
preserve area. It's a really nice area for that clinic.

Speaker 3 (05:07):
It is a really nice area. You almost think like
you could put a house out there or something other
than you're right on sayn Road, but you're basically surrounded
on three sides and across the street with the Wetlands
Preserve down there in Pittsburgh. I forget the actual name
of it, but you have kind of all the tall
grass and it's really beautiful. You have a lot of

(05:27):
wildlife out there. But yeah, it's a cool building. It
was actually, as you know, Sean and old radio station
but then the prior owners, which happened to be two
architecture firms, purchased it and completely remodeled it. So it's
got a lot of really cool architectural features and things.
So we've been open there now since I think May

(05:49):
or June, and so we're seeing patients now there five
days a week, Monday through Friday, eight to five. It's
very convenient if you live on the south side of Madison,
or if you live in places like Fitchburg or gone
Stoat in those areas, it's it's a quick five or
ten minute drive. So we have some businesses down there
too that are now utilizing that clinic.

Speaker 2 (06:10):
It's a great clinic, and I hope folks.

Speaker 1 (06:11):
Do you get folks that just stop in for I
know obviously during open houses, but have you had people
kind of stop in and just kind of saying, Hey,
I just kind of wanted to check this place out
and say hello and introduce myself.

Speaker 2 (06:21):
Do you get that from time to time?

Speaker 3 (06:25):
I would say yes, not a lot. Maybe we get
that more in James Will than anywhere, but yes, it
does happen sometimes. But if people are interested, they definitely
can give us a call to get more information they
can utilize the website through the contact us, we do
offer these what we call them meet and greets with

(06:45):
you know, the potential physician that would be seeing you.
And the idea behind that is just so you can
kind of get to meet the doctor for a few
minutes and ask them general questions about the practice. Unfortunately,
you know, we can't get into specifics of people's medical
conditions and things until they're actual patients in the practice,
but we are happy to schedule those meet and greets

(07:06):
if people would like to come in and see the
clinic and also to meet with a doctor that they
would be seeing as their primary And.

Speaker 1 (07:13):
The website you mentioned, of course you can contact. Through
the website you can learn more about direct Primary Care
as well all online ADVOCATESDPC dot com. That's Advocates DPC
dot com a great website to learn more about Advocate
MD Direct Primary Care. Also, yeah, you can submit a
question right there if you want to email. Very convenient
to do. And doctor I was I was mentioning as

(07:34):
I'm going through this list, even this stuff was pretty
shocking to me. Some of these some of these behaviors.
Let's before we get into this, this this kind of
breakdown of some of the some of the bad behavior
that that's been exposed. People often think, and I think
part of why some of this stuff is able to
happen is for folks that maybe have had a doctor

(07:54):
for years and you know they or they know some
of the names here in town, Well that was the
hospital I was born and add or those type of things.
There's there almost feels like things that are that are
being done in some of these situations kind of take
advantage of folks kind of feelings on that is, Like
I know we've talked about the past. I mentioned the
hospital that I was born in became like part of

(08:17):
a big chain and it kind of it kind of
literally I like had like an emotional, visceral reaction the
first time I saw that. But but I think that
some of this stuff, they're able to do this because
they know that people, you know, whether it's their their
primary care doc that they that they had been going
to for years, or because they've got this history with
these with these hospitals and clinics, they almost seem like

(08:38):
they tend to take advantage of that when it comes
to what they're doing to their patients and what they're
doing to people.

Speaker 3 (08:46):
Yeah, I mean definitely this whole you know, the mergers
and acquisitions and what we see of very few community
you know, independent based hospitals any longer. You know, that's
all financially driven that really has nothing to do with
patient care. You know, we see, especially in more rural areas,
you know, our smaller hospital systems that they you know,

(09:07):
really can't keep up with the uh, the competitive practices
of these large health systems. It's it's always it always
confounds me, and it frustrates me when I'm driving down
the road and I see a billboard for one of
our local huge systems where it's like, wait, so that's
a nonprofit, that's a not for profit, but they are

(09:27):
allowed to spend millions of dollars in advertising, right, Like,
so how does that work exactly? You know? But so yeah,
I think it's it's kind of in a way when
you have a system, you know, the healthcare system. Obviously,
the primary goal is supposed to be to take care
of patients, and and part of that is having access,
right and then you on the other side of that,

