What Does Price Transparency Mean in Medicine

Episode Transcript

Speaker 1 (00:00):
This is full scope with doctor Nicole Hempkiss right here
in thirteen ten Wi b A. Of course, doctor Hemkiss
comes to us from Advocate MD, a direct primary care
practice with four clinics west side of Madison. Right in
Middleton at twenty thirty two oh five Glacier Ridge Road,
east side of Madison, one fifty seven South Fair Oaks,
Janesville for you Rock County, southern Dane County folks, right

(00:21):
at ten twenty one Mineral Point Avenue. And the newest
location right in Fitchburg thirty two twenty Syine Road. That
is right in that beautiful, beautiful nature preserved just south
of the beltline. Great locations for Advocate MD. Eight physicians
at Advocate MD as well. You can learn more online
the website ADVOCATESDPC dot com. It's Advocate DPC dot com, telphner,

(00:42):
make an appointment, become a member at Advocate MD six
oh eight two six eight sixty two eleven at six
oh eight two six eight sixty two eleven. In doctor,
you know you're growing when I start messing up the
addresses of some locations there are. There are so many.
It's an amazing story. We're going to talk this week
about about what's going on with price TRANSPA and some
of the other things that have gone on when it

(01:04):
comes to that area, and how effective some of those
laws have and have not been. But real quick, I
mentioned the four locations, the eight doctors of Advocate MD.
The expanse of Advocate MD is a great thing because
it shows people are the more they learn about what
you guys are able to do at Advocate MD, the
more patients that come on board, the more folks that join.
Thus you add more doctors, you make things, keep things

(01:26):
convenient by adding more clinics. It's really been a pretty
amazing growth that you've had at Advocate MD over the years.

Speaker 2 (01:32):
Yes, we're very fortunate.

Speaker 3 (01:34):
I started the clinic in the beginning of twenty nineteen
by myself and I had no staff. We had what
just one clinic in Middleton, So I was the one
that answered the phone, I made the appointments, I have
roomed patients, I drew blood, I did everything. And then
you know, as we've grown, we've been very fortunate to
now have eight physicians including myself, and also we have

(01:58):
four clinics, and you know, a lot of our growth
has been through you know, word of mouth through you know,
having businesses now find out about direct primary care and
sign up for their employees. But yes, I am grateful
that people are learning about DPC and learning that there's
an alternative to the traditional system.

Speaker 1 (02:17):
When we talk to about you mentioned businesses, and I
know you get a chance to get out and talk
with business leaders and a lot of a lot of
business organizations as well. Are they just as surprised what
you're able to offer at what costs? Are Are they
just as surprised as just families and others when you
start talking to them about what you're able to offer
at advocate MD and kind of what the pricing for

(02:38):
that service is.

Speaker 2 (02:40):
Yes, for sure.

Speaker 3 (02:41):
You know, I think many employers, I mean whether they're
small or large.

Speaker 2 (02:45):
You know, we deal with you know, small companies with.

Speaker 3 (02:47):
Five employees all the way to very large companies that
have a thousand employees, but all of them, you know,
if they're trying to provide a benefit for their employees,
they you know, are looking at cost and for more businesses,
healthcare is their second largest cost after payroll. And we
have these larger companies that are self funded, so they
are basically paying out their own claims, so they see,

(03:09):
you know, when their employee goes into see their primary
care doctor, or goes into see a specialist, or goes
in for surgery or an emergency room visit, and they
get those claims because they pay those claims directly, they
don't have a middleman necessarily, so they can see the
cost of things, and also they see from year to
year how much the cost of things are going up. So,

(03:30):
as you've talked about, Sean, you know, as everything, the
cost of everything keeps increasing, but healthcare increases at a
higher rate than everything else. This has been going on
even before inflation started to go up like crazy over
the past few years.

Speaker 2 (03:42):
But healthcare has always, for the last.

Speaker 3 (03:44):
Twenty years at least, been increasing at a higher rate
than all of the other industries. So, you know, when
you're seeing insurance premiums going up by fifteen to twenty
percent every year, I mean this is not sustainable, right, So, as.

Speaker 2 (03:59):
Employers one to be able to provide the best benefits for.

Speaker 3 (04:01):
Their employees and to be able to attract quality employees, Like,
how are we going to continue to provide healthcare benefits
when our costs are going up fifteen to twenty percent
each year, but our revenue doesn't go out.

