The Pros and Cons of EMR

Episode Transcript

(00:00):
Eight, eight thirteen ten wib Aand full scope with Wisconsin's direct care doctor,
doctor Nicole Hemkiss. Of course,Doctor Hemkiss. She comes to us
from Advocate, MD, a directprimary care practice. Three locations west side
of Madison in Middleton right at threethirty two oh five Glacier Ridge Road,
east side of Madison, right atone seventy five South Fair Oaks Have in

(00:22):
Jamesville ten twenty one Mineral Point Haveright across from the hospital and soon to
be number four coming in June.The Fitchburg South Madison location right at thirty
two twenty Sigin Road. Doctor Hemkiss, How you doing this morning? I'm
doing great, Sean. I'm readyfor Friday. I bet I've got Mother's
Day coming up this weekend. Thatshould be uh sh'd be exciting. Got

(00:45):
anything fun planned? The kiddo's gotanything planned for you? Have they not
told you? As far as Iknow, there's nothing planning. Who knows.
Maybe they'll surprise me. Yeah.I have a feeling, and then
sometimes you know what the best thebest days. Just let mom relax,
I know you. I did getan invitation to my six year old's school

(01:07):
this afternoon for a mother's day tea. But we're supposed to bring our own
blanket in our own snacks. Thisis too much work already. Yeah as
well, well you enjoy your weekendand enjoy your day, and happy Mother's
Day tea, doctor hemkiss, andwe've got a really important stuff to talk
about, and we're going to kindof get back to back to basics.

(01:29):
One of the really cool things aboutAdvocate MD and being a direct primary care
practice are all the different things you'reable to do for people at an affordable
and an affordable price. And reallyit's a really really great model. And
we're going to talk about what exactlydirect primary care is the patients and other
things at Advocate MTY. We talka little bit about that in this moment.

(01:49):
Speaking of learning more about direct primarycare and Advocate MD. The website
ADVOCATESDPC dot com. That's ADVOCATESDPC dotcom Delph number six eight two six eight
sixty two eleven. That's six soheight to six eight sixty two eleven to
make an apployment to become a memberat Advocate MD. And again that website
ADVOCATESDPC dot com. That's ADVOCATESDPC dotcom. Let's talk about direct primary care

(02:12):
and a little bit about obviously AdvocateMD and what you guys are able to
do at Advocate MD, but alsohow it really differs from what a lot
of folks may be currently familiar with, but it may be reminiscent of the
way for a lot of us,the way medicine used to be practiced.
Yeah, so direct primary care isa membership based model, so patients pay
a monthly membership fee. On averagefor an adult, it averages out to

(02:36):
around seventy dollars a month. Butthey pay this membership fee, and then
that means when you come in fora visit, there's no copay, there
is no charge for that visit.There's no additional charges for anything we do
in the office that doesn't involve likea third party. So for example,
if you come in and get bloodwork done, we have to send that
blood work out to lab Core,so we you know, lab Core is

(02:58):
going to charge us for that forthe processing and then we're just going to
pass on that cost pretty much atwholesale cost to the patient. But anything
that we can do within our officethat doesn't involve someone else, there's no
charge for that. So if wedo a minor procedure, you know,
the doctor injects your knee or removesa mole, we don't charge anything for
that. But let's say we haveto send that mole out to the pathologists

(03:21):
so they can take a look atit. Then there, you know,
would be like a forty or fortyfive dollars charge for the pathologists charge.
But again, the doctor that's seeingyou, that's are doing the procedure,
is not charging anything. So youknow, it's really a very different way
of doing things from the big system. And the big misconception that I wanted
to dispel is that this is nota system for people that don't have insurance.