(09:50):
have a financially driven part of this, and so by
increasing prices of things, that decreases access, right, because there's
a lot of people that will then avoid healthcare because
they can't afford it or they're scared of what it
might cost. So that that's there are conflicting goals there,
and I think, yeah, a lot of these examples in

(10:11):
this article from Becker's Hospital Review, these Scurrelly Awards, which
I had to refresh my memory of who as you
mentioned Martin Screlly, Sean, I had to refresh my memory
because I know I can picture the guy's face. But
it was this this drug, I didn't remember the name
of the drug, but darra prim which was an anti

(10:32):
parasitic that overnight he increased. He acquired this company, bought
this company, the pharmaceutical company, and then the cost of
the pill used to be thirteen fifty per pill, which
think about that, that's still pretty good. That's pretty expensive pill, right,
because if he needs thirty of them, that's a few
that's one hundred something dollars. But he increased the cost

(10:53):
from thirteen to fifty a pills seven hundred and fifty
dollars per pill, So how many hundreds of percentage increases that?
And so he was convicted in a federal court on
two counts of securities fraud and conspiring to commit securities fraud.
And then he actually served time in prison, and he
had to repay sixty four million dollars and he was

(11:17):
permanently banned from any role in any sort of biopharma
pharmaceutical industry company, and he was released from prison earlier,
I guess in the in the twenty twenty two I guess.
But anyways, that that is just an example of how
extreme this can be. I always say, you know, when

(11:38):
we look at the cost of things in hospital systems,
you know, things like labs and MRIs and procedures and
even the supplies they charge you for, you know, the
box attissue and the you know, everything that you get
in the hospital room. There's nothing wrong with making a profit,
right like, there's there's nothing, there's no sin in that.
I mean, I'm an entrepreneur and I am for free market,

(11:59):
but you do not have to make a profit of
the expense of bankrupting people, right like, I mean, it
is almost to the point of being disgusting. How you know,
they can take something like pharmaceutic, something like oncology drugs
and chemotherapy and put such a crazy markup on these

(12:20):
things to where you know, chemotherapy treatments that maybe could
cost you know, a few thousand dollars are hundreds of
thousands of dollars, right, so like you know, maybe somebody
could afford ten thousand dollars, but they can't afford you know,
five hundred thousand dollars, and that's what that's what they do.
So I think it's good. I mean, my goal is
to bring some light to these things because I think

(12:42):
a lot of these practices kind of hide in the darkness.
Hospitals don't talk about this kind of stuff, right, they
don't want people to know what they're doing. So I
think it's good when a lot of these different, very
shady things that health systems, pharmaceutical companies, ensure a companies do,
that people become aware of that.

Speaker 1 (13:02):
And it's it's it's strange because it's it's ever so
often one of these stories makes the news, and it's
it's unfortunately all to common is you know, the squarely
thing that made the news that've got people very upset.
But it's not as though that type of behavior or
that type of you know, that profiteering and that dysfunction.
It still exists, still out there, and we're going to

(13:24):
break down some of the some of the those who
were recognized in twenty twenty four.

Speaker 2 (13:28):
Not a way you want to be recognized by the way.

Speaker 1 (13:31):
We'll talk about some of the things that had happened
that cause folks to get on this list. We'll talk
with doctor Hemkiss about that in just a moment. In
the meantime, if you haven't had a chance to check
out the website, head on over to Advocates DPC dot com.
That's Advocate DPC dot com. I think direct Primary Care.
It's a great website to learn more about Advocate MD,

(13:53):
what they offer, the doctors, the locations, and so much
more at Advocate DPC dot com. Ready to become a member,
make an appointment. I got to just pick up pone
give a call six oh eight two six eight sixty
two eleven. That's six oh eight two six eight sixty
two eleven. We'll consider our conversation with doctor Cole Hempkiss.
We will do that next as Full Scope with Advocate
MD continues right here thirteen ten WIBA eight twenty one

(14:16):
thirteen ten WUIBA and Full Scope with Doctor Nicole Hemkiss
of Advocate MD, the website ADVOCATESDPC dot com. That's Advocates
DPC dot com. Telf what i'mer to make a point
and become a member at Advocate MD six oh eight
two six eight sixty two eleven. That's six 'oh eight
two six eight sixty two eleven. I'm talking with the
doctor this week a list that was compiled involving some

(14:40):
of the most egregious examples of profiteering and dysfunction in healthcare,
and one that has made a lot of headlines for
various reasons. United Healthcare they did make this list at
number two.

