The History and Future of DPC

Episode Transcript

Speaker 1 (00:00):
Thirteen ten wuib A and full scope with Wisconsin's direct
care doc doctor to Coole Hemkiss. Of course, you can
learn more about Advocate MD, of course at Direct Primary
Practice right here and Madison the website Advocates DPC dot com.
That's Advocates DPC dot com. Great website to learn more
about direct Primary Care. As I mentioned, also you can

(00:20):
learn about the doctors. The locations, of course, four locations
of Advocate MD, Eastside and Middleton excuse me, west Side
in Middleton, east Side and Madison of course down in
Janesville the clinic there right on Mineral Point Avenue, and
the newest location right in Fitchburg right on the south
part of Madison at thirty two to twenty SI Road.
Great beautiful area. All four locations of Advocate MD absolutely fantastic.

(00:44):
And as mentioned, joining us this morning is doctor Cole Hemkiss. Doctor.
How you doing this week?

Speaker 2 (00:49):
I'm doing fine? Shown how are you?

Speaker 1 (00:50):
I'm doing really good? Real quick? About the clinics, and
I do like to ask about this once in a while.
One of the things I really like is how they look.
It's it seems, you know, kind of like a like
a weird thing to like but there is a reason,
like you do actually a lot of work to get
the clinics up and open, and some of it is

(01:10):
most of it, All of it is very much by
design the way that they're that they're laid out, isn't it.

Speaker 2 (01:16):
Yes, you know, we want them to look enough like
a like a regular medical clinic, because, as I say
to people, it's for many people the direct primary care
model and going into direct primary care clinic is enough
of a jump or a change where you know, they
might be a little bit apprehensive or unsure of what
it's going to be like when they come to see us.
So we want it to look like a medical clinic.
But at the same time, it's a lot smaller. You know,

(01:38):
there's somebody that's going to greet you when you walk
in at the front desk. You know you're not going
to be led through a maze of hallways, and you
know signs directing you of where to go. You don't
have to check in at a console, so it's it's
going to be just much more personalized. You know, we
always get comments from patients about how easy it is
to just get in again. On purpose, we have kept

(01:59):
these on a small and not put them into like
a large building where you have to navigate, like, oh,
do I take the salvator? Do I take that? You know,
So just to make it simpler on patients again, because
sometimes for people coming into a doctor's visit, I mean,
hopefully it's an enjoyable experience. For some people, they might
be coming in for a medical issue that they're worried about,
so they already start with a little bit of apprehension

(02:21):
or fear before they even get in to see us.
So hopefully we are trying to make it easier for
them to navigate and to feel comfortable when they walk in.

Speaker 1 (02:30):
I think you've mentioned this, and I know a number
of other people have mentioned this to me recently as well.
Is you talk about, you know, being able at advocate
MD patients bring them right in and you know the
rooms that the exam rooms are right there, and you're
putting your exam right away. I'm hearing this. I think
with some of these big systems where they're like not
only are you using a kiosk, but they're like handing

(02:51):
them like a card and they're like trying to I
mean these things, these big hospitals and these you know,
these primary care doctors in these hospitals. It's very confusing,
even when you have somebody showing you around. But I've
heard stories of them like being handed in number and
basically being told go find your room. Are you seeing
that or hearing that as well?

Speaker 2 (03:09):
Yes, there is at one of the very large local
systems here and at some of the smaller surrounding community
health systems. Now they're doing this self rooming, and I
think there's a few different ways that they can do that.
But yes, you are told a room number or you know,
goal twenty five or something, and we had to do
it with my daughter when she went to the pediatrician,

(03:31):
which probably will never have to experience that again. But
you know, I think they also in some cases give
you the little device like you're waiting at a restaurant
for a table or whatever, and then it lights up
or something. But again, you know, they always try to
couch these things in the way of like, oh, this
is better patient care or somehow we're improving the patient experience,
Like how is that improving the patient experience? Like I mean,

(03:53):
obviously you are able to decrease your staffing because you
don't need somebody, you know, I don't that person that's
you know, helping patients get back to their room. But again,
it doesn't really help the patient to feel like they're
getting very personalized care when they're having to kind of
figure out how to get to their exam room and
and just don't have that again, person that's walking them

(04:16):
into the room, because that is the thing, you know.
I always try to train our staff that, you know,
a person walks in the front door, you greet them,
you you walk with them back into the room. Although
for us the room is three feet away from the
front reception desk, but in these cases, they're walking down
multiple hallways and you know, having to figure out where
to get to So I remember when I did it.

(04:37):
I we got to the room and we sat down
and I thought, well, I hope this is the right
room because there's nobody in here, and you shut the
door and then you wait for eventually the medical system
to come in.

