(This article is the first in a two-part telemedicine series.)
Telemedicine is the New House Call
Telemedicine was slowly growing back in 2014, particularly in rural communities. It was embraced in healthcare deserts for people without access to medical care.
Clinics serving poor or low-income patients embraced telemedicine early. They didn’t have the money to keep enough physicians on staff to meet growing demand.
Patients without alternatives embraced telemedicine. Hospitals saw telemedicine as a cost-savings effort, but there was less incentive for most medical practices. Patients who could get to a doctor went to the doctor’s office.
For telemedicine to expand, it would have to be widely accepted by physicians and their patients.
The Novel Coronavirus
When the pandemic hit, patient preference was no longer an issue. Access to care became a problem for everyone, not just the poor or underserved. However devastating the pandemic, telemedicine has been embraced as never before.
By April 2020, ambulatory care visits declined by 60 % and still have not risen to pre-pandemic levels. Preventative care, like physicals or pap smears, decreased as both patients and doctors tried to limit exposure.
For physicians, the adoption of telemedicine was forced. Most cobbled together a telemedicine system as best they could without jeopardizing quality of care. The question is – is there a way to make money by practicing telemedicine? Even after the pandemic?
The answer is yes.
Benefits of Telemedicine
Doctors who are just building a practice have the most to gain from incorporating telemedicine. It allows them to build a customer base while still generating revenue. Younger physicians tend to be more comfortable doing video consults and remote monitoring. E-prescriptions are already a standard practice.
From a patient perspective, even before the pandemic – 9 out of 10 people over 40 were open to telemedicine. In 2017, US patients aged 51-60 submitted more insurance claims for telemedicine than of any other age group.
There are tremendous benefits for both physicians and patients. The list below highlights just a few of them:
- Sick People don’t Travel: There’s no commute to the office with telemedicine. When a patient is too ill for ambulatory care, they can still be seen. If a patient is a no-show – no wasted time or travel.
- Shorter Consults: The average time for an office visit is 2 hours, including travel time. The average length of a telemedicine consult is 15 minutes.
- Billable Downtime: When days are slow or while you’re building a practice, fill the time with telemedicine consults to bring in revenue.
- Onboard More Patients: Getting an in-office appointment takes 24 days on average. A telemedicine appointment can be had in approximately 20 minutes.
- Office Space: Smaller practices can operate a telemedicine service out of a home office. Larger practices may be able to reduce the amount of office space they need.
- Gain Patients: Telemedicine providers can serve patients outside their practice area. It’s fulfilling to provide access to care and generates billable hours.
- Digital Collaboration: Very helpful for practices that serve Medicare Advantage plans. In the transition from Fee for Service to Value-Based Care, teamwork is considered essential.
- Online Education: Presentations or classes that are normally presented at conferences or events can be available on demand. Online courses can generate significant income.
- Access on the Go: Patients can see their doctor no matter where they are. Traveling on business, going on vacation – telemedicine is convenient for patients and improves cash flow.
- Second Opinions: Connect with other physicians to quickly provide a second opinion. Telemedicine allows for the forwarding of a patient’s EMR. Patients don’t have to schedule an appointment to have a diagnosis validated.
- Direct Payment: Some telemedicine is billed directly using encrypted electronic payment gateways. No more insurance headaches.
Telemedicine isn’t optional for medical practices. Servicing patients remotely due to COVID-19 opened up a new customer experience. Many of them embrace the convenience of remote consults. Teledoc saw 100,000 patients in a month and that was in 2016.
Patient expectations are shifting. Just like providers, they want affordable, accessible healthcare without losing quality of care. Change isn’t coming, it’s already here.
There’s an app for that
There are “doctor on-demand” apps that connect patients to telemedicine practitioners. One of the most interesting is SteadyMD. The app matches a patient’s personality to a physician. The doctor is an alternative to a traditional primary care physician. The app collects EMRs and any personal data captured on apps like Fitbit or Weight Watchers.
SteadyMD doesn’t take insurance. Patients purchase an annual membership, either an individual or family plan. Annually they can expect to pay between $1200 and $2200. There’s no deductible and doctors take on a limited number of patients to ensure access.
Every primary care physician needs to pay attention to this model. SteadyMD makes no secret of intending to poach your patients.
The most common telemedicine services are described below. Some consults are better done by video than the phone, but it will depend on the technology owned by the patient. Commonly used video applications like Facetime or Skype are not HIPAA compliant. There were exceptions granted during the COVID pandemic.