Speaker 2 (14:54):
Doctor.

Speaker 1 (14:55):
Let's talk about about why they why they made this
Becker's Hospital Review list.

Speaker 3 (15:03):
So everyone is familiar with how United has been in
the news lately, and unfortunately the death of the CEO.
You know, United is is pretty notorious even amongst the
health insurance community, and that says something that they are
kind of well known for having a a I would say,

(15:25):
bad reputation in terms of claims, denials and things like that.
This particular article was talking about how they get a
higher federal reimbursement when they are documenting that patients have
like a greater number of health complications. This is I mean,

(15:46):
I think a pretty well known practice in the medical
community that you know, coding in certain ways in order
to get a higher reimbursement. But it's saying that they
secured tens of billions of dollars in additional tax payer
fund did payments over the past decade, and then they're
currently they have multiple federal lawsuits going on for these practices,

(16:06):
and they have an anti trust investigation because they're so large.
Now we've talked about how United has not only an
insurance company, they own a system of doctors. So, like
I think they said, one in ten physicians is somehow
working for United Healthcare in some way because of these
you know, physician organized managed organizations that they have, and

(16:29):
then they own it a pharmacy benefits manager, they own
the the home health Agency. They I think they own
a TPA, a third party administrator too, So they own
basically every every line in the supply chain of healthcare.
They own a piece of that, which is is a
dangerous thing in a way, right because once you control

(16:52):
all of those pieces, you can you can set your prices,
and if you controlled a large enough piece of the pie,
you know, if United Healthcare has a has a controlling
share in certain markets, it gets very hard for hospitals, physicians, offices,
you know, other independent offices to negotiate pricing because they

(17:14):
can basically set their own pricing and they can say,
you know what, well, if you don't want to pay
us this, we'll just pull out. We'll just take everybody,
all of our patients out of this market, you know whatever.
If it's a if it's a small or medium sized
market that doesn't have a lot of competing you know,
health insurances. So there's many reasons why that's that's just
not a good thing.

Speaker 1 (17:34):
It's it's and it's I think for a lot of
folks when they when they hear these type of stories,
until they've experienced some of this stuff firsthand, I almost
feel like there's like this ignorance is bliss it. You're like, oh,
I'm paying my insurance, so I am you know, I'm
just skipping along and everything's fantastic. Then you go to
use it and you're like, wait, what have I been?
What have I been paying for? And the insurance type

(17:58):
providers out there, they're not a own on this list,
amgen and I I I love science. I love breakthroughs.
I love seeing the stories of new revolutionary drugs and
medications that can help people and really prolong lives and
other things. Unfortunately, sometimes when those things are created, it's
very very difficult for regular folks to get access to it.

(18:20):
And this company, Amgen or Amgen they have, they've had
there's a reason they're on this list.

Speaker 3 (18:26):
Doctor.

Speaker 1 (18:27):
Let's let's talk about about these guys or this Yeah,
they're drug Yeah.

Speaker 3 (18:32):
So there's many different very shady borderline you know, whether
it's legal or illegal practices that pharmaceutical companies have. They
you know, do things like designer drugs or copycat drugs
where they can change like a single molecule coming off
of that that you know formula, and it doesn't really
change the effectiveness, it doesn't really change you know, the

(18:54):
potency of the drugs, but then they can remarket it
as a new brand name. Is when the patent expires,
they lose you know, millions or billions of dollars. So
it's talking about how there's a particular cancer drug where
they were approved for it a certain dosage and they
could actually have this drug at a lower dosage with

(19:15):
similar efficacy and fewer side effects. But despite all of that,
they're trying to get approval for the higher the FDA
approval for the higher potency drug I mean sorry, the
higher dose drug, because that's going to be additional revenue
for them to be able to market that drug. And
this is a common thing with different brand name pharmaceuticals.

