Episode Transcript
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Speaker 1 (00:00):
Eight oh, five, thirteen, ten, wuib A and full scope
with doctor Nicole Hemkiss, Wisconsin's direct care doctor. You can
learn more about doctor Hemkiss and all the doctors at
Advocate MD. Also all four locations online the website ADVOCATESDPC
dot com. That's ADVOCATESDPC dot com. Also online, you can
(00:20):
learn more about direct primarycare, what makes such such a
great option for you and your family, and if your
employer great option for primary care when it comes to
your employees. Check out Advocates DPC dot com. That's Advocates
d PC dot com. Telphon number, make an appointment, become
a member at Advocate MD six h eight two six
eight sixty two eleven. That's six 'h eight two six
(00:42):
eight sixty two eleven. As mentioned to the doctor, she
joins us this morning, doctor Nicole Amkiss, doctor, how you
doing this week?
Speaker 2 (00:49):
I'm doing good, Sean, how are you, dude?
Speaker 1 (00:51):
Really good? Busy time a year for everyone, and we've
got a lot of stuff to touch on this morning.
We're going to talk about hospitals, how they're rated, and
how that's rating systems not the most effective or most
I don't know if you want to call it if
it's the most realistic system. We're also going to talk
about something that I love talking about, which is technology
(01:14):
and specifically AI. We'll get to that in just a moment.
But first, Doctor real quick mentioned, of course four locations
of Advocate MD, eight doctors at Advocate MD across the
four clinics, and that is absolutely fantastic for patients, isn't it.
Speaker 2 (01:29):
Yes, you know, we have a direct primary care clinic.
That's a little bit unique. You know, many direct primary
care clinics have you know, one doctor, maybe two doctors,
and have one clinic. The thing that makes us different
is that we do have a lot of options as
far as physicians and locations, so patients can go to
any of our clinics that they happen to be on
(01:50):
one side of town. You know, if they need an
urgent care appointment, we get to get them into wherever
it's convenient for them. And again, if we have a
business that's looking at doing direct from here, this makes
it a lot more feasible and attractive to them because
you know, of course their employees live on different parts
of town. So yeah, we're really happy to be able
to offer that and.
Speaker 1 (02:12):
Very convenient as mentioned. Of course, started out on the
west side in Middleton, then he added the east side
location right on Farroks Ab then of course for folks
in southern Dane County and in Rock County as well,
yet put the clinic in Janesville, and then the newest location.
I hope folks have had a chance to check that
one out at thirty two to twenty Sign Road. That's
right in Fitchburg, right on the Fitchburg Madison line. If
(02:33):
you haven't been out that area, it's beautiful to get
the bike trails back there, and of course the nature
preserve as well. You can learn more about Advocate MD
online the website Advocates DPC dot com. That's Advocates DPC
dot com and doctor AI. It is everywhere. I think
we've all maybe experienced, on maybe a small scale, the good,
(02:55):
and we've probably experienced some of the bad as well.
And we're starting to see AI come into healthcare. And
I don't want to be too presumptive, but I'm going
to say it. I'm going to guess it's probably very
similar in healthcare as it is with other applications. Let's
talk about the emergence of AI and and what it's
being used for, and some of the downfalls that are
(03:16):
potentially presented by incorporating AI.
Speaker 2 (03:20):
Yeah, I think I have a lot of mixed feelings
about AI. I think many of us are scared by
the possible implications of it. But it's interesting in healthcare.
