What Can Healthcare Learn from The Federal Government

Episode Transcript

Speaker 1 (00:01):
Thirteen ten WIBA and full scope with doctor Nicole Hemkiss,
Wisconsin's directcare doctor. You can learn more about doctor Nicole
Hemkiss and all the doctors at Advocate MD online. The
website ADVOCATESDPC dot com. That's ADVOCATEDPC dot com. The website,
it'll teach you all about direct primarycare. I also let

(00:23):
you know about Advocate MD, all the different services they offer,
the procedures, membership, what's included. If you are a business owner,
make sure you check out the website ADVOCATESDPC dot com
or somebody in that in that room, maybe HR one
of those areas, because direct primarycare it's an amazing option,
not just for you and your family, but for employees

(00:45):
as well. It's a really fantastic way to have access
to see your doc and it's affordable. Again, check it
out online ADVOCATESDPC dot com. That's Advocates DPC dot com.
Eight doctors at Advocate MD. Four locations Madison west Side
right in Middleton at thirty two or five Glacier Ridge
Glacier Ridge Road, east side of Madison on fair Oaks

(01:08):
down in Jamesville at ten twenty one Mineral Point Avenue
and the newest location right in Fitchburg right and Fitchburg
Madison Line right at thirty two to twenty sign road,
as mentioned. Doctor Nicole Amkiss joins us this morning, doctor,
how you doing today?

Speaker 2 (01:22):
I'm doing well, son, how are you?

Speaker 1 (01:23):
I am doing great, And we've got so much to
talk about and very It's interesting sometimes headlines and kind
of unrelated fields make the news and it kind of
makes you wonder about other areas that they may be applicable.
And obviously right now what's been going on in the
government with DOGE and other things other people are saying

(01:44):
to say, is there may be room for this type
of cutting in other industries. And let's talk a bit
about healthcare and what healthcare looks like, why it's so expensive,
and why it might be a fake place to be
looking to I don't know if they're ever going to
do it, but looking to cut some cut some of

(02:05):
that that overhead doctor.

Speaker 2 (02:08):
Yeah, you know, it's been on my mind because every
day it seems like you're hearing headlines from DOGE about,
you know, cutting the health and human services by a
large percentage. You know, we just heard of the Department
of Education. I think they're cutting by fifty percent, you
know us AI D. Of course they cut the majority
of that. And I would say that I am a

(02:30):
huge proponent of finding where there is waste, and I
think the government is a great example of a place
where unfortunately it's kind of gone off the rails in
terms of there's so much spending and taxation and you know,
you wonder where where does all of that money go?
And you know, there are a lot of government agencies

(02:51):
that have you know, thousands of staff, and you wonder,
what do all of those people do, you know every day.
I'm sure many of them are very nest, but I
feel like there are probably jobs and agencies where, you know,
they don't necessarily need to be there. Again because there
is in the government, there is not necessarily an incentive

(03:11):
to control costs. There should be, you know, we should
be balancing the budget and doing all of these things.
But you know, it's not really run like a business
is run, right because that it would have went out
of business a long time ago, because we're in debt
for you know, multiple years. But you know what if
we look at you know, kind of how much administrative
cost that are going into these things and think, you know,

(03:34):
for all of these administrative costs. Are we actually seeing
a benefit? Is there actually a downstream you know, reward
or result from all of these administrative people that are
are are doing these functions? Are they necessary functions? And
it makes me kind of compare it to as you said,
sean health care. And we know that health care, the

(03:54):
administrative cost of health care has gone up exponentially and
the last uh twenty years, or you know, of course
in the last five to ten years. You know, I
would say that if you look back historically decades ago,
you know, we had smaller community hospitals, We had smaller
you know, community clinics. And as things have grown and

(04:16):
mergers and acquisitions and hospitals have become larger and larger.
You know, what used to be probably a smaller community hospital,
you know, like some of the Madison hospitals started out,
you'd probably have had a president and a vice president
and a handful of administrative staff. Now, you know, the
local hospitals have hundreds of administrative staff. You know, one

(04:39):
time I heard a statistic that I almost could not
believe that they set at an average hospital for every
one bed, you know, so I would say a medium
sized hospital might have, you know, three hundred to five
hundred beds. A small a very small hospital like in
a smaller town, would have maybe twenty or thirty beds.