Speaker 2 (04:14):
Necessarily fifteen to twenty percent.

Speaker 3 (04:16):
Each year, so they really are kind of being pressured
more and more to look at alternatives, and it's.

Speaker 1 (04:21):
An amazing We talk about what's interesting about direct primary
care and what you're able to do at Advocate MD
is the value is when people start to learn about
all the services and folks can listen back to previous shows.
I know a couple of weeks ago we talked a
lot about the services offered right in clinic to all
the things that the doctors at Advocate MD are able
to do. We talked about the pricing and what a

(04:43):
huge value it is. People are shocked to see the
two come together. And I remember a number of years
ago there was one of the big complaints about healthcare
is lack of transparency. Is that you don't know what
you're going to be paying, what it's going to cost
when you have services rendered at some of these I
should say some at these large, large systems, and there

(05:03):
was this push for transparency and I think a lot
of us, myself included, thought one we'd see transparency in two.
Once we started to see that it would make things
a bit more competitive. How has that played out in
the real world, doctor.

Speaker 3 (05:17):
Yeah, so I think, as you said, Sean, over the
last at least the last five to ten years, you're
seeing more and more, you know, politicians that are campaigning
on this. You know, you see it and even in
their campaign ads about you, I lowered the cost of insulin,
or I lowered the cost of this inhaler, and you know,
it is shocking until most of us experienced this on
a personal level, how much health care costs. I think

(05:40):
sometimes maybe for the past twenty years or so, people
had you know, quote unquote good insurance, or maybe we
weren't privy to what these these you know, crazy high
exorbitant prices are for a lot of healthcare.

Speaker 2 (05:53):
But all it takes is a couple of times.

Speaker 3 (05:55):
Where you get hit with a large bill that you
thought your insurance was going to pay. It could be
or a lab or a procedure. I think all of
us have experienced that, and then then it becomes you know,
more of an issue for us personally. And so I
think politicians are seeing this or hearing this from their
constituents of like, oh, well, we do care about the

(06:15):
cost of medications and the cost of hospital care and
patients that are going bankrupt because they can't afford to
pay for their cancer treatments, or you know, all of
these these crazy high cost that we see. So about
three or four years ago they passed a law on
the federal level called the Hospital Price Transparency Final Rule

(06:36):
that was in January of twenty twenty one. And so
the idea behind this is that if we increase transparency
of pricing, meaning we can see the actual true price
of what a hospital is charging for that procedure, for
that test, you know, for that hospital visit, then we

(06:56):
will be able to bring more competition, right because then
you know, you can't shop around for everything. Of course,
like you can't shop around for your emergency room visit.
You know, you're not going to shop around if you
if you have an obscure medical condition or you have
a very specialized, you know, unfortunate you know, form of
cancer where you need to see one doctor for that.
But there are many things in healthcare, most things in

(07:18):
healthcare where we should be able to shop around, you know,
for that lab test, you know, for that minor out
patient procedure that's not an emergency.

Speaker 2 (07:26):
Those things should be shoppable.

Speaker 3 (07:28):
And when I say shoppable, I don't just mean finding
the lowest cost, I mean finding the the medical doctor
who can perform that. You know, it's the most highly skilled,
high quality doctor, but also is performing it for you know,
the price that is is you know, the best price.
And again sometimes we equate price with quality, which in

(07:50):
healthcare there is no correlation. There's actually an inverse correlation
between price and quality because many times, let's use again
the example of a certain let's say we have a
very specialized surgeon that does one type of surgery. So
that person might be doing you know, hundreds or thousands
of these procedures, and they might be charging a cash price,

(08:11):
or they might be at an outpatient facility that's not
owned by a big hospital system, and they're charging you
a more affordable price because they have lower overhead. They
have you know, they've cut out the middleman of the
huge hospital system that's taking a huge chunk of every
surgical procedure they do.

Speaker 2 (08:26):
And that doesn't mean that.

Speaker 3 (08:27):
The surgeon is less skilled, that doesn't mean that their
equipment is less technologically advanced, none of that. So again
just to dispel that misconception, but there was a study
that was put out, I think a few weeks ago
by an organization called Turquoise Health, which I know nothing
about and I'm not promoting them in any way, but
they did a study that they looked at two hundred

(08:50):
hospitals across ten the ten largest metropolitan areas of the
United States, and the goal of this was to try
to see if these hospitals transports NCY rules are actually working.
Is it actually bringing cost down, because that's what we
would assume would happen, or that's what we would hope
would happen. And the conclusion of the study was actually

(09:10):
that it is bringing cost down, it's not bringing them
down at as significant of a level as I would
I would hope, or as I would expect. So they're
seeing somewhere between like four to six percent overall price decrease.