You know, this topic came across my mind because I
saw a headline in an article about, you know, how
AI is going to fix broken patient communication practices, which
(03:40):
I thought communication interesting, That's an interesting part that you know,
there's many things we think AI could fix in terms
of maybe efficiency, process efficiencies and things like that, you know,
kind of the behind the scenes things. But communication, you
know that that's typically interacting between two human being or
(04:01):
a doctor and the patient. So I find it really
interesting and also maybe concerning. You know, there's things that
AI has definitely made an impact on obviously, you know,
the electronic medical record, you know, I know there are
some systems here locally where the doctor is using their
cell phone. They're sitting their cell phone down in the
(04:22):
room when the patient comes in for the visit, and
the cell phone, you know, with the permission of the patient,
the cell phone is recording the entire conversation. That they
are having and then it is transcribing that into a note,
and if it's sophisticated enough, which many of them are,
it's taking out the details that are extraneous, you know,
like if they're talking about, you know, how to day
(04:42):
you know what you know, uh, oh we went on
a trip to you know, Europe, or you know, they're
taking all that out and they're including the pertinent medical
information and it's even structuring your note. I mean, it's
crazy the stuff that it can do. So, you know,
in that way, I can see, you know, some of
the busy work that doctors do or nurses or other
healthcare personnel, like the busy work stuff where we have
(05:04):
to you know, type notes and things after the visit
or you know, something we do it while we're in
the room. That I can definitely see. But the part
that's concerning to me is that you know, we already
know that in some systems now if a if a
patient sends a message to a doctor through you know,
the system that many of us are familiar with is
my chart. If they send a message to the doctor. Now,
(05:27):
there are some healthcare systems where the person that is
responding to is actually not a person. It's a it's
a computer program. So you're not talking to your doctor
or your doctor's nurse. You're getting some sort of a
automated AI generated message back. You know, that's interpreting what
the words and your your message are and somehow formulating
(05:49):
a response to that. That sort of stuff concerns me,
right because in healthcare there are a lot of nuances
and and you know, things that could be interpreted, you know,
very small details that might be interpreted in very different ways. Right.
So for example, you know, a patient can send me
a message about having a UTI and there's a few
(06:10):
questions I will ask them maybe to determine whether this
is something where okay, come in, bring it. You know,
we'll test your urine, or you know, this is something
more serious, we need to put you on antibiotics right away,
or this is something more serious, we need to get
an ultrasound to make sure your kidney, you know, kidney
function looks good. So the fact that a computer is
interpreting this and you know, we I guess we all
(06:31):
know the computers are more are smarter than human beings, now,
I guess, but there could be very small nuances in
that patient's message or things that are left out and
unless you're asking the appropriate questions and interpreting that data
in a very specific way. And I guess sometimes it
also gets back to the art of medicine versus you know,
the science of medicine, because there's both. And then obviously
(06:55):
there's a certain way that we talk to patients, right like,
you know, we have to be empathetic, we have to
be understanding. We have to provide them information in a
way that is you know, uh, palatable, that's understandable. You know,
we have to be able to convey you know, bad
news or you know, negative results to them in a
way that is delicate or that you know that they
(07:17):
can act on that or understand that. So so I
think there's so much to AI that we still still
has yet to be determined, but the fact that it's
changing so rapidly, and you know that that that part
concerns me, you know, And one.
Speaker 1 (07:33):
Of the things that we we you know, like if
you're on social media, for example, and there's like an
AI generated image and maybe you know a lot of
our grandparents kind of fall for it and share like, oh,
this great great knitted cat just is not getting all
the likes that should that's what they I mean, that's
a little it's it's it's it's kind of goofy. It's
ultimately harmless. When it comes to medicine, that's kind of
(07:55):
one of those areas where you really want want somebody
that no like an actual human being that has has
a high level of education doing that kind of thing.
And are they required doctor by the way, And I
don't even know, I don't know if this is there's
probably an answer to this question, but like with those
like chat features on for some of the healthcare, do
(08:18):
they have to tell you that you're chatting with an
AI body or is it just one of those things
that just never mentioned and people may not even realize.
I know that AI is so impressive now there's probably
cases where people have chatted with AI and probably have
no idea that that was AI.
Speaker 2 (08:34):
That's a really good question, Sean, And I don't you know,
since we don't really utilize AI in terms of any
we don't utilize it for any sort of patient communications.
