Understanding the DPC Model

Episode Transcript

Speaker 1 (00:00):
Eight oh seven thirteen ten WIBA Full Scope with doctor
Nicole Hemkiss, Wisconsin's direct care doc. Of course, doctor Hemkiss
comes to us from Advocate MD. It's a direct primary
care practice with four clinics. We've got to Fair Oaks, Jamesville,
Rock County, Southern Dame County. Great clinic there for Advocate MD.

(00:22):
And the newest location in Fitchburg right at thirty two
twenty syin Row. That's right on the Fitchburg Madison city line.
Beautiful nature preserved there. I mentioned Janesville too, I should
mention now right on Mineral Point Avenue in Janesville.

Speaker 2 (00:36):
Very convenient.

Speaker 1 (00:36):
All four locations of Advocate MD. Fantastic doctors. I do
believe eight physicians if I'm tallying up right right now
at Advocate MD, that we're sitting at eight right now.
And I always always got a double check doctor, because
you never know, you may have added another one.

Speaker 2 (00:50):
Since the last week. So great to talk to you.
How's your day going so far?

Speaker 3 (00:55):
It's going well. I'm looking forward to the weekend. How
are you.

Speaker 1 (00:58):
I'm doing this same as you, doctors, same as you,
and we've got UH as always we've got We've got
really important, UH conversation.

Speaker 2 (01:07):
It should be.

Speaker 1 (01:07):
It should be a lot of fun and very informative
as well. We're gonna talk about, of course, the big
beautiful bill, what's in there when it comes to direct
primary care and hs.

Speaker 2 (01:16):
A and uh uh uh f s A and.

Speaker 4 (01:19):
H R A.

Speaker 2 (01:20):
And we're also going to figure out exactly what those things.

Speaker 1 (01:22):
Are and how they apply with UH with direct primary
here Before we get to that, though, doctor mentioned, of
course the four clinics of Advocate MD, the eight physicians
at Advocate MD. There's a reason why there's there's doctors
at Advocate MD. And and when you started started Advocate
m d Uh, that was something that was really important
to you, was to make sure that that patients were

(01:43):
getting in to see their doctor, not uh. And again
there's great roles for for pas and other things, but
that really wasn't a priority to you to make sure
that when folks came to the clinics they were seeing
their actual doctor, wasn't it.

Speaker 3 (02:00):
Yes, you know, I think you bring up a great point, Sean.

Speaker 4 (02:03):
You know, healthcare has changed a lot, and I think
all of us have experienced the change in healthcare over
the last twenty or thirty years or since. You know,
we think about when we were little kids and when
when we were kids, Sean, you and I think were
similar ages, like when you went into the doctor's office,
you saw a doctor, right, So that has changed a lot,
and I think some of it is driven by you know,

(02:25):
supply and demand. Some of it is driven by financial reasons,
you know, of course, and so again as healthcare seems
to be more and more focused now on the bottom
dollar rather than the patient care, patient experience, you know,
quality of care time. Part of this direct primary care
model and our practice at Advocate m D, is that

(02:47):
we want to be offering an alternative, a better alternative.

Speaker 3 (02:50):
Right.

Speaker 4 (02:50):
So, if people are having a hard time seeing a
doctor in the big systems, well we have doctors and
as you know, you know doctors. We've talked about it
many time times. Doctors are getting more and more burnt out.
They are leaving the system. They are you know, retiring
early or doing something else, you know, the giving up
their whole medical career.

Speaker 3 (03:08):
It's crazy.

Speaker 4 (03:10):
But in our model of direct primary care, the doctor
is given the opportunity to have a much slower pace
of their practice, to see less patients, spend more time
with them develop that doctor patient relationship, which is why
most of us, including myself, became a family medicine doctor.

Speaker 3 (03:27):
You know, I, you know, you have the.

Speaker 4 (03:28):
Choice in medical school. You have to make the decision,
you know, do you want to be a surgeon, Do
you want to be a radiologist?

Speaker 3 (03:34):
Do you want to be an antseusiologist. You know. There's
many factors involved.