(03:44):
You know, ninety percent of ourpatients have insurance, probably higher that
probably ninety five percent. But sothe reason that they're doing direct primary care.
You know, every week we talkabout cost and we talk about how
health insurance is becoming more expensive andhow people have typically now higher deductible.
So if you have a three thousand, five thousand, ten thousand dollars deductible,

(04:05):
what that means is that every monthyou're paying a premium, usually a
lot of money, and then youthat doesn't actually kick in until you meet
that deductible, and then many timesyou have co insurances and all of that
on top of that, even afterthe deductible is met. So this direct
primary care model is really from dayone. When you sign up from US,
you you are getting care, youare getting access to care. You

(04:27):
come in again, you know,most of the care that you will receive
will be paid for through your monthlymembership fee, so you're not seeing you
know, the surprise medical bills comingin the mail. So this is a
model for people you have insurance,and that we do recommend that people have
some form of catastrophic insurance because youknow, if you get into if you
have a you know, appendicitis,or you get into a major accent and

(04:47):
have to go into the emergency department, you know, that is beyond what
our clinic is providing. You know, and then of course sew You know,
people always say like, how areyou able to do this for seventy
dollars a month? And you know, we don't limit people's visits. We
don't say to you you can onlycome in once a month or you come
in once every six months. Thereason we're able to do that is because
we keep our overhead low. Andthe big chunk of that is because we

(05:10):
don't accept insurance. Right so eventhough you have your insurance, let's you
know, whatever your insurance is,Blue Crossflashield, United, whatever, it
doesn't matter. You're going to keepthat for the catastrophic stuff. But when
you come in to see us,none of that is going to go through
your insurance, you know. Soit's kind of two separate, kind of
parallel systems that are operating, thatare taking care of different things. And

(05:31):
the direct primary care is going tooffer you more accessible care, meaning it's
easier to get an appointment. Thedoctor's going to spend a lot more time
with you. You're going to geta lot more comprehensive care. We're not
going to just you know, shuttleyou off to the specialist every time you
come in for something. Your bloodpersure a little high, Okay, we're
going to send you here, youdoctor. You know, We're going to
try to take care of as muchas we can within the office. So

(05:53):
it's it's a very different model ofcare than those ten minute visits you get
in the large system. You know, we talked to about bill and cost
and how that works. We've doneI know a recent show or two about
those type of things, and forfolks that want to listen back, you
can always head on over to AdvocateDPC dot com or wib A dot com.
Check out that podcast. It's prettyamazing. And as we talk with

(06:14):
doctor Hemkis I mentioned the website Advocacydot com. That's Advocate DPC dot com.
Great website. To learn more aboutAdvocate MD. They're telephone number to
eight two six eight sixty two eleven. That's six so eight two six eight
sixty two eleven to make an appointmentto become a member at Advocate MD.
And we talked about some of thetype of patients that use Advocate MD in
direct primary care. And I'm doctorHemks. A lot of people may be
surprised to know that every you know, nearly everybody carries insurance. One of

(06:40):
the things that in one of thenuanced things that folks are surprised about is
you don't bill insurance as you're asyou were talking about there, what's included
with a membership. That stuff isall included with your with that monthly with
your with your monthly membership fee,that's all included. There's not like waiting
for the insurance to approve something orany type of middleman, and that's really

(07:02):
how you're able to make things soaffordable and such high quality. Addv can
D is not having that middleman ofan insurance company kind of dictating what you
do and how you do it exactly. So you know, the ironic part
is that many times when we getinsurance involved, it actually increases the cost

(07:23):
of things, you know, becausenow you have another middleman, you have
additional you know, paperwork and bureaucraticred tape. And you know, we've
used the example of you need anMRI. So if you have insurance and
you're getting that MRI, what thenormal process is that you know, I
see a patient in the clinic andwe evaluate them and we say, oh,
it looks like you know, youhave low back pain, you have

(07:44):
whatever the issue might be. Okay, let's let's get an MRI. I
put that order in the computer,you know, my staff, it sends
it through. And if I wasin a fee for service practice, like
a big insurance based practice, thenthat would get sent to the insurance company.
The insurance company is going to denyit. You know, nine percent
of cases they send back a priorauthorization or pre certification, all these different

