Transparency & Fairness in Healthcare

Episode Transcript

Speaker 1 (00:00):
At six thirteen ten Wi BA and full scope with
Wisconsin's direct care doctor, doctor Nicole hem Kiss. You can
learn more about Advocate md ALL on their website Advocates
DPC dot com. That's Advocates DPC dot com. Also, you
want to do a little detective work, check out the website.
You might get some clues, might get some insights, some information.

(00:21):
Learn more at Advocates DPC dot com. Telp number six
O eight two six eight sixty two eleven. That's six
eight two six eight sixty two eleven. Doctor Hemkiss. How
are you doing this morning?

Speaker 2 (00:33):
I'm doing great, Sean, How are you?

Speaker 1 (00:34):
I'm doing really well. And although I do miss the uh,
the warmer temperatures. Folks that that don't know you grew
up in Florida, what the heck think every think about?
You know, maybe spending half your time even in.

Speaker 2 (00:47):
I'm like my mom, Well, your mom.

Speaker 1 (00:51):
And dad have been sending me messages saying, can you
please some.

Speaker 2 (00:53):
Courage stop talking to Yeah, so I grew up in
the Orlando area. Yes, I do think it's I don't
know if it's global warming or what's going on, but
whenever I visit Florida, I'm just I'm shocked by how
warm it is down there. But I do enjoy the seasons,
and this is probably the best time of year this
fall kind of crisp, cool air, it's not too cold yet,

(01:16):
you know. I like this time of the year it is.

Speaker 1 (01:18):
It is a good time of year. I just sometimes
just start to dread what's what's on the horizon. And
and doctor, We've got a lot of really important stuff
to talk about this morning. Technology in the in the
in the clinics, and kind of getting involved in doctor
patient relationships. Again, love technology. Some of the stuff though,

(01:39):
is sometimes wonder like is this going a little bit
too far? We'll find out about some of those details
and where AI is coming in on some of this stuff.
But first I did want to ask you about direct
Primary Care and Advocate MD, and of course what you
guys do eight physicians at at Advocate MD. Four locations.
Of course, you've got Middleton right on Glacier Ridge Road,

(02:00):
east side of Madison, on fair Oaks, right in Fitchburg
at thirty two to twenty SI Road, which I'm going
to guess this time here you get some spectacular views
with that sanctuary right there. And of course location right
in Janesville at ten twenty one Mineral Point Avenue. Doctor,
let's talk just real quick about Advocate MD and what
Direct Primary Care offers folks, especially as we're kind of

(02:21):
looking at open enrollment and other things for people right now.

Speaker 2 (02:25):
Yes, so direct Primary Care is a membership based model,
so that means you pay a monthly membership or your
employer pays that membership. On average, it's usually around seventy
to eighty dollars a month for an adult, and then
when you come in to see us, there's no co pays,
there's no cost for that visit. There's no hidden cost.
If we do end up needing to do something like

(02:46):
lab work or dispense some medication from our office, you
would know the cost of all of those things ahead
of time. Nothing is hidden. So it's kind of a
wholesale based cost for any of the ancillary services that
we do in the office, but your your visits, any
type of visit, is included in that price. So it's
very much unlike the insurance based healthcare system, where every

(03:09):
time you walk in the door of a hospital or
a clinic or an urgent care clinic, you will be
generating a charge you know, no matter if you see
a doctor or probotomist or a nurse, there's going to
be a charge when they check your blood pressure. There's
going to be a charge when they draw your blood,
when you see that doctor for your you know, cholesterol
follow up visit or you're well exammed, there is going

(03:29):
to be a charge associated with all of those interactions.
And that's how these big, you know, multi million you know,
million dollar non profit systems, you know, make profit is
that they have this fee for service system. But in
our system, the idea behind it really is that we
are generating our revenue from the membership charges and then

(03:50):
all these other ancillary services we offer, you know, again,
whether it is you know, blood work or an X
ray or a heart monitor, we are kind of just
breaking than on those things. You know, we're just passing
along the cost that the third party vendor is charging
us onto the patient.