Speaker 4 (03:38):
Of course, but I think for me one of the
big factors was I could not envision myself. I really
liked surgery. I like the hands on part of it,
the you know, technical part, but the kind of just
wrapping my head around, you know, being in a room
with no windows, and like just not having kind of
that that closer, more direct patient interaction and and the

(03:59):
family interactions, and like learning about their their stressors and
the work life and the family life and all of
those things. As as a family doc, I get to
experience all of that, which is awesome. So for me,
having forty five minutes to an hour to talk to
patients is just you know, invaluable. I don't you know,
I don't know how you replace that. So, as you said, Sean,

(04:22):
when patients are looking at their experience in our current
healthcare marketplace, and they're seeing that not only are they
paying every year more and more for their health insurance
and getting less and less out of that, and they're
seeing that, you know, they go in for a visit,
you know, it takes, of course, backing up, takes nine
months to get the visit, but then when they get in,

(04:42):
they spend maybe ten to fifteen minutes with the doctor, if.

Speaker 3 (04:44):
They can even see the doctor.

Speaker 4 (04:46):
I recently talked to someone I can't even remember who
it was, but they were telling me how it had
taken them a year and a half, a year and
a half to get an appointment with their primary care doctor,
or you know, they had made an appointment and then
you know, a week or two before the appointment was
canceled because that person was no longer available, or maybe

(05:07):
they had left, and then they were rescheduled with maybe
a PA or a nurse practitioner, and then something happened
where that appointment didn't end up happening. They're rescheduled again,
and it's just when you think about how low the
bar is now, it's kind of mind boggling that people
even will put up with that. But there is an alternative,
you know, So in the direct primary care model Advocate

(05:27):
m D, you will see a physician. Every time you'll
see your physician, they're going to spend longer with you. You're
going to have more direct communication with them if you
need something.

Speaker 3 (05:37):
So it's very different and.

Speaker 1 (05:39):
It's an amazing model, and as you mentioned, it's it's
I think for a lot of us, how we remember.
I remember my doctor growing up. It was a husband
and wife doctor team. Their their clinic was literally a
converted house in Brookfield, right on Blue Mound Road, and
it was you know, they'd have a little waiting room
up front, and we knew the doctors, they saw our
whole family. They you know, my mind could could call

(06:01):
them anytime, and they were very responsive and I think
for a lot of folks they yearned for that. And
that's one of the great things you mentioned direct primary
care and what you're able to do. There is an option,
There is an alternative, and not just for you and
your family, which is a fantastic thing. If you're an
employer looking for some really good options to offer your
employees when it comes to primary care, make sure you're
checking out Advocate MB. Of course, their website Advocate DPC

(06:24):
dot com. That's Advocates DPC dot com. All great information
on the website, great data, make an appointment, give them
a call. Six oh eight to six eight sixty two eleven.
That's six oh eight to six eight sixty two eleven.
So big changes, really, really, really Again, the first word
is big. So it's a big, beautiful bill. A lot

(06:45):
has happened over the past few weeks with that, and
obviously some of it affects healthcare. And I want to
ask you about before we kind of get into this.
You'll hear about like folks say, oh, I've got an
HSA or I've got an FSA or an HR real quick,
before we kind of get into how those can apply
with direct primary care?

Speaker 2 (07:03):
What exactly are those things? Kind of in a nutshell, doctor.

Speaker 4 (07:06):
Yes, so I think it's confusing and it's hard to
keep track of all of these different terms. But so
hs a healthcare savings account. These are things that are
now by law required to be attached to a high
deductible health plan. So you cannot purchase an HSA a
healthcare savings account as a standalone product. From everything that

(07:28):
I've seen and heard and talked to, insurance brokers, So
this has to be attached to a high deductible health plan.
That that being said, that could be a high deductible
health insurance plan that the consumer, the patient is purchasing
themselves on their own, you know, through the marketplace or
or you know, through an insurance broker. That can be
a high deductible health plan with the HSA that their

(07:51):
employer is offering to them. But the reason that hsas
are so such a great option is because in many
cases that money is it's pre tax so you put
money into that, you're not being taxed on it. You
can use that for a multitude of things. In the
case of employers, many times their contributing into that, and