Speaker 2 (09:24):
And the other word that they like to use.

Speaker 3 (09:26):
Is price convergence, which again I guess that always makes
me a little anxious because it's like, is the price
converging to a lower price or a higher price?

Speaker 2 (09:36):
Right?

Speaker 3 (09:36):
So that means that once a bunch of people know
what the other person is charging, are they all like
they can't? I guess convolute and say you know, you know, oh,
we're going to all charge the higher price for that surgery.
So we you know, let's talk about what you're charging.
Let's all charge the higher price. So this price convergence idea,
I guess the thought behind it is that it should

(09:56):
be converging to a lower price. But again just the
overall idea of in a free market, you have competition.
So in a free market, somebody is going to figure
out a way if you're charging to a high of
a price, which all of us can agree. Healthcare is
too expensive and many people out there can't afford it.
So if we have a problem like healthcare being unaffordable,

(10:17):
then someone is going to figure out a solution to
make it more affordable. And so having pricing transparency will
help kind of guide that solution.

Speaker 1 (10:24):
Doctor, I've got to ask. We talked this morning with
doctor Nicole Hempkiss of Advocate MD. The website advocates DPC
dot com. That's Advocate DPC dot com transparent from the
get go. By the way, as we talk with doctor
Cole hempkis you can actually go right to the website.
It tells you how much membership is. I what to
cost per month depending on your age. Group. Also talks
about some procedures and other things that they can do
in the office, all spelled out black and white. Very transparent,

(10:47):
and I know that's a very high priority for what
you do at Advocate MD. Again, you can learn more
online ADVOCATESDPC dot com. That's Advocates DPC dot com, delfhare,
make an appointment, become a member six eight two six
eight sixty two eleven and that's six eight two six
eight sixty two eleven. So we talk about transparency and
those type of things obviously mentioned what you've been doing

(11:07):
an advocate and being very very upfront about costs and
being very open about membership and other things. Why why
are hospitals so reluctant to show and share their numbers
and share their data.

Speaker 2 (11:21):
Yeah, I think there's a couple different reasons for that.
You know.

Speaker 3 (11:24):
I think if if people had, you know, if their
eyes were wide opened, or if all of this was
kind of if the lid was lifted off of all
of this, I think people would be shocked.

Speaker 2 (11:34):
I think people would be angry. You know.

Speaker 3 (11:36):
I have definitely given presentations or had discussions with employer
groups throughout the years, or even patients, you know, throughout
the years where I've talked about some of this pricing
discrepancies and people, you know, I've had people say like, well,
how can they do this?

Speaker 2 (11:52):
Like how is this legal to do this? Why is
this not on the.

Speaker 3 (11:55):
Evening I remember somebody saying something like why is this
not on the evening news every night?

Speaker 2 (11:59):
That they're doing this and they're ripping people off.

Speaker 3 (12:01):
Like this, And as I always say, Sean, I mean,
there's no you know, there's no sin in making a profit.
Like nobody is saying that, you know, hospitals can't make
a profit, that that you know, independent practices can't make
a profit.

Speaker 2 (12:14):
But what hospitals.

Speaker 3 (12:15):
Charge is can be ten or one hundred times in
magnitude of what their actual cost is. And also keep
in mind that you know, patients that are going to
the hospital or a medical system, you know, they're not
doing this for like luxury or entertainment, right.

Speaker 2 (12:31):
They're doing this because they need medical gain.

Speaker 3 (12:33):
So we're taking people and sometimes the most vulnerable moments
and gouging them with exorbitant prices. And then what do
they do when they can't pay those bills? They get
sent to collections. In some parts of the country, they
have to. They're they're prosecuted in a court system when
they don't pay their bills.

Speaker 2 (12:49):
So yes, it is.

Speaker 3 (12:50):
Definitely makes an impact on people on a very personal level.
And I think that hospitals are scared for people to
see what they charge.

Speaker 2 (12:58):
I think they don't want people to be outraged.