Speaker 1 (04:07):
It's a great model and it's it's very I think
sometimes people are like like, wait, there's got to be
a catch, or also they think it sounds too easy,
it sounds too simple. It's there's no catch, and it
is actually that easy when it comes to become a
member at Advocate MD. You literally just head on over
to the website. You can enroll right online or give
them a call. Make that apployment six eight two six
eight sixty two eleven. That's six h eight two six

(04:28):
eight sixty two eleven. Very affordable. Whether you're looking for
a great option for yourself and your family, or if
you're an employer looking for some great options for your employees.
What a great thing to offer, What a great benefit.
Direct Primary Care and Advocate MD again. Learn more online
Advocates DPC dot com. That's Advocates DPC dot com. I
like AI, I like technology. I don't like things getting

(04:51):
too much in my stuff, and I don't definitely rely
on technology for my overall well being. There is something
called an AI scribe making its way into clinics across
the country. What are AI scribes?

Speaker 2 (05:06):
Doctor, Yes, and even bigger than the AI scribes. You know,
the newest thing which was new to me. I have
heard of AI scribes, and that's been something that's been
around for a few years. But this ambient listening technology
that now that they are apparently employing in hospitals, and
you know, the excuse that they use for all of

(05:28):
this is you know, workplace burnout. You know, nurses and
physicians are burnt out. You know, they don't have enough
time to take care of patients. You know, we have
a shortage of of you know, healthcare professionals. All of
those things are true, but it is interesting the ways
that they are finding now. Of course, technology allows them
to eliminate more positions, right because they're replacing people with

(05:48):
you know, computers and this AI technology. But in this
article that it was on and I I'll post it
probably on Facebook or one of the other social media posts,
but it was talking about how ambient listening is going
to be now employed in a lot of hospital rooms
and and it brings up you know, of course, there's

(06:10):
pros and cons with any type of technology, as you know, Sean,
and I know you're into the latest you know, rings
and and uh gadgets, but but I I always worry.
I mean I don't even have like an Alexa in
my house because I don't like people listening to my
you know, I mean they say your phone even does that.
But you know there're you see you even when you're

(06:32):
looking up something on your phone, and then all of
a sudden they start you know, popping up the Amazon
ads of whatever thing you were just looking up on
a search engine, or you start you were looking up
a movie name, and then you all of a sudden
they're start You're getting ads for that that movie. It's
it's crazy. But so in this this article, it's talking
about how they're going to employ this ambient listening in

(06:53):
hospitals so that now nurses, you know, used to the
old fashioned way and this is the way it was
when I worked in hospitals. You know, there's a button
that you press and then the nurse is supposed to
come in. Unfortunately, many times that doesn't happen right like
or the LPN or the nursing assistant. It's supposed to
respond to that to see what the patient needs. Do
they need to help getting out of bed, do they
need a drink? Do you know it could be multiple

(07:15):
are they having more pain? But they're saying that if
they're allowed to listen, I mean, I think it would
have to be listening constantly, because they're going to be
listening to see if there are noises that they're hearing,
or if they're hearing the patient talking. They're even saying
that it's going to be able to have some sort
of pattern recognition to be able to you know, detect

(07:39):
potential signs of pain emotion technology. So it's very cool
in a way that we have gotten to this point
where you know, we have technology that can do all
of this. But I always again get concerned in terms
of you know, patient privacy and even just you know,
because you're in a system, I mean in the hospital,
that doesn't necessarily mean that everything you do and say

(08:01):
within the walls of that hospital room should be recorded
or that somebody should have the ability to listen to
that right like, So that that is a very kind
of concerning part of it too.