(08:12):
then the employee can also contribute into that, and it
also rolls over, so it becomes kind of this tax
sheltered savings account that you can, you know, hold on
to for many years. And again I don't want to
get in too much into the weeds because I am
not an accountant or anything, so I don't know, like
at the end of twenty years, you know, you know
what you do with that money, but you can, you know,

(08:33):
use that for health related expenses and what's happened recently.
There's always been this gray area and the IRS tax code,
and many times either patients bring up the question or
the concern. We've had a lot of brokers through the
years that have said, you know, this isn't clearly defined,
or we're concerned about you know, HSA use with the
high deductal health plan if someone is also enrolled in

(08:54):
a direct primary care. But what happened I think on
July fourth when Trump signed this in to President Trump
signed this into law.

Speaker 3 (09:03):
So this big.

Speaker 4 (09:03):
Beautiful bill which I am sure, like you Sean have
not read all eight hundred pages of it.

Speaker 3 (09:08):
Or is it eight hundred or eight thousand?

Speaker 4 (09:11):
Yeah, yeah, I heard somebody say the number, and it
just sounds like a big number. But you know, the
part that I do know about. And again I can't
speak to the whether the whole thing is positive or
positive or negative, or how it's adding to our debt
and all of that, but I will tell you that
this one provision is a very positive thing because it

(09:32):
will allow patients, healthcare consumers more availability, you know, more
options to use direct primary care. And what it basically
is saying is that now specifically HSAS SO as you
mentioned Sean. You know, there are these things called fsays,
which are flexible spending accounts. There are HRAs which are

(09:52):
healthcare reimbursement accounts, and those are different products that you know,
again it's similar to HSA's fas. Typically you have a
little bit more flexibility. They're all pre tax things, but
FSAs you might have more flexibility. And what you're using
this for not just medical expenses. HR's are typically something
that your employer is putting money into, and again those

(10:14):
typically have less flexibility to be used, but sometimes those
also can be used for direct primary care. But speaking
you know, just in terms of hsas, because many people
have hsas. Now, the law, through this big beautiful bill
and the provision is called the Treatment of Direct Primary
Care Arrangements, So it clearly defines now in federal law.

(10:38):
Its codifies in law that DPC arrangements or memberships, you know,
whatever term you want to use, are not health insurance
and therefore they can be used within HSA products. So
that then reassures people that either currently have high deductible
health plans with HSA's that they can be you know,
in a direct premiary care member ship. It also gives

(11:02):
them the option that they can use HSA money for
direct primary care memberships or for other ancillary services occurring
through the DPC clinic. Again, you know a lot of
insurance brokers prior to this have had concerns if they're
let's say their employee, you know, all of their employer
groups are offering these high deductible health plans with hsas,

(11:23):
but then they want to offer DPC. Oh, well, is
this going to somehow be you know, in contradiction and
conflict to the you know what the I R S
Is saying about having you know, high deductible health plans
with hsas with DPC. So now all of that has
been clarified, and it reassures people that know, there is
no problem with doing those you know, pairing those things together,

(11:45):
and it actually makes it much more you know, appealing
to have direct primary care as part of the high
deductible health plan and.

Speaker 1 (11:53):
Doctor to some of this is we talked about getting
some clarity too, you know, I know one of the
things and I think anybody that's that talk to other
folks about direct primary care and you know, regular listeners
to the program as well that have told their friends
and family there there's sometimes questions that come up, and
as you hear about about you know, finally providing some
clarity and some concrete guidance about about options for folks

(12:17):
when it comes to funding and those other things. This
has got to help that area as well quite a bit.
I know that that obviously you're talking with folks every
day about it. They always have questions and having a
little bit more you know, having a little a little
more options that are a little bit more clear about
what you're able to do, this has got to be
a great benefit as well for members and others.

Speaker 4 (12:38):
Yes, you know, it's it's something that's you know, again,
been this kind of great area that I think we've
had historically patients that have hsas, you know, whether they're
using their HSA money for the direct primary care membership
or they're just part of our practice and maybe they
use the HSA for lab cost.

Speaker 3 (12:56):
Or other things.