(08:05):
names for things. And then Ihave to complete a form, I have
to write an explanation, send themedical records. It goes back to the
insurance company. Many times they denyit again. They might ask me to
do what they call like a peerto peer review or a doc to doc,
meaning I have to figure out atime in my day to call a
doctor on the phone and talk tothem for ten or fifteen minutes to explain

(08:26):
to them or defend to them whyI'm ordering this MRI on this patient so
that the insurance company will pay forit. And then you know, this
process can go back and forth fordays or weeks, so it's delaying care
for that patient. There's obviously acost associated with all of this, right
there's the doctor's time, the staff'stime, you know, all of these
people that become involved in this.But in this direct primary care model,

(08:48):
if I need an MRI on apatient and we're paying cash, which is
typically you know, one tenth ofthe price, then I just put the
order in the computer and then I, you know, send it through to
my staff. They call facts thatMRI facility, or they call them they
schedule it, and that process canhappen within twenty minutes or fifteen minutes instead

(09:09):
of days or weeks. So it'sit's mind boggling how that can happen and
be such a more efficient way ofdoing things. And again, the cost
of it is actually lower, righteven besides the fact that we're not involving
a multitude of people, The costwhen we pay cash for that MRI versus
the insurance price for the MRI ismuch less to pay cash. It's pretty

(09:31):
amazing what you're able to do atAdvocate MD. And obviously folks are responding
as we talk about three soon tobe four clinics at Advocate MD, we're
going to talk in a moment justabout the doctors as well at Advocate MD,
and that's important too. The doctorsat Advocate MD and doctor hemkis.
When you talk about the staff atAdvocate MD, everybody's an MD or a
DOO, and we're talking about fullytrained licensed doctors, not pas or nurses

(09:56):
or anything like that. When youmake an appointment to see your doctor,
you are seeing your actual doctor,your actual MD, which is weird to
think that that's not typical now.And the other in kind of the the
insurance system is a lot of folksthat if they're making appointment to see their
doctor, they may get a chanceto see their doctor for an annual physical.

(10:16):
Otherwise they're they're kind of getting inand seeing other doctors or more often
physicians assistants or or those type ofthings. At Advocate MD, you actually
get in to see your doctor foryour appointment. That's pretty amazing, it
is true, and you know,it kind of kind of goes back to,
you know, sadly, what we'reseeing happening. The trend that we've

(10:37):
been seeing happening maybe over the lastten years in our healthcare systems is that
physicians are being replaced by non physicians. You know, in some cases it
is difficult to find physicians and difficultto hire physicians. But you know,
I would always say that, youknow, if you treat doctors well and
pay them fairly, and they enjoywhat they're doing, and you know,

(10:58):
most of the vast majority of doctorsreally like taking care of patients and practicing
medicine, it's the system that youknow, quote burns them out. So
what you see happening in large systems, though, large hospital systems like we
have here locally in Madisone is thatmost of the decisions now are made based
on financial reasons. Right It's notthat they're making these decisions saying what's best

(11:20):
for this patient right here. Youknow, we're going to we're going to
choose the best physician, the bestperson we can put into this position that's
going to take the best, mostcomprehensive, high quality care of high quality
care of that patient. So inother words, you know, non physician
providers might cost less to that hospitalsystem. So you know, we see
now when doctors are retiring or leavingsystems, most of them are being replaced

(11:43):
by non physician providers. And youknow, there are very good ones out
there, but it is a verydifferent level of training, education experience than
a physician. You know, physiciansobviously go to school for for many many
years to get their MD, andthen they go through residency and then you
know, they have additional clinical hours, they have multitude of exams that we

(12:03):
have to pass to get to thatpoint. So I would say that in
our practice advocate MD, we onlyhave physicians. And that is a very
conscious decision that I made early on, and I have stuck to my guns,
and I've had people, you know, try to influence pressure me a
little bit to hire non physician providers, and I've just always felt that this