Speaker 1 (08:11):
I think does it get concerning also as you know,
we think of the other examples that we may be
familiar with some that you cited their doctor. We're like,
you'll talk about something and all of a sudden there'll
be a recommendation on your phone. Does do we get
concerned also that sometimes AI, based on some things, might
start making recommendations or other things, you know, to the
to doctors and medical team of saying like this this

(08:34):
and this equals this and you need to do that.
I mean, I know we're probably not quite there yet,
but That's one of those areas where I know how
these businesses work, and if there's an opportunity to push
a particular product or opportunity to kind of insert themselves,
they're going to take it. So that's one of those
things that kind of I don't know if it's we
ever heard anything like that, but that's one of those

(08:55):
areas that that makes me uneasy as well. What about
Oh do you have you seen anything on that or
is obviously something probably concerns you just as much.

Speaker 2 (09:04):
Yeah, I think I think it's so new right now
that I haven't heard of that, But I always wonder
who owns this information? Right? Like do you? I'm assuming
that now if if a patient is admitted into a
hospital that's employing this type of technology, they're probably signing
a piece of paper that's saying we are allowed to
listen in your room. I mean, think about that. That's

(09:26):
kind of crazy when you think about it. But who
then owns that information? Right? Because then that is some
sort of a recording or a listening device. You know
that that's obviously it's somehow integrating into the EMR system,
or it's it's somehow they're they're able to record. You
know again your your signs or you're any indication of

(09:48):
pain or all of these things are likely being recorded somewhere,
likely in the EMR system. And so then if other
things come up within that recording that maybe aren't things
that you would want in your electronic medical record, like
you know, who filters that, who decides what's included and
what's not included, and as in everything else, and you know,

(10:08):
we have very strict now HIPPA rules as far as
patient privacy and you know, patient information, but like now
there's so much information available that again it gets back
to who owns that information. If there's one electronic medical company,
which we know that EPIC now has a monopoly, I
think it's you know, sixty to seventy percent of mrs

(10:29):
and this country employee EPIC. So now they are also
the ones, as you mentioned, that are doing this AI scribe.
And so for years, I would say at least the
last five years, probably more than that because I'm not
the most technologically an advanced doctor, but they've been having
these scribe programs where basically, you know, I could take

(10:49):
my phone or a tablet or a computer and I
can you know, ask the patient when I walk into
the room. I personally do not do this, but I
you know, I know physicians that do. Where they ask
them as is it okay if we record this conversation,
because you know then it's going to be put into
your note. So it just saves me some time of
having to write an additional note, and it also allows
me to focus more on you as the patient, and

(11:10):
I can make eye contact with you. I don't have
to be looking at the computer screen to write my note.
And it's it's almost to me, it's it's kind of
a sad commentary of where we've come, but where we've
where we've gone to this point where the physician has
to do so much documentation and has to see so
many patients that it's become cumbersome, to the point where

(11:30):
they have to have a recording device to be able
to like document their patient interactions. And again in our
system of direct primary care, because you know, for me,
I might see four or five patients in a normal day,
and so those visits that are forty five minutes to
an hour, you know, it's not so so onerous for
me to take five or ten minutes after that visit.

(11:51):
And you know, jot down whatever, additional notes, or finish
up my note, put in some orders, whatever I need
to do. But if I was seeing, you know, twenty
patients a day, it would for sure be a lot
of work. You know, we're talking three or four hours
at the end of your day. So that's why they're
they're employing all of this. But this AI scribe technology. Again,
it was interesting because in the article that I shared,

(12:14):
and again I'll post this probably on Facebook, it was
talking about how specifically Epic now has their own product
that they're you know, they very recently rolled out, and
so they are it talked about somewhere in this article,
like where they will be sharing this information. And one
of the things that they listed is like with payers,

(12:36):
which I found to be interesting because obviously there are
circumstances in which insurance, you know, needs access to some
of your medical records. Of course, like for example, you're
being referred for an MRI or you're being referred for
a surgery, you know, they might ask for additional they
will ask for additional documentation of why does this person

(12:57):
need this lumbar spine MRI, why do they need total
hip replacement. Let's see the documents proving that they actually
need this procedure done, and then they of course will
determine whether or not they actually will approve it. But
when you have a device where you're recording everything, and
again it brings back the question of how are you
filtering that information? You know, are there things included? Because

(13:19):
when I talk to a patient, obviously we talk about
probably a lot of personal things and other things that
I'm not necessarily putting into their note because it's not
pertinent to their medical visit. But when you have AI
doing it, are you know, they're supposedly filtering through all
of that. But it just again it makes you wonder
how that information will be.