Speaker 4 (12:58):
The interesting part too, you know, is this legislation also
kind of defines what can be used within this direct
primary care the things that can and cannot be used
for the HSA money, and so you know, the memberships,
those can be used with the HSA money lab cost
unless they have this exception that says like labs not

(13:21):
typically performed in a primary care setting, which again so
that wouldn't apply to us. And then vaccines covered. You know,
ancillary things like whether it's I guess, procedure costs or
supply charges, those sort of things, those would be covered.
One of the things that it says that will not
cover is prescription drugs, and most likely again this is
just me guessing or making assumptions. This is likely because

(13:45):
people that have high deductible health plans have a prescription
drug plan. As part of that plan, they have a formulay.
You know, they're getting their drugs for some set cost.
In unusual circumstances, you might have a high deductible plan
or some other insurance plan where you have no prescription
drug coverage and everything is going towards you're deductible. That
sometimes is the case, but most people have some prescription

(14:06):
drug coverage. So what they're saying is that you can't
use your HSA money in a direct primary care clinic
to get to pay for prescriptions you're getting from the
direct premiary care clinic. But what that does not mean
is that, again this is all very confusing. It doesn't
mean that you can't be in a direct primary care clinic.
And you know, if you say to me, you know,
doctor Hemkis, you know my matopra law for my blood

(14:29):
pressure is going to cost me thirty dollars for a
ninety day supply through my insurance. But here in the clinic,
it's going to cost five dollars. So I'm just going
to pay cash. I'm gonna pay that five dollars. Again,
that's that's a no brainer because even though you have coverage,
like we've talked about, Sean, that it's going to cost
you more to use the insurance. So so again you

(14:49):
can still do that. You can still pay cash.

Speaker 3 (14:51):
For those things. You just couldn't use HSA money to
pay for those things.

Speaker 4 (14:55):
So so yeah, I think it really will help the
you know, I don't want to say open the flo gates,
but I think I think the way we are moving
in healthcare is that as healthcare costs become more and
more expensive, as you know, Sean, every year the insurance
premiums are going up and just everything is going up,
I think more people and more businesses are moving towards

(15:17):
these high deductible health plans, and so then you know,
what is the option to kind of fill that gap. Well,
the filling of the gap is direct primary care. And
then now that you can also use HSA, you know,
either in terms of the memberships in terms of the
ancillary costs, that gives even more reinforcement to this kind
of allowing direct primary care to fill the gap. You know,

(15:39):
you have the HSA money that helps kind of subsidize that,
you know, paying for that direct primary care you know.
So so I think it's going to be a really
great thing to allow people more people to use the
direct primary care membership using.

Speaker 1 (15:54):
Your money for what you want to use it for,
which is really high quality and access to your physician.
It's a great data start that journey. Learn more. Of course,
we talk about whether it's a high deductible or health
share and other information.

Speaker 2 (16:06):
One of the great things.

Speaker 1 (16:07):
About Stopping by ADVOCATESDPC dot com. Doctor Hemkiss has a
great section there about what direct primary care pairs well
with as far as that insurance coverage. And again of
course tell your primary care that's covered by your membership,
you don't use insurance, you don't have to worry about
anything like that. Again, you can learn more online. Great
data add on over the website ADVOCATESDPC dot com. Even better,

(16:29):
it's great data. To make that appointment become a member
at Advocate MD. I gotta do this, pick phone, give
a call six oh eight two six eight sixty two eleven.
That's six oh eight two six eight sixty two eleven.
We'll continue our conversation with doctor Nicole Hemkis. We will
do that next as full scope continues right here on
thirteen ten WIBA A twenty six thirteen ten WIBA and
full scope with Wisconsin's directcare doctor, doctor Nicole Hemkiss. Of course,

(16:52):
doctor Hemkiss comes to us from Advocate MD, a direct
primarycare practice right here in southern Wisconsin for convenient locations.
Eight physicians at Advocate MD.

Speaker 2 (17:01):
Great data.