(05:00):
Large hospitals, like large academic medical facilities might have a
thousand beds or more. But they said for every one
bed patient bed, there is one administrative person. So again
that means in large hospitals there are a thousand administrations,
you know, and when I say, I should say people
working in the administrative offices. So so again you know,

(05:24):
insurance billers and coders, schedulers, you know, the people that
call the insurance and file the claims and just you know,
handle the disputes, the prior authorizations, the pre certifications, all
of that. And then again it makes you wonder, with
all of those administrative costs, where does that money then
come from. Does that money just get passed along to

(05:47):
the consumer, to the patient you know of course through
higher bills, higher insurance costs. Does that money get taken
away from from clinical you know, staff, So like maybe
we're not able to hire as many nurses and doctors
because we have to have all these administrators that are
filing the insurance claims. I think it's a combination of things,
of course, but it is it is interesting. I remember

(06:09):
for years when I worked in the Chicago area, and
I worked mostly in hospitals as a hospitalist. So that
means you take care of patients when they're admitted into
the hospital, throughout their hospital stay, and then until they're discharged.
You're kind of like almost like a primary cure doctor
while they're in the hospital. But at that time I
was not doing outpatient and so you know, when they're

(06:32):
being admitted to the hospital, you know, you get to
kind of see the inner workings of how the hospital
works and all the kind of the organizational flow chart.
And I was kind of shocked. I mean, and you know,
I've been doing this for more than a decade, but
you definitely saw the changes that were happening. And you saw,
for example, and this was like a medium sized community hospital,

(06:53):
so maybe four hundred five hundred beds. But so each
unit of the hospital, let's say, each floor of the hospital.
So if it's the medical surgical floor, or the pre
op or the orthopedic floor, or you know, there's all
these different you know, there's an oncology floor, so each
of these units, you know, you would have I don't know,

(07:14):
ten to twenty nurses, and then each of these units
you'd have a nursing director or a nursing manager, and
an assistant nursing director a unit, a unit manager, a unit. Uh.
It's like there were so many levels of nursing administration
at each of these units, almost mind bogglingly, so that like,
why do you need all these different managers and things.

(07:37):
I mean, I understand why you need some of them,
but it definitely has morphed into this thing where there
are so many more people in non clinical roles within
the healthcare system. And again I blame a large part
of this on insurance because I think as insurance has
become more complicated, you know, intentionally so and require more

(08:00):
administrative red tape, and you know, again all the prioritizations
and pre certifications and the billing and the coding, that's
added to a lot of the administrative costs. But I
do think that there also is just an aspect of
it for some reason, there's the part of it too
where you know, once people are getting burnt out. This
happens with doctors and nurses in many different areas of medicine,

(08:24):
where they will kind of pull back from direct clinical
care patient care and they will move into an administrative role.
So again, I think in some ways we've created these
roles almost as an escape for people that no longer
want to do clinical medicine and treat take care of
patients because it's becoming harder and harder. And then it's
like a catch twenty two, right, because you pull more

(08:45):
people from the clinical side of it and you put
them into administrative roles, that therefore means we have less
people take care of patients. It makes it harder for
the people that are left behind. So I see that
aspect of it, and I think I've told the story
before that, you know, working in the hospital, you know,
there was like a team of people that their entire
job was to review the charts and then to come

(09:05):
back to you and say, why don't you code this
as a you know, a level one four, a level
one five, or why don't you add this to the diagnosis?
You know? And this was one hundred percent. Intention is
a financial intention. It has nothing to do with patient care.
It's just a it's an insurance billing and coding process
where they are wanting to change the way you are

(09:26):
are coding something in order to build the insurance and
therefore the patient right because many times the patient is
stuck with that bill to a higher level. There was
an entire team of people that that's all they did.
So yeah, that that that part always makes me kind
of wonder, you know, why do we need all these
administrative people. And again in that particular case, that was

(09:46):
to you know, of course, increase the income for the
health system.

Speaker 1 (09:49):
Talking this morning with doctor Nicole Hemkiss of Advocate MD,
the website Advocates DPC dot com. That's Advocates DPC dot com. Healthcare.
There are obviously some serial, you serious issues in the
state of healthcare in the United States. Is a nice
thing when it comes to your primary care. You've got options.
You've got a fantastic option Advocate MD and Direct Primary Care.
You can learn more online the website Advocate DPC dot com.