Speaker 1 (04:47):
What's as we talk about the patient experience, we're going
to talk this week about direct primary care in particular,
and obviously we're going to talk about advocate MD in
a little bit about your history as well at the clinic,
but over wrong talk about the experience for the patient
and really being patient focused. That really ties in nicely
with the history of direct primary care. Let's talk a

(05:09):
little bit about how direct primary primary care came about,
what's kind of the background there and what drove direct
primary cares to pop up across the country, and then
we'll get into kind of Madison and Dane County and
else wells Rock County with advocatemity. So let's starts. Let's
start off talking about the history of direct primary care overall. Doctor.

Speaker 2 (05:29):
Yes, you know, I think that for many people if
you're just hearing about direct primary care for the first time,
if you listen to our broadcast, I'm sure you're not.
But some people the first time they hear about DPC
direct primary care, they might think that this is something
novel and something new that's just come about in the
last few years. But it's actually been a model that's
existed now probably about twenty years, maybe a little bit

(05:50):
more than twenty years. And it started off there was
a handful of doctors, I would say fifteen to twenty
doctors scattered across the country. So you know, a doc
in Idaho, a couple docs in Kansas, a few docks
in Iowa, Florida, Texas that you know, I think that
they had a similar idea and you know, kind of
put their heads together and they had seen the the

(06:12):
issues that were arising in healthcare, you know, two decades ago,
and those issues were health insurance is getting much more expensive.
You know, people can't afford the health insurance, right so, like,
you know, how are they going to afford the health care?
The access issue was starting to become more of a problem.
So doctors are being booked out further and further, and
then from the doctor's perspective, of course, doctors are being

(06:33):
pushed to see more patients and spend less time with them.
So they started looking trying to figure out what could
be a solution to this, and the thing that seemed
to come up every time was that what if we
stopped taking insurance. So insurance is what is really putting
a drain on our overhead costs as a private physician.
You know, so if we have to hire for every

(06:54):
one dock, if we have to have two to three
employees that are doing billing and coding and having an
expense of electronic medical records, because really that is the
billing device now, so now for every one doc, there's
let's say three staff members, and again two out of
three of those probably or maybe even more than that
are not even involved in direct clinical care, like they're

(07:15):
not nurses or mays. They are just involved in the
back office billing parts. And I remember when this happened
to me when I was practicing in Florida and we
converted to a different electronic medical record. But anyway, so
they figured out that if they could separate out insurance
and not take insurance, and this kind of came about
a little bit of a spinoff of concierge medicine, which,

(07:37):
as many people know, you know, concierge medicine probably came
about in the late eighties, early nineties, so that's been
around for a long time, forty years. Probably concierge medicine
came about because there were people that were kind of
upper middle class, affluent people that decided, you know what,
you know, these fifteen minute visits or you know, having
to wait three to six months to see a doctor.

(07:58):
You know, I don't want to do that, Like I
want better care, I want better access to care. So
there started to be doctors that would take on smaller
panels of patients. You know, instead of them having two
to three thousand patients, maybe they have three hundred patients,
and then they can really offer them those longer visits,
easier to make appointments, spend you know, spend more time

(08:20):
with them, be available to them after hours if they
need something. So the difference though between concierge in direct
premiery care and there's still are concierge practices that exist
across the country. We don't really have any here locally yet,
but you know, places like Florida, California, New York, there's
a lot of concierge practices and the difference is, you know,
a concierge practice is instead of like in our practice

(08:43):
of direct premiery care, we charge on average around seventy
to eighty dollars a month for a membership, a concierge
practice might charge you know, one hundred and fifty to
five hundred dollars a month, so it's exponentially more expensive.
The other big difference is that they also will bill
your insurance. So you come in for that visit, I
see you for an annual exam, or I see you

(09:05):
for an acute visit. I'm going to build that through
to your insurance. Plus I'm also going to charge you
the membership fee. And again, you know, this is for
people I would say targeted to people that are kind
of upper middle class or wealthy because they can afford
to pay for the very expensive insurance and to pay
for the very expensive membership. But the reason that they're

(09:26):
doing that is because they want a doctor that's going
to be available. I need an appointment next week. Okay,
you'll spend thirty to forty minutes or longer with me
talking to me about this issue, not ten minutes. So
that's the big difference between concierge and DPC, And I
think you hear a lot of kind of still misuse
of those two terms. And even I remember, like when

(09:46):
I was testifying in front of the Wisconsin Legislature, there's
still a lot of misunderstanding even with our elected officials
as far as what the difference between these two are.
Because a lot of times the unfortunately the the mis
educated ones will we'll try to hold up DPC of
oh this is something for wealthy people. Oh, you're going
to exclude all the people that can't afford the direct

(10:08):
Primary Care membership, Like no, that's not true. So our
our membership runs the demographic from you know, people that
can't afford traditional insurance, you know, people that are self employed,
you know, things like hairdressers, realtors, you know, people that
work for companies that they don't provide them with health insurance.
And then of course we do have the runs the
full demographic, and we have people that are upper middle

(10:30):
class or more wealthier, people that just want to more
personalized care. Yeah, that's that's the big difference between the
concierge and the DPC.