Speaker 1 (13:39):
Used, what kind of judgment that AI is going to use,
and yeah, what kind of motivations there may be to
use some of that stuff. I think back to this
years ago. I remember going to see a doctor and
they had a live scribe, and I remember the doctor
when came into the room said I use I think
something to this effect of I use a live scribe.
So and so is listening to our conversation. Is this

(14:01):
okay with you? And I had to say yes or
no before it happened. And you'll wonder too about especially
with things like AI and other technologies that are so integrated,
whether you disclose or not. I don't know that people
fully would comprehend, and including myself, I don't. I don't
want to say that that that other people would in
either it's it's it's that stuff. It's like when they're like, oh, hey,

(14:24):
this is this this this visit's going to be ar
AI monitor or something. I don't know that people fully
understand all the ramifications. That's scary stuff. I do want
to ask you a little bit more about about EPIC
as well as some of their practices and some of
the other things. When it comes to uh that information,
we'll talk with doctor Nicole Hampkis about that in just
a moment. In the meantime, you want to get back

(14:46):
to basics. You want to get back to the great
old ways. Remember back in the day when you go
in and you see your doctor. You can meet with
your doctor or doctor knew you, doctor knew your family,
The doctor cared about you, had the time to take
care of you. It's a great option at direct Primary
Care and Advocate MD take take the great amount of
time in those appointments. You can learn more all about
direct Primary care online Advocate at DPC dot com. That's

(15:07):
Advocate DPC dot com. TELF number to make appoint become a
member at Advocate MD six h eight two six eight
sixty two eleven. That's six h eight two six eight
sixty two eleven. Are going to continue our conversation with
doctor Nicole Hempkins of Advocate MD next as full scope
continues right here thirteen ten WU I B A A
twenty three thirteen ten WI B A and full scope
with Wisconsin's directcare doctor, doctor Nicole Hempkiss, Doctor Avkiz comes

(15:29):
to us from Advocate MD, a direct primary care practice
with eight physicians, four locations, a lot of great information
available to you online at Advocates DPC dot com. That's
Advocates DPC dot com. Great day to become a member
and make that appointment at Advocate MDLL. I got to
do is pick up a phone game call six oh
eight two six eight sixty two eleven. That's six oh
eight two six eight sixty two eleven. I've heard the

(15:51):
phrase often about no honor among thieves. Let's talk a
little bit about what goes on when it comes to
some of these technological and techechnology a partnership with some
of these some of these bigger, bigger operators out there,
and kind of how they treat some of their their
vendors and other things. It's you'll wonder about about some

(16:12):
of the legality of some of these practices. Obviously, leave
that up to a court, but it does create questions
about about fairness, and it also creates questions about when
it comes to that data and information that's being collected,
who actually owns that stuff.

Speaker 2 (16:28):
Yes, you know, part of this article that was talking
about epics AI Scribe and it's on this patient Kiosk website,
but they also went into some details about how kind
of the history of EPIC and when they have rolled
out these kind of different modules they call them so

(16:49):
so they they didn't initially they were more of kind
of a straight up, you know, electronic health record company
in the beginning, and of course they see opportunities available
to start integrating all of these different things their labs,
the telehealth So the aiscribe is kind of another example
of that. They started integrating with insurance companies through these

(17:10):
payer platforms, and it was it was funny but not
surprising that you know, it talks about how Initially they
set up partnerships with these companies that have been doing this,
so you know, like a lab integration platform where they
again have the software, the technology where they've been doing
this for years, and so they had a partnership with EPIC.