(10:13):
That's Advocate DPC dot com. To make an appointment, become
a member at Advocate MD. All you got to just
pick up phone, give a call six oh eight two
six eight sixty two eleven. That's six h eight two
six eight sixty two eleven. We'll continue our conversation with
doctor Cole Hemkins talk a little bit about insurance companies,
what do they do when it comes to administrative costs,
and what exactly is all their own We'll find out

(10:35):
from doctor Hemkes on that next as as of course,
as as Full Scope with doctor Hemkiz continues right here
at thirteen ten WIBA thirteen ten WIBA in Full Scope

(11:02):
with doctor Nicole Hemkiss, Wisconsin's directcare doctor. The website ADVOCATESDPC
dot com. That's Advocates DPC dot com. Learn more about
Advocate MD Direct Primarycare, the doctors, the locations, ways that
they offer very affordable and amazing access to primarycare. Again,

(11:22):
you can learn more online the website ADVOCATESDPC dot com.
That's ADVOCATESDPC dot com. Telp number six soh eight two
six eight sixty two eleven. That's six 'oh eight two
six eight sixty two eleven to make an appoint, become
a member at Advocate MD. And doctor let's talk about
primarycare specifically, and we were kind of talking that last
segment about all the bloat that's in healthcare, especially when

(11:47):
it comes to hospitals and insurance and if you are
in some of those systems, that that is certainly the
case as well in primarycare. Let's talk about the importance
of primarycare, but also how direct primary care and specifically
what you're able to do with advocate MTY really does
reduce most, if not all, of that that literal bloat

(12:08):
that's that's in the systems.

Speaker 2 (12:12):
Yeah, So I look at primary care as four categories.
So the first category is preventive care. So that includes,
you know, your annual exams, your annual you know well adult,
you know well woman exams, well child exams, well male exams.
That's making sure that you're up to date, whether it's

(12:33):
your screening tests like colonoscopies, mammograms that make sure you're
your vaccines, discussing those, you know, if there's lab work
that needs to be done that you know in a
in a screening preventive care capacity. That's the first aspects
of preventive care, and I think in many cases that's
the part that can be missed. You know a lot

(12:55):
of times people think like, I feel pretty good. I
don't really need to go to the doctor this year,
you know I, I mean, I don't have any symptoms
of anything. I'm not in pain, you know, I you know,
I don't have any complaints. I would say, especially in
middle aged you know, relatively healthy people that don't take medications.
But really you should check in with the doctor because again,
there are definitely medical issues that can arise where you

(13:19):
don't have symptoms. You can have very high blood pressure
and not have any symptoms. You can have very high
cholesterol and never know it until a blood test is done.
You know. Again, these are the reasons we check people's
vital signs every time they come in. These are the
reasons we check things like a lab panel periodically to
make sure that that looks okay, you know, things like
colonoscopies and mammograms. Again, you can have zero symptoms and

(13:43):
have colon cancer. Unfortunately, most of the time, when you
start displaying symptoms, that means that it has in some
cases progressed, it's a larger poll up, it's it's you know,
it's turned into something worse than if we had caught
it earlier. That's why we do preventive screenings, you know. Again,
So that's why sometimes I hear patients say like I
don't really need to do that colonascopy and feeling fine.

(14:05):
That's exactly why we want to do it now, right
before you start feeling bad. So having that discussion again
is the discussion with the patient. You know, we're not
here to force you to do something, but we I
definitely want to talk to my patients about the pros
and cons of things. The second aspect is, you know,
chronic disease management. So again the next step, you know,

(14:26):
if we do you know, if we can't prevent something
and then it actually becomes an issue like high blood pressure,
high cholesterol, thiray disease, diabetes, then helping you manage that,
which means you know, having regular visits, you know, again
checking lab work if that's applicable to the condition. You know,
if a patient is taking medications or doing lifestyle medicine,

(14:50):
you know, following up with them every three months or
six months and saying, oh, the blood pressure is doing better.
Oh you know that, you know, let's continue this or
let's change something again. Another kind of misconception sometimes is
that physicians are kind of just here to push medications
on you. You know, I always tell patients, if I

(15:10):
could have all my patients on no meds and we
can manage all of their medical issues through lifestyle medicine,
which means you know, nutrition and exercise and stress management
and all these things. I would be one hundred percent
on board with that. I would love to have that.
That also makes my life easier, right, I don't have
to read full a bunch of prescriptions. I would love
it if if everyone wanted to do that. And again,

(15:32):
there are many people that they can, you know, be
exercising every day and they don't smoke or drink, and
they eat a really healthy diet and they still have
high blood pressure where they still have high cholesterol. So
there are definitely medical chronic medical illnesses where we can
do everything that's in our capacity to do and still
either we have a genetic predisposition or some other reason

(15:53):
that you know, this this arises and you know then
again that's when we turn to things like medications, so
helping you manage chronic illnesses again, so that if we
can keep the blood pressure in the cholesterol and the
blood glucose and all of that stuff under a good
level of control, then that hopefully helps prevent you know,
catastrophic things from occurring down the line, like heart attacks