Speaker 1 (10:39):
And it's it's it's interesting too, is because people say, well,
then how is it that that concierge is costs so much?
And and uh, direct primary care is so affordable when
you start, and I think the part that people start
getting confused by is that access. They say, well, how
is it that you're able with direct primary care to
offer that that access of you know, forty five minute appointments,

(11:03):
ability to get in to see your doctor when you
need to. People always wonder, and I've been asked this
a number of times as well as well, how does
direct primary care do it without charging exorbitant amounts? I
mean seventy eighty dollars a month is very affordable. How
does direct primary care work and that you're able to
keep those costs down.

Speaker 2 (11:21):
Yeah, so by most estimates, you know, they say thirty
to fifty percent of waste in healthcare, and I guess
this could be in many different settings in healthcare, but
in let's say an outpatient setting, much of our waste
again comes from having to hire the additional personnel to
do all the insurance billing and processing. And then as
you can imagine, the insurance denies a claim, they ask

(11:42):
for a prior authorization, they ask for a pre certification.
All of that is a lot of busy work for
the doctors the staff. So again in our model, hopefully
we don't really have to deal with a lot of that.
So we translate those cost savings into keeping it very
affordable for the patient, and again we don't have. Another
big area of waste is a healthcare administrator. So as

(12:06):
you've seen with any of our local large hospital systems
that own primary care doctors, there's multiple layers of bureaucracy.
You know, they've got CEOs and cmos and the medical directors,
the site directors, the nursing managers, the nursing directors. So
all these people making six figures half a million dollars
a year, like a lot more than that. So all

(12:27):
those people don't exist in a direct primary care environment,
right like we You know, all we have in our
practice are working physicians, clinical physicians. I am the medical director,
and we don't have any other healthcare administrators. And then
we have patient care technicians that basically function as a
medical assistant. So you know, again we don't have a
large administrative staff. We don't have billers and coders and

(12:51):
utilization review they call them. They go through all the
charting and see how we can maximize our billing. So
that's how we're able to really keep the cost down
and make it The idea is that we make it
affordable enough to where people can have our membership and
then still retain either a high deductible insurance plan or
a health share something that would cover them for a
catastrophic event.

Speaker 1 (13:10):
We'll talk to you mentioned for folks, you know, whether
they're you know, maybe work in the in the real
estate realtors and those type of things where maybe they're
not offering offering health insurance and independent contractors. I know
a lot of folks do that type of thing. On
the other side of that spectrum is I know you
work with a number of area businesses. We'll talk about

(13:30):
employers and how direct primary care works really well and
is a great benefit to offer your employees. We'll talk
with doctor Nicole Hempkis about that in just a moment.
In the meantime, if you haven't been over to the
website yet, I urge you to had on over Advocates
DPC dot com. That's Advocates DPC dot com. A lot
of what we talk about here on the program each
week is covered as well on the website. So it's

(13:52):
a great resource. Advocates DPC dot com, great data. Pick
a phone, become a member at Advocate MD. All I
get to just give them a call six eight two
six eight sixty two to eleven to make that appointment.
That's six h eight two six eight sixty two eleven.
Look to your conversation with doctor Nicole Hempkiss of Advocate MD.
We'll do that next as full Scope continues right here
on thirteen ten to wuib A. This is full Scope

(14:16):
with doctor Nicole Hempkis, Wisconsin's directcare doctor. Of course, doctor
Hemkis comes to us from Advocate MD, a direct primary
care practice. Four locations, eight doctors at Advocate MD to
serve you. You can learn more online the website Advocates DPC
dot com. That's Advocates DPC dot com. Telphon over make
a point, become a member six oh eight two six

(14:37):
eight sixty two eleven. That's six oh eight two six
eight sixty two eleven. And doctor, I know, you get
an opportunity quite a bit to uh talk with business
leaders in the community, whether it's here in Dane County
or in Rock County and talk with them about direct
primary care. And I often will say, if you're looking
for great options for your employees, definitely check out Advocate MD.
I know there's a smaller offices, bigger companies work with you,

(15:03):
and that's a great feature for folks. Let's talk about
an Advocate MD. I can work with employers to offer
primary care to employees.