Speaker 1 (17:02):
Learn more online ADVOCATEDPC dot com. As I mentioned earlier,
even better, great data. Make that appointment at Advocate MD.
Become a member six h eight two six eight sixty
two eleven. That's six oh eight two six eight sixty
two eleven. As we talked this week about a little
bit about direct primarycare, and I know sometimes folks wonder
how exactly do I become enrolled? Mention the phone number

(17:23):
two six eight sixty two eleven. But how does that work?

Speaker 2 (17:26):
Doctor?

Speaker 1 (17:26):
For folks that are looking to become a member and
one to get enrolled with Advocate MD, what's that process like?

Speaker 4 (17:34):
Yeah, So I encourage everyone to come to our website,
the ADVOCATEDPC dot com and you know, take a look
at there's a lot of good information on there, not
only about direct primary care, what the membership includes. You know,
it shows you the biographies of all of our doctors.
It talks about there's this pair width section that talks
about how this works alongside of insurance or some sort

(17:56):
of other catastrophic coverage like health shares. And then the
last thing is that there's a contact us butt in
which you can click on and it's going to ask
just your your name, email, something like that, and so
you can send a message through there, and then all
of those messages come to me. So if you're interested
in enrolling, or if you have additional questions, maybe something
that came up as we were talking today, you can

(18:19):
send me questions through there, and then typically, you know,
once I get that email, I respond to it. So
I send the patients, the patient, the person that's wanting
to enroll, I send them the enrollment link and the
scheduling link, and then we encourage anyone who's enrolling with
us to you know, fill out the enrollment link and
then you know, come in for an initial visits, a

(18:39):
new patient visit to meet the doctor that you're going
to be seeing, you know, and it might not even
be that you're due for a visit, but it's nice
to get established. You know, they're going to go through
your medical history, you know, ask you a bunch of questions,
you know, lifestyle questions, see what concerns you have, make
sure you're up to date with all your health maintenance stuff,
and then you are, you know, part of our practice.

(19:01):
So if something were to come up, like you have
an urgent care need, or your child does or you know,
whatever it might be, you know, you kind of already
have developed or you have a little bit of a
relationship with that doctor, and so it's easier to kind
of go from there. But yes, the enrollment process is
very easy. It's it's basically filling out an online enrollment form.
It might take I don't know, five to ten minutes

(19:22):
to complete that, and then once you've done that, you're
part of the practice and you have the option to
you know, see a doctor, you know, as soon as
you would like to. And again, so for like new
patient visits, non urgent care visits, you know we're looking
at sometimes it's a handful of days. Sometimes it's maybe
a week, two weeks tops to see a doctor for

(19:43):
a new patient visit. If it's an again an urgent
care problem and you are an enrolled member of our practice.
You know, sometimes we have patients that call the office
that want to be seen for urgent care that are
not part of our practice. Well we don't do that
right because we're not an urgent care clinic. But if
you are a member of patient our practice that's already established,
yes we get you in the same day for whatever

(20:04):
the urgent need is. So that's another important reason to
get established with the practice.

Speaker 1 (20:10):
Talking this morning with doctor Nicole Hamkiss, and it is
a great day to become established, to become a member,
such a great such a great thing to offer again
not just for yourself your family, but if you're an
employer looking for some great options, what better than Advocate
MD and having having all those great things. I know,
it's a competitive out there when it comes to getting good,
good employees. And retaining employees. What a great feature that

(20:30):
could be for your for your business to offer direct
primary care through Advocate MD. Again, you can learn more
online ADVOCATESDPC dot com. That's ADVOCATESDPC dot com.

Speaker 4 (20:39):
Again.

Speaker 1 (20:40):
You can email questions as well. If if you've got
some questions of court, doctor Hemkiss loves answering those telpul
number making a point become a member at Advocate MD.
It's six oh eight two six eight sixty two eleven.
That's six 'oh eight two six eight sixty two eleven,
Doctor Hemkiss. It's always great chatting. You have a great
weekend and we'll talk very soon.

Speaker 3 (20:58):
You too, Sean, thank you.

Speaker 1 (20:59):
And again that website Advocates DPC dot com. Dana, Emma
and Jake from Wake Up Wisconsin Wkwchannel twenty sevens morning
news team. They're going to join us next right here
on thirteen ten wui b a