(12:26):
is the right thing to do forthis type of practice, direct primary care,
we really are are taking very comprehensivecare of patients and trying to manage
a multitude of things in our officerather than refer them out to other doctors.
So for us, it really makessense to have a all physician practice.
And it makes so much sense ifyou're looking for a great option for

(12:48):
yourself, your family, if you'rean employer. We're in such a competitive
market right now when it comes tohiring good employees. What a great option
to offer your employees Direct primary care. The ability to see your doctor when
you need to see your doctor,length the appointments up to an hour if
needed or longer, you know,you never know what's going on, and
having that conversation with the doctor.It's it's it's such a great, great

(13:09):
model direct primary care and advocate MDtoday is to day. To learn more,
head on over to the website ADVOCATESDPCdot com. That's Advocates DPC dot
com. Even better, pickup phone, become a member at Advocate MD,
give them a call this morning sixoh eight two six eight sixty two eleven.
At six oh eight two six eightsixty two eleven, we'll talk about
the doctors at Advocate MD and talkalso about the importance of independent doctors and

(13:33):
independent practices. We'll find out fromdoctor Hemkiss about that next as Full Scope
continues right here on thirteen ten WIb A A twenty four thirteen ten WIBA
and full Scope with doctor Nicole Hemkissof Advocate MD, Wisconsin's direct care doc.
You can learn more about doctor Hemkissall the doctors at Advocate MD,

(13:54):
as well as the separate locations.Learn more about what we mentioned earlier.
The doctor pointed out that a greatmajority almost all folks that are members at
Advocate MD also carry some type ofother insurance or health shares. You can
actually learn more about those options atthe website ADVOCATEDPC dot com. That's ADVOCATEDPC
dot com and it is an amazingmodel direct primary care for yourself or your

(14:16):
family and employer. If your employeemaybe suggests to your employer about Advocate MD,
you can learn more at the websiteADVOCATESDPC dot com. That's ADVOCATESDPC dot
com telph number six oh eight twosix eight sixty two eleven. That's six
'oh eight two six eight sixty twoeleven and three soon to be four locations.
And I remember when we first starteddoing the show, it was one

(14:39):
soon to be two doctors at AdvocateMD, and we left that last segment
talking about the medical doctors and doctorson staff at Advocate MD. That's important.
Let's talk a little bit about theteam around you, doctor Hemkesho,
Who the doctors are and where folkscan get to know them. Yes,
so if you go to our websiteADVOCATEDPC do on there, there's an about

(15:01):
us and you can read the doctor'sbiographies. You know, all of our
doctors are experienced, they worked andthey worked in large systems for many years
before they decided to come to directprimary care. We have two new doctors,
doctor Julia Danz who's starting next weekand doctor Giselle Argento Burio, who

(15:22):
speak Spanish, who started with usabout a month ago. We're very excited
about both of them and that thepractice continues to grow. And part of
this model again is to have thesekind of smaller panels of patients. So
when our doctors start to get morefull, which might be around you know,
four hundred five hundred patients, thenwe try to hire another doctor so

(15:43):
that we won't have the issue thatwe see in large systems where you can't
get in with your physician for multiplemonths and that you know, again these
very small short visits. So that'spart of this direct primary care model that
is really nice. One of thethings too. And I don't know that
folks really I hope that they thatthey understand this is direct primary care is

(16:07):
a model that's that's taking hold fordarn good reason across the country. Advocate,
MD, you started this practice anumber of years ago. You've built
this practice. You are the youare the medical director as well as as
a doctor, an advocate MD.This is your thing. This is a
this is a Dane Rock County,southern Wisconsin business that you've put together.