But that would be an interesting question because I bet
you there's something in the small print, like when you
sign up with my chart in epic, you know, there's
probably some terms of service that you click a box
that somewhere buried in that you know, nobody reads those
(08:56):
all those pages, so there's something buried in the pages
of like, okay, I'm that it's okay if you know
some of my communications or responses are answered by you know,
something automated, I'm sure there's something in there. The thing
that always gets me though about this AI conversation, I guess,
especially the healthcare realm, is that many of it is
couched in the way of not just providing efficiency, which
(09:19):
I totally could understand that part, but it's it's also
couched in the way that it's going to provide better
care or better communication with patients, and it's it's just
ironic because AI, the name of AI is artificial intelligence, right,
So you are not speaking to a person any longer.
Right then, and again it goes back to this whole
idea of the doctor patient relationship and really that being
(09:43):
the foundation of you know, medical care, right, So you
have to have a good doctor patient relationship. You know
what if ninety percent of your communications now are being
answered by an AI bot, like you know, even if
they're giving you maybe the right answers that's not your doctor.
And that's also you know, your doctor is not the
one that is, you know, gathering that part into your
(10:04):
medical history or into their brain to say like, oh yeah,
I remember missus Jones when you sprained your ankle last year,
or you know, all of these things that we remember
about our patients when we take care of them, and
that kind of goes, you know, brings me back to
the direct primary care model because in our model, as
we've talked about Sean, you know, we take care of
a much smaller panel of patients. So instead of a
(10:26):
family medicine doc having two to three thousand patients in
the large systems, our docs have you know, four hundred
to six hundred patients on average, so I mean, you know,
less than a quarter of the size of a big
hospital doctor. So when you have four hundred to six
hundred patients, we answer our own communications, so if it's
you know, an email, a text message. And in the
(10:49):
same article that I sent to Sean, it said something about,
you know, the new standard of care is that you know,
healthcare people need to be available twenty four to seven,
and again that made me think of DPC because we
do uniquely, our doctors are available to their patients after
hours if there's something urgent going on or during the
(11:09):
day even you know, so the patient text us and
we respond to that. And again, the way we can
do that is because we keep a smaller panel of patients.
So so to me, again, you know, the answer doesn't
necessarily have to be we have to figure out more
efficient ways to do this, which might mean let's substitute
a computer for a person. You know. The answer might
(11:30):
be that we need to kind of re envision what
healthcare looks like. That doctors shouldn't have panels of two
to three thousand patients. Maybe they should have panels of
five hundred patients. You know. Maybe you know for sure
that's going to allow the patient a better experience. There's
no doubt about that, right, nobody can can debate that point.
But but yeah, the the kind of irity of AI
(11:53):
entering into all of this, as of course, we have
a physician shortage, a healthcare worker shortage, and so I
foresee that this will only become you know, a bigger
and bigger part.
Speaker 1 (12:04):
That's a it's a it's a it's a sad state
as well. When you when when you see that, that's
how they you know, the issue, there's the there's a
problem clearly in these uh as you mentioned, there's shortage
of doctors. There's doctors are overburdened. The expectation placed on
them by these by these big, big systems is to
see more and more patients have less that connection. And
(12:24):
rather than the solution being well, let's find a way
to actually have more connection, maybe maybe having fewer patients
on a panel, their response is well, let's find a
machine to handle and it's there's like that disconnect like
but that's not solving the problem. That's making it probably
likely worse. And one of the great things is actually,
i should say likely making it much worse. As we
(12:46):
talked this morning with doctor Hempkis of Advocate MD, there
is a better way when it comes to primary care,
of course, is direct primary care. You can learn more
about Advocate MD on their website Advocates DPC dot com.