Speaker 2 (15:11):
Yeah, you know, I remember when the practice started seven
years ago, a little bit more than seven years ago. Now,
it was hard to get in front of employers, you know,
even small employers. And you know, people are very skeptical
about this if they've never heard of it before. But
the big thing that we've seen change and we work
with companies from five employees all the way up to

(15:34):
we have you know a few companies now that have
a thousand employees. You know, we have a lot you
know somewhere in the middle where they have you know,
twenty to fifty to one hundred employees. But so this
really can work for any size employer group. You know,
for the smaller, smaller companies, sometimes they're either if they're
very small, if there are less than fifty employees, they
might not be able to afford to offer health care benefits,

(15:56):
so they might be just offering the direct primary care.
If they have more than fifty employees, they have to
offer a mech qualified plan, so they have to offer
some form of insurance, and so they will many times
put a high deductible insurance policy with the direct primary care.
And again the idea is that we are filling that
gap until they were to hit their deductible But for

(16:16):
the most part, you know, ninety percent of their medical
needs we're going to take care of in our clinic,
and then they have that high deductible health plan. If
they need something like surgery, they need to see a specialist,
they need to go in the emergency department, they still
have that there, so they don't have such a financial risk.
But for the very large companies, so the one hundred
plus employee companies, many of those are self funded, so

(16:38):
that means they're paying out their own claims. So for them,
this is basically essential, especially in the market that we
are in here in the southern Wisconsin Madison market, because
when they are sending their employees into a hospital owned
primary care doctor, everything that that person has done downstream.
So if that primary care doctor says, you need to

(16:58):
see a dermatologist because I don't time to remove this mole.
You need to get the MRI done here, let me
order these blood tests, every single thing that that primary
care doctor does, including their own office visit, is going
to be exponentially more cost to that employer to pay
out that claim than if they come in and see
us in a direct primary care because the employer pays
the direct primary care membership. But then when they have

(17:19):
something done in our office, let's say they have blood
work done, we just spend some medication, we do an
X ray, all of that, All of that stuff is
basically done at cost. I mean, our markup is our
margin is so minimal, so that X ray that's eighty
dollars that we charge the employer eighty dollars. You know
they go in to do that. At the hospital it's
five hundred to one thousand dollars. And then if it's

(17:40):
something that we can't do within our practice, within our clinic,
we help that patient to navigate to say, okay, you
do need the MRI, Okay you do have a high deductible,
Well let's send you to the local independent MRI facility
versus sending you into the hospital, because again that MRI
will be six hundred dollars versus six or seven thousand dollars.

(18:02):
So for the employer who's paying out those claims, of
course they want to pay the six hundred dollars MRI
and not the six thousand dollar MRI. And again, because
we are independent and we are owned by a hospital system,
we don't have anybody pressuring us of where we send people,
whether that's a specialist for a radiology test. The unfortunate
part is that when you are a doctor who's employed

(18:23):
by a large hospital system, not necessarily that the pressure
is always like overt or just openly there. But there
is kind of like an understood thing that you will
refer within your system, right and it's kind of the
path of least resistance. So like, Okay, you need to
see an E and T. You need to see a cardiologist,
even though it's going to take you six months to
get into that cardiologist. I'm just going to send you

(18:44):
through the large hospital system here versus there's a cardiologist
that's thirty minutes away that you could see in a week,
that's not going to charge you an exorbitant amount for
that consultation. But you know that is kind of not
in their wheelhouse, like they're not even thinking about that,
not thinking about the financial cost to the to the patient.

(19:04):
So again, if you go to a direct primary care,
we're kind of taking all of those things into account.

Speaker 1 (19:08):
It's pretty amazing what goes on at Advocate MD, what
you're able to do. And of course that word advocate
is there for a reason, really working for their patients
at Advocate MD, and doctor Hempkiss and all the doctors
at Advocate MD. I love to get to know you,
love to get you in as a patient. Don't forget
as well. If you are a regular to this program
or new and you're like, oh, that's interesting. Don't forget

(19:29):
to tell your friends as well about Advocate MD where
s you can learn more online. The website advocates DPC
dot com. That's Advocate DPC dot com. Great data. Start that,
start that membership. Become a member at Advocate MD, make
that appointment. All you got to do is pick a
phone game a call six oh eight two six eight
sixty two eleven. That's six 'oh eight two six eight

(19:49):
sixty two eleven for Advocate MD. And again that website
Advocates DPC dot com. Doctor hempkiss, it's always great chatting.
You have a fantastic weekend. We'll talk real soon.

Speaker 2 (19:59):
Thanks Shan, you too.

Speaker 1 (20:00):
And again the website that's ADVOCATESDPC dot com. This is
thirteen ten W I B A