(17:31):
But then EPIC, of course after a few years is
probably like, well we can do this, right, Like, let's
just do what they're doing and you know, make more
money off of it. We don't have to pay an
outside person. So they did that with their lab information technology.
And then they did that with telehealth. You know, initially
they employed a outside telehealth partner, then they designed their
own telehealth platform. They did that with the the insurance billing,

(17:57):
the revenue cycle stuff, and then again really EPIC in
most EHRs or EMR systems, electronic health record, electronic medical record,
those things now one of the main purposes of them
is to be a billing, a mechanism of billing, a
mechanism of you know, insurance coding, and you know, being

(18:18):
able to collect payments. So that didn't used to be
the case, right, That used to be a separate thing.
Now that's integrated into the electronic health record, which again
there's all kinds that's fraught with possible opportunities for bias,
and you know, just not you know, not the greatest
incentives there. But so they they partnered again with these

(18:41):
payer platforms and then they of course a few years
later designed their own payer platform. So they kicked that
person to the curb. And so when the problem with
it is, though, when they have sixty to seventy percent
of all the health records in the United States, how
does anyone compete with that? Right? Like, like, how does
any star up or even not a startup, an existing

(19:02):
company when they own that much of the health record industry.
You can't really compete with that. And so even someone
that tries to innovate, they can basically just kind of
take their idea and integrate it into their platform, and
they have kind of exclusivity, and they, you know, have

(19:22):
a monopoly. So many health systems don't want to move
away from EPIC, so they kind of control control a
lot of different They have their fingers in a lot
of different pots. So that that to me is a
very concerning thing because, like we've talked about before on
the program, monopolies in general are not a good thing.
They're not a good thing. In healthcare, right, because we

(19:43):
know that hospital monopolies, healthcare monopolies, multiple studies have shown
this sow in this they increase costs, they decrease choices,
they tend to decrease innovation. So with patients, you know,
if you have a couple of hospitals versus five or
six hospitals in your community, those hospitals tend to charge more,

(20:05):
they tend to have, you know, probably worse service, right
because it's like, well, we're the only hospital in town.
Where else are you going to go? You're going to
drive an hour to the next town. So so again,
in general, the more we have of something, you know,
this is a kind of a very generalized viewpoint, but
what we see is that the more you have of

(20:27):
competition and something, you tend to drive down prices, you
tend to drive up customer service, innovation, all of these
things because they're competing for your business. Right, So like, oh,
well this is a this is a pain point. You know,
you're having to wait too long to get into the doctor. Okay,
well go over here, we'll see it today. You know, like, oh,
this is your too expensive Here, we'll go over to

(20:47):
this MRI facility we'll do the MRI for one tenth
the price. And slowly we're seeing this happening, thank goodness,
in the Madison market, where we do have more you know,
outside facilities that own aren't owned by big hospital systems,
you know, and I'll plug some of them mh imaging
in Middleton and smart scan MRI. Also in Middleton we

(21:07):
have orthopedic and spine centers, large orthopedics practice, you know.
So we're seeing more private specialists, we're seeing more private
radiology options, and that's very encouraging because again, historically, or
at least long history ago, that was the norm, and
then hospitals took over everything and bought up all the

(21:28):
doctor's offices and all the imaging facilities and all the
surgery centers, so they controlled all of that. But now, slowly,
we we're shifting that to where it's a lot of
it now is going more outside of hospitals and more
cash based. Again, that offers patients more options and they
can decide, you know, if I really want to go
to this particular hospital. I love this hospital, I think

(21:50):
they're the best. I'm willing to pay a little bit more,
I'm willing to wait longer to get in. That's your prerogative,
but it's also nice to have an option to be
able to pay less, get in owner and have a
very high level of service and a high quality. You know,
medical treatment.

Speaker 1 (22:04):
Options are important, and one of the great options when
it comes to primary care is direct primary care and
Advocate empt great data. Make an appointment at Advocate MD,
pick up phone game a call this morning six oh
eight two six eight sixty two eleven at six oh
eight two six eight sixty two eleven. The website Advocates
DPC dot com. That's Advocates DPC dot com. Doctor Hepkiss,
it's always great you enjoy this fantastic weekend and we'll

(22:25):
talk soon.

Speaker 2 (22:26):
Thanks Sean, you too,