(19:39):
That's why in our practice of direct primary care, are
there certain brand name drugs that people need? Yes? Are
there certain you know, brand name drugs where they have
not come out with a generic equivalent. Yes, those exist.
There are some, for example, autoimmune or rheumatologic meds, or
some diabetes meds that you only can get in an
injectable form, and they haven't become generic yet. But for

(20:02):
the vast majority of prescription medications, let's say ninety ninety
five percent, there is a generic alternative that works just
as well. You know, it might be a twice a
day and not a once a day. You know. You know,
it might be a shorter acting and not a long acting.
You know, it might not be as convenient, but but

(20:23):
there are generic alternatives that could be like one to
one hundredth the cost. So again, in a model like
ours where we aren't driven. We basically sell our meds
at cost. We break even on selling the meds. We
don't make anything off of selling our generic medications in
the office. But when there is a financial incentive to

(20:45):
come up with something, and basically again it's it's not
the incentive. Yes, there are incentives to develop new drugs
to treat new conditions, but in this case, they're saying
that this drug doesn't really do anything to treat a
condition any better than the existing drug, but they want
to get permission to sell it because that will generate
you know, millions of dollars for them. So those those

(21:07):
kind of examples abound in the pharmaceutical industry.

Speaker 1 (21:10):
It's it's as we kind of break some of these
down and we think about you know, you talk talk
their doctor about how they kind of game this system is.
And again I think most people are are of the
beliefa you know, free market and you know there should
be and if if you're doing investing in research, obviously

(21:30):
not all research is going to be fruitful. There should
be some there should be a reward and a monetary
reward for for great things. What I think what what
as you highlight there I think what drives everybody kind
of crazy is that then there's a system that allows
these these pharmaceutical companies to kind of game that system
and really hold back on getting these things out to

(21:54):
people that need them and keeping them affordable when the
when the time comes, and kind of breaking through the
this list. It's quite extensive. I was kind of peeking
at it earlier this morning, and I have a feeling
We're going to have to do a second program on
this because I'm just kind of scratching the surface here
with with some of the names on this list. And
we will definitely get to that on next week's show,

(22:16):
Real Quick Doctor. Before we wrap up this week, though,
we started our conversation about, of course, the doctors at
Advocate MD and talked about the clinic locations, and I
think one of the areas that I don't think we've
talked enough about is the convenience of Advocate MD. And
I know part of why you've strategically opened clinics where
they are is because it's convenient, but it's also convenient
to make an appointment. It's also convenient to actually get

(22:37):
in to see your doctor when you need to see it.
I need to see them. It's a really it's it's
really based on that. And I know we see some
great results for folks that actually have access to healthcare
and their healthcare care providers, really good overall health for those.

Speaker 2 (22:53):
Folks, don't we.

Speaker 3 (22:55):
Yeah, you know, I've said before it's sad that we
are now at the point where people's bar is so
low for our healthcare world, where when you call the
doctor's office, the expectation is it's going to take you
multiple months to get an appointment. I think I shared
with trying to just get an appointment for my daughter
with a pediatrician. Recently, they told me it was like

(23:17):
ten months to get an appointment for the pediatrician. So
it's sad that we've come to the point where this
is acceptable. Like, it's not acceptable, right, Like, I mean,
you are paying for health care through most people are
paying through for health care through their health insurance company,
and then when you actually need to access it, you
do not have good access. If you are having to
wait more than a couple of weeks for an appointment,

(23:38):
that is not good access. If you have an acute
issue and you're being sent to an urgent care clinic
or an er that is not good access. So you
don't have to accept that the bar is that low
because there are alternatives out there, and they're very affordable alternatives.
This isn't something that's going to cost you multiple thousands

(23:59):
of dollars a year. So I would I would recommend
people explore the website and you know, reach out to
us if they have questions.

Speaker 1 (24:07):
Great day to do just that, head on over to
Advocates DPC dot com. That's Advocates DPC dot com. Looking
for great primarycare options for yourself your family. If you
are an employer looking for some great options for your employees,
definitely check out Advocate MD. The website Advocates DPC dot com.
That's Advocates DPC dot com. Delphanever six oh eight to

(24:27):
six eight sixty two eleven. That's six oh eight two
six eight sixty two eleven. To make that appointment to
become a member at Advocate MD again the website Advocates
DPC dot com.

Speaker 2 (24:36):
Doctor, it's always great chatting.

Speaker 3 (24:38):
You have a great day, you too, Sean, thank you.

Speaker 1 (24:41):
News comes your way next right here on thirteen ten
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