(16:17):
and strokes and things like that. And so then another
category of primary care is urgent care. So you know,
this is when the acute things happen, Like you have
a really bad cold, you sprain your ankle, you have
a sore throat, you know, you cut your hand, you
have a migraine headache that's not getting better. You know,
all these things that can arise where you need more

(16:39):
urgent attention. You need to come in and we evaluate you.
You know, if you need stitches or you need a
medication administered in the clinic. You know, all of those
things we can do in the primary care setting, again
hopefully preventing you from needing to go to an urgent
care or especially to go to an emergency department. Do

(17:01):
we take care of everything in the in the primary
care and an advocate in d in the clinic. No,
Like if you have an acute appendicitis, or you're having
symptoms that are worries someme for you know, an acute stroke,
if you are having chest pain and you're somebody that
has risk factors for having a heart attack, we are

(17:21):
going to send you to the emergency department for those things.
But many things, I would say as someone that used
to work in the emergency department, many many things that
go into the emergency department, do not need to go
in there. Again, if you have a small cut, if
you you know, sprain your ankle and you're not sure
if it's broken, if there's a break there or not.

(17:42):
All of those things we can handle in the clinic.
You know, again, your your you're nausead, you're throwing up,
you have a GI virus, you have a you feel
really crappy because you have a really bad flu. We
can see all of those things in the clinic. You
don't have to go into the emergency department or the
urgent care for that. So the category and then the

(18:02):
last category is so minor procedures. As family medicine docs,
we are trained to do a lot of procedures. You know,
I was trained to deliver babies and I don't do
that anymore. But we're trained to do a lot of
skin procedures, so things like removing moles, removing cyst toenail removal.
We are trained to do orthopedic procedures like joint injections,

(18:26):
trigger point injections, so anything whether it's a knee or
an elbow. You know, like if you have knee pain,
if you have like tennis elbow, you know, heel pain.
We're trained to do all of that. And then again
things like splintering bones or casting if if someone has
a fracture, we can do that in the office. And

(18:48):
then gynecologic procedures of course like well woman exams, but
also things like indometrial biopsies, we do iud placements, you know,
we do something called koposcopy. So there's a lot of
women's health kyindecologic procedures we can do. And then we
have doctor Balen of course that does some procedures, more
procedural stuff than I guess the average family medicine docks.

(19:10):
So he does the sectomies and something called prolotherapy. And
again the old school family medicine docks you know, would
do a ton of procedures, and of course that has
slowly fallen out of favor because now those procedures are
since the specialists because they can build at a higher level.
So so yeah, doctor Balen still does a lot of

(19:31):
the same procedures that used to be pretty mainstream for
family medicine docs. So so again in all of those
different if you take all of that together, you kind
of think, you know, for most people, we can probably
take care of ninety percent of their medical needs. For
some people, we can take care of one hundred percent
of their medical needs. You know. For some people, maybe
they still need to see a specialist once a year

(19:53):
or a couple times a year. You know. Of course,
there's people that you know, maybe have a need to
have surgery and things like that, and they will go
to see an outside specialist for that, And we can
still refer into the big systems and patients can still
use their insurance even if they come and see us.
Everything that we do in our clinical setting we're not
going through insurance for and again most of that is

(20:15):
covered through the member, the monthly membership. But again, our
goal is to do as much as we can in
the office without having to refer people out unless it's
something that's beyond our scope. You know.

Speaker 1 (20:26):
And one of the things that that I know we've
talked about too on the show is you mentioned the
different things you're able to do at the clinic and
in clinic and the idea like for for folks in
that insured system, if they're if they're going to you know,
they've got they've they've got a need for a splinter
or a suit or something. It's not even imaginable that

(20:47):
they'd be able to see their primary care doct or
even go to that primary care clinic. They're automatically going
to be sent right to urgent care. Whereas a member
of Advocate MD, you can reach your doctor when you
need to talk to your doctor. You can see your
doctor when you need to see your doctor, which is
an amazing benefit. We talk about all the great benefits
of being a member at Advocate MD. Just imagine that.

(21:08):
And it's very very affordable. I think average, you said, doctor,
about seventy dollars a month for most people. And yeah, yeah,
it's a it's a really really amazing stuff. Talk about
some of the benefits. You can learn more online ADVOCATESDPC
dot com. That's Advocates DPC dot com, Delph, whatever. Great
day to make that appointment, become a member at Advocate MD.
Six oh eight two six eight sixty two eleven. That's

(21:29):
six oh eight two six eight sixty two eleven. Doctor,
You enjoy this great weekend and we'll talk again real soon.

Speaker 2 (21:35):
You too, Sean, thank you.

Speaker 1 (21:36):
This is thirteen ten wib I