That's Advocates DPC dot com website to learn more about
Advocate MD Direct Primary Care. All the doctors at Advocate MD,
the clinics as well. Again, all that information available to
(13:07):
you at ADVOCATESDPC dot com. Telph number six oh eight
two six eight sixty two eleven. That's six h eight
two six eight sixty two eleven. What about ratings, Well,
we'll get the details from the doctor about hospital ratings
and some of the flaws and some of the issues
that arise when it comes to some of the current
systems for hospital ratings. We'll find out from the doctor
what that's all about next as Full Scope continues right
(13:29):
here on thirteen ten WIBA eight nineteen thirteen ten WIBA
and full Scope with doctor Nicole Hemkiss, Wisconsin's directcare doctor.
You can learn more about doctor Hemkiss and the seven
other physicians at Advocate MD all on their website ADVOCATESDPC
dot com. That's Advocates DPC dot com for very convenient
(13:50):
locations for you your family. Also looking for some great
options for your employees, definitely check out Advocate md again
the website ADVOCATESDPC dot com. That's Advocate DPC dot com.
Telp for number six oh eight two six eight sixty
two eleven. That's six h eight two six eight sixty
two eleven. And ratings and uh and that type of
stuff really do make the world go around. I was
(14:12):
talking to a friend of mine that's looking at buying
an existing business and one of the one of the
things that he was impressed with with the current businesses
it's online rating. I don't know which one of these
like important websites that ranks businesses. It had like a
four or five star and he's like, that's a really
good thing. Wow, that makes her break some business deals.
And of course, when it comes to your healthcare and
(14:35):
you got to go to the hospital, maybe you have
to have a surg surgical procedure or something, and you're
looking at hospital grades, Logically, you want the highest grade.
You want those eight pluses, you want those those high,
higher rated institutions to have you looked at and doctor. Wow,
there's a dare I say scandal when it comes to
(14:55):
hospital rating system. What is going on here?
Speaker 2 (15:00):
Yeah, So there was a recent article about a group
of hospitals down in Florida that are suing one of
these ranking agencies. This agency's name is called Leapfrog. They
specifically do safety rankings, but they're suing them based on
you know, how they collect the data and interpret the
data and when they come out with these rankings. The
interesting thing is that you know, these rankings that they
(15:23):
put out have kind of far reaching implications. I didn't
kind of even understand all of the implications until I
started doing some research. But I think many of us
are familiar with, like US News and World Reports. You know.
Health Grades is another one online that a lot of
people look at. You know, so when people google, okay,
I need to have this surgery done or I need
to see this specialist, many times they're going to go online.
(15:45):
They're going to google that in their local area, and
these rankings will come up. Another one that you might
be familiar with is the CMS ranking. So that's a
governmental agency that controls Medicare and Medicaid and they put
out their own rankings. You know. The difficult part is
that all of these ranking systems use slightly different data.
They rank things in different ways, or they rate the
(16:08):
way things in different ways. You know that the way
that they rank things is constantly changing, you know, from
year to year. So the other part that is is
lesser known is that, you know, some of these ranking systems,
like US News and World Report, they have some sort
of like way that hospitals can either donate or give money,
(16:29):
and there's some sort of financial incentives, you know, that
can potentially blur the line of how they rank people.
I'm sure that they would say that those things are
kept separately, but of course they have some sort of
paid advertisements and things in their magazines too, so like
they're you know, it seems like they would have a
bias towards giving those hospitals that are doing paid ads
(16:50):
like a higher ranking. So so that part where the
rankings are influencing the patient's decisions. And then potentially if
if a hospital system gets a lower rank thanking that
they could you know, potentially lose a lot of money
because of that. That's why these hospitals in Florida are
now suing this this leap frog. But I think, you know,
(17:11):
there's a lot of complicated issues from this, you know,
So how do these ranking systems, how do they collect
their data?
Speaker 1 (17:17):
Right?
Speaker 2 (17:18):
Are they actually getting reliable or accurate data? Right? So
many much of their data has to do with patient safety,
you know, complications things like morbidity, mortality, you know, readmissions
after surgeries or after hospitalization. Some of them are based
on patient experience, which obviously it can be very subjective.
And also the types of questions you ask patients about that.