Speaker 3 (13:00):
I think that in general, most health systems portray or
market themselves. I mean, the local systems are the same
as a mission driven you know, we're doing this for
the patient's benefit. And once you start, you know, exposing
all of these prices and the exorbitant you know, price
increases or you know, or if you can say like
old hospital X, this surgery is, you know, fifty thousand

(13:22):
dollars and at hospital, why it's twenty thousand dollars. Why
are they charging two and a half times with the
other hospital charges? You know, I think people will start
to have more of a distrust or a you know,
kind of a disillusionment of you know, why hospitals are
doing what they're doing. And you know, as we've talked about,

(13:43):
hospitals are profit driven right there. They are non profits,
but they are driven towards profits because the main goal
is no longer to take care of the patient, it
is to see how they can maximize their revenue, you know,
And as a physician, I saw that when I worked
in hospitals systems, because you're pushed to see more and
more patients, and the emphasis is not on quality or

(14:05):
time or you know, how well you're taking care of
that patient. It's all just on you know, volume, and.

Speaker 1 (14:10):
They've really found ways to, as you mentioned, to really
maximize those profits. And you know, as you point out,
there's nothing wrong with and certainly everybody has and everything
that if you're providing a service of value, you should
you should be compensated for it. And as you point out,
that's not the that's not the problem here. The problem
here is you have people in great need and and

(14:31):
rather than trying to be reasonable, you're just trying to
squeeze with these systems every penny out of them possible.
And it's it's pretty eye opening and pretty sad to
see what's going on. The nice thing is, especially when
it comes to primary care, there are options. There are
alternatives for you. Definitely check out Advocate MD Direct Primary
Care if you are looking for some great primary care

(14:52):
physicians and coverage for yourself and your family. If you're
an employer looking for great options for your employees, what
a great thing to offer direct primary care through Advocate MD.
You can learn more online Advocates DPC dot com. That's
Advocates DPC dot com. What to do a conversation with
doctor Cole Hemkis. We are going to talk about the
challenges with price transparency. We'll get into that next as

(15:12):
Full scope with doctor Cole Hemkis continues right here on
thirteen ten double U ib A. This is full scope
with doctor Coole Hempkiss right here on thirteen ten double
U I b A. You can learn more about doctor Hemkis,
actually all eight doctors, all for clinics. You can learn
more also about Advocate MD, the practice, what it costs, membership.
All that stuff is all up online at Advocates DPC

(15:32):
dot com. That's Advocates DPC dot com. Also, you're saying, well,
what do I do for like catastrophic or other type
of insurance coverage? How does that work? There's a great
section on advocatedpc dot com that shares what it pairs
well with and kind of what everything covers. A lot
of great information up on the website. Telphy number six
O eight two six eight sixty two eleven. That's six
oh eight two six eight sixty two eleven. And doctor,

(15:54):
before we had to go to break there, we just
kind of started talking and touching on price transparency and
there are challenges. Let's let's talk a little bit about that.

Speaker 2 (16:01):
Doctor. Yeah.

Speaker 3 (16:02):
You know, I've heard people kind of talk about price
transparency for healthcare, and you know, equated to like a
menu of prices or or you know, other analogies to
you know, when you walk into a restaurant and you
get a menu, or you know, just seeing the price
of something with a label on it, where.

Speaker 2 (16:20):
It's easy to figure out. But healthcare, you know, does
have some challenges. You know.

Speaker 3 (16:26):
I think one of the big challenges is that it
is so complex, right, So, I mean there are things
that are not as complex, you know.

Speaker 2 (16:31):
I mean I think there are certain goods and services
and medications.

Speaker 3 (16:36):
And lab work and things like that that are are
relatively simple and we could price those pretty easily.

Speaker 2 (16:41):
There are things that become more complex, right, Like.

Speaker 3 (16:43):
When you have surgery done, you know, you can't necessarily
always predict how long that person's going to be in
the hospital, you might not be able to predict if
they have complications, you know, what type of anesthesia they're
going to use, what the surgeon's actually going to do
when they get in there. So so even things like
surgery might be a little bit more complicated.

Speaker 2 (17:01):
You know. The other challenge we have with price transparency
and healthcare.

Speaker 3 (17:05):
Is that we have to make this digestible to consumers
that are not you know, physicians or nurses or healthcare people.

Speaker 2 (17:14):
We have to make it easy to understand.