(16:30):
And folks need to understand that thatthat you're independent. When we talk about
some of the relationships in the insurancesystem with doctors kind of being a feeder
to the to the hospitals and thosekind of things, you are an independent
doctor and independent primary care doctor andindependent clinics, and you work with other
independent specialists and others as well,don't you. Yes, you know,

(16:52):
I think what most people, Imean, anybody probably over the age of
thirty, I would say, hasprobably seen or maybe four You probably have
seen some changes in healthcare during yourlifetime. And many of us remember the
days where there were many independent privatepractice doctors. You know. I know
my pediatrician as a kid, myfamily medicine doctor as a kid. They

(17:15):
were all private practices. They weren'towned by big hospital systems. You know.
That was a practice of three orfour doctors, you know, and
that used to be very common nowadaysif you look across the country, but
especially here in Madison, that's veryuncommon. Right. We don't see a
lot of private, independent family medicinephysicians, primary care doctors anymore. You

(17:37):
know. This started to happen tenor fifteen years ago. Were large hospital
systems and we all know the namesof the local ones basically started buying out
independent practices. And you could say, well why was that. Right?
Part of that was so that mostof that was so that they could control
the downstream revenue. Right, So, as a family medicine doctor, I
might need to send somebody in fora procedure or a surgery, to see

(18:02):
a specialist to get an MRI done, and they want to be able to
control where that person goes. Soa lot of that has to do with,
you know, what network that patient'spart of and what hospital that that
doctor's employed by, because just kindof the path of least resistance is to
refer them through that hospital system forall of their testing and their continuing medical

(18:23):
needs. But what that has createdis a healthcare environment where patients have a
lot less choices and there's a lotless competition, right, which we know
that drives up that drives up cost, and that drives down innovation and quality
when we have a monopoly, rightbecause like if somebody owns, you know,
eighty percent of the doctors in acommunity, then there's not a whole

(18:48):
lot of people that can come inand compete with that, and then they
can kind of decide what price they'regoing to charge, and they can also
they don't really have to be constantlyinnovating and improving their quality giving better patient
care because they pretty much like whereelse are you going to go? You
know? So so here in Madison, unfortunately, we don't have a lot
of private practice primary care doctors,and we don't have a lot of private

(19:12):
practice specialists, you know, Imentioned months ago, I think or we
did a program a while back aboutOrthopedic and Spine Centers of Wisconsin, which
is a group of eleven orthopedic surgeonsthat left one of the local systems here
SSM and started their own practice.And this kind of stuff doesn't happen every
day right where most of the doctorsin the department leave to start a private

(19:33):
practice. But we need things likethat happening because as patient, you know,
I'm not only a doctor, butI'm a patient and I want to
have more choice. I want tohave the choice of seeing a private orthopedic
doctor or seeing a private cardiologist ifI want to. And if you if
you lose that choice, that's that'sgoing to be really bad for us as

(19:55):
a community because we will basically beall of us will be shifted kind of
into the same system, better care, better time, shorter you know,
you get to see your doctor whenyou need to see your doctor, and
say shorter time to get in.As a matter of fact, it's staggering
how quickly, especially when when folksneed to their doctor. How quickly you
can get in to see your doctorat Advocate MD, and how much time
your doctor gets suspend with you,actually, you and your doctor. It's

(20:18):
an amazing model. Today is todayto learn more online Advocates DPC dot com.
That's Advocates DPC dot com. Telpha number six O eight's two six
eight sixty two eleven. That's sixeight two six eight sixty two eleven.
Looks like we're about about a monthout from the grand opening of the Fitchburg
location. We may need Doctor todo the show live from from the Fitchburg
location because more like five minutes fromyour studio, So yeah, you definitely

(20:42):
will have to talk about that.Of course. The newest location going to
be opening mid June on Siein Road, also west side in Middleton, east
side of Madison on Faroaks A,and in Janesville ten twenty one Mineral Point
Avenue. More information online Advocates DPCdot com. That's Advocates DPC dot com.
Doctor hempkiss you enjoy this weekend andwe'll talk real soon you too,

(21:03):
Sean, Thank you. News comesyour way next here on thirteen ten wib A