(17:40):
But but so, like I think it's it's hard because
most people just look at the end result of it,
you know, which is the ranking, and they don't actually
know everything that goes like that goes behind that. So,
you know, they talk about things like the CMS rankings,
And one of the things I found out in my
research is that how a hospital has their CMS ranking
(18:02):
center for Medicare and Medicaid services, that can determine actually
what their future insurance reimbursement rates are. So like that
whether it's private insurance or Medicare and Medicaid, you know,
if their ranking goes down, potentially the insurance company could say, okay,
well we're going to pay you less you know, this
year for the surgery because you're ranked four stars instead
of five stars. Just a total example there. But but
(18:26):
and again the other part that they've talked about was
that there's a lot of instability of these rankings. So
like if one of these ranking systems decides to weigh
one thing a little heavier than something a little less.
A hospital system that was ranked you know, five out
of five stars or top ten hospital and their you know,
their area or the country, then all of a sudden
they fall down, and it doesn't have anything to do
(18:48):
with the hospital, right, it doesn't. They didn't change any
of they're practices, They didn't change their quality of care,
their complication rate didn't go up. It was completely dependent
on how that ranking system decided to weigh those different variables.
So they change the way to the variables, they change
their equations, and then all of a sudden, the hospital
rank either goes up or goes down. And it also
(19:08):
talks about how, for example, small hospital, so it compares
large academic facilities versus like a small community hospital that
has you know, twenty to fifty beds or large tertiary
care center that has five hundred to one thousand beds.
So that large tertiary care center, they're going to be
taking care of some of the most complicated patients. They're
(19:31):
going to be taking care of patients that have specialized surgeries,
that are hospitalized for many, many days. They have higher
readmission rates that small community hospital. First of all, they
have much less volume, right, so there's less of a
chance of having readmissions. But they also take care of
much less complicated patients. Because if they have very complicated
(19:52):
patients who need specialized surgeries or any of that, those
patients will be sent to a tertiary care center. So
in many ways, it actually fi beavors the community hospitals
or the smaller hospitals versus the large hospital systems for
all of those reasons. And in many ways too, it
could possibly incentivize or disincentivized hospitals to take on more
(20:14):
complicated patients, right because if it's like, oh, this guy's
get been in really he's been admitted to three different hospitals, Well,
I don't you know, should we do the surgery here,
you know, because there's a high chance this isn't going
to go well, so they can then you know, there's
laws about this, but they might choose to not take
on some of those more complicated cases. So it's all,
you know, it's all quite Yeah, it's quite complex.
Speaker 1 (20:39):
It's interesting you talk and you mentioned earlier about kind
of alluded to some of this too, that some of
these safety grades are also they say that the allegations
are distorted by undisclosed financial incentives, which again, these are
all the types of things that you really don't want
to see when it comes to when it comes to
the hospital, when it comes to your healthcare. You want
to a straight answer, and of course the grading systems
(21:01):
are out there to make it simpler for us so
we don't have to do all that digging and researching ourselves.
We say, okay, well I trust this organization and there
and they're grading. And unfortunately it does not sound like
these A lot of these systems are as trustworthy e
They're one of the great things. As we talk and
gets a chance to chat with doctor Nicole Hemkiss each
and every week here on thirteen ten WIVA. One of
(21:22):
the great things about healthcare when it comes to primary care,
there's an amazing option out there called direct primary Care.
Great for you your family. If you are an employer looking
for primary care for your employees, a great option there.
Check out Advocate MD, the website Advocates DPC dot com.
That's Advocates DPC dot com. That's where you'll find more
(21:42):
information on advocate MD. Even better, today is a day
great day to pick up phone, give a call, make
that appointment six soh eight two six eight sixty two eleven.
That's six 'h eight two six eight sixty two eleven,
Doctor Hemkiss. It's always great chatting with you. It looks
like it's going to be a great weekend to have
you enjoyed it. We'll talk real.
Speaker 2 (21:57):
Soon you too, John, Thank you.
Speaker 1 (21:59):
News is next year thirty D ten w I b
a