Speaker 3 (17:17):
And again, it's one of these things where it is
so such a huge topic and there's so many potential
procedures and services and types of office visits.

Speaker 2 (17:27):
And you know the complexity. So when when doctors.

Speaker 3 (17:30):
Build for office visits, there's a level of complexity. And
what's incorporated into that is, you know, what were the
things you talked about with the doctor? Did they you know,
how many aspects of a physical exam did they do?
Did they go over a review of systems, which means,
you know, did they ask you a bunch of questions
about all the systems in your body and the symptoms
that you're having. Is so they look at all these
different criteria in order to eventually come up with a

(17:53):
coding for that visit.

Speaker 2 (17:54):
And it's not easy.

Speaker 3 (17:55):
They write entire books about this, right, So so when
you look at things like that, you know, you've try
to figure out how do we make this so that
a consumer can know what a level you know, one four,
a level one three visit means, like what does that mean?
So it isn't an easy task to accomplish, I would say,
so I think that, you know, we still have those challenges,

(18:16):
but I think there are.

Speaker 2 (18:16):
Things that are very easy.

Speaker 3 (18:18):
You know, you can look at things like MRIs and
X rays and you know, obviously different kind types of
urgent care visits. You if you have a sore throat,
if you sprain your ankle, you know, those sort of things.
We can do a diagnosis based. But again I think
that they're trying to start with this. And there's this
tool that all hospital systems have to make public now

(18:39):
called the charge Master. And again I always wonder how
much of this the actual general public.

Speaker 2 (18:45):
Knows how to use, or first of all, do they
even know that it exists?

Speaker 3 (18:48):
You know, and then if you try to go into
the charge master, you know, online, and you're looking up
a procedure like, oh, I know I have to get
my hip replaced, or I know that I'm going to
have this MRI, you know, the MRI with or without contrast,
you know, what is the actual anatomical part that you're
looking at? You know, you have to know the answers
of all of these things. So again it's I think

(19:10):
it's not completely you know, user friendly in terms of that,
and I think that's something that they are continually, you know,
trying to work on and improve on. And then I
think the final piece of it is when a patient
has all this information, what do they do with it?

Speaker 2 (19:25):
Then? Right?

Speaker 3 (19:26):
Like does it actual does having that information make there
be a change in the action or the results?

Speaker 2 (19:32):
So, like, let's say they can look.

Speaker 3 (19:34):
All this information up and they find the correct test,
they find the correct surgery, and they realize that their
you know, head MRI is going to be ten thousand
dollars at hospital A and it's going to be five
thousand dollars at hospital B. So they can then choose, Okay,
I'm going to do it at Hospital B. Do they
do they have to negotiate that? Do they have to
go back? And you know, like say to their insurance

(19:56):
company or say to the hospital like, oh, I see
your price here, or do they go back to the
hospital and say, will you match this price? I think
there's so many intricacies to it in terms of how
do we then go ahead and use that information. For example,
for a large self funded employer, that could be used
as a negotiation to say like, Okay, well we're not
paying for this at this price because the hospital down

(20:17):
the street will do.

Speaker 2 (20:18):
It for half the price, you know.

Speaker 3 (20:20):
Or do you then say, okay, we're just going to
send everybody to hospital be because you know you're not
willing to meet our price.

Speaker 2 (20:26):
So I think there's there's a lot of different.

Speaker 3 (20:28):
Aspects of it, and I think we haven't had the
ability to have transparent pricing long enough to be able
to answer all of these questions fully yet.

Speaker 1 (20:36):
And I think there's some people saying, well, what doesn't
my insurance company negotiate on my behalf. That's a whole
other show. And by the way, folks, if you if
you missed any part of today's showhere you want to
listen to those there's a bunch up at wiva dot com.
We've talked in depth about it. I do like how
you left there, because it is pretty eye opening too
when you start to realize just just the game that's

(20:56):
kind of going on there. Good thing is, especially when
it comes to primary care, you've got a great alternat
of direct primary Care Advocate MD. Get to the website today,
Advocate DPC dot com. That's Advocate DPC dot com. Telphy
number six so eight two six eight sixty two eleven.
That's six oh eight two six eight sixty two eleven.

Speaker 2 (21:12):
Doctors.

Speaker 1 (21:12):
Thank you so much for taking time to join us
this morning. You have a great day, me too, Sean,
thank you. News comes your way next here on thirteen
ten w I B a