This interactive map from Fair Health shows U.S. telehealth insurance claims by region. Compare 2019 and 2020 to see the types of consults and the number of claims.
The image below covers the western region.
Most physicians have put together a telemedicine response during COVID19. But Is it scalable and secure for an ongoing telemedicine practice? Is everything compliant moving forward – are you protecting patient data?
There are different models for telemedicine practitioners:
- Work as a consultant/employee with a telemedicine firm.
- Do telemedicine consults in your practice. (Continued in Part 2)
1. Work at a Corporate Telemedicine Firm
The fastest way to make money is to work with a telemedicine firm. That market is booming, and they are all hiring.
Telemedicine companies handle all administrative tasks. They provide a HIPAA compliant platform and build the patient base. Physicians control their time and decide the hours they are available. Some companies offer benefit packages or a sign-bonus.
They prefer to hire doctors with multiple years of clinical expertise. Judging from the hourly rates for telemedicine consults on Practice Bloom, there’s a lot of leeway. Even with limited experience, it can’t hurt to apply.
These are telemedicine pay rates by specialty. If someone was working full-time in telemedicine this is the maximum possible pay. Getting the patient volume to justify full-time work may be difficult.
|Specialist||Hourly range||Annual range||Average salary|
|Family Medicine||$15 to $200 per hour||$28,000 to $386,000||$191,202|
|Psychiatrists||$25 to $181 per hour||$60,000 to $300,000||$189,000|
|Radiologists||$30 to $200 per hour||$150,000 to $500,000||$494,400|
|Pediatricians||$45 to $100 per hour||$45,000 to $250,000||$190,000|
|Cardiologists||$50 to $200 per hour||$50,000 to $500,000||$464,400|
|Endocrinologist||$30 to $200 per hour||$60,000 to $280,000||$200,000|
|Gastroenterologist||$40 to $150 per hour||$150,000 to $300,000||$175,000|
The rate breaks out to 1866 hours or 233 days if you work full time – about 2/3 of a year. Remove the cost of commuting, marketing, and billing – it’s not a bad deal.
Firms offer full and part-time positions. Full-time comes with a solid benefits package – a big cost saving for a home office practice. Some firms are offering hires stock options in the company. Doctors can work off a 1099 as an independent contractor if they prefer to write off expenses.
This is no different than any other professional job – don’t accept your first offer. Make sure you understand how and when you get paid. Be clear about how much control you have over your time and if there are any consult quotas you’re expected to meet. Ask about liability and data security. Don’t sign any contracts or non-competes without talking to an attorney.
Generate More Revenue
Volume pays. Telemedicine firms pay for consults. The more patients you see, the more money you make. You may be able to make more if you work nights and weekends or take emergency consults. (Consider time zones too – 2:00 am in New York is only 10:00 pm in Seattle. On the flipside – 8:00 am in Maine is 4:00 am in California.)
Video pays more than phone. The expectation is that 3 to 5 video sessions can be done per hour, earning a doctor up to $150. A nurse practitioner can earn between $60 – $100.
Get licensed in multiple states. This list includes licensing boards, fees, and turnaround times for each state. (Note: The information is from 2019 but is still a good starting point.) There’s some investment involved here – time and money – so choose strategically. Ask the telemedicine company to cover licensing. Some may be more willing than others.
Expect a seasonal uptick in fall and winter. (Just like in a regular practice.) Adjust your hours to be more available during peak times. Then enjoy spring/summer downtime on fall/winter money.
Go part-time with multiple providers. Having access to telemedicine patients is how money is made. If you’re signed up with more than one firm, you can minimize times with no one to treat.
Make money during downtime. Taking a telemedicine job doesn’t mean you have to give up the job you have. For doctors building a practice, a part-time telemedicine gig can bring in extra cash.
Patients Like Telemedicine
There is every indication that telemedicine is more than a response to a pandemic. Not only is it more efficient for healthcare providers, it is more convenient for patients. They can see someone almost immediately – no long delays to schedule an appointment. Patients who are ill don’t have to travel to talk to someone.
Because the provider is virtual, patients can access services on the road, instead of waiting to get home. Smartphone apps make video calls easy. If patients are short on charge or low on data, an encrypted chat is a quick fix.
Another less discussed benefit is the growing market for direct pay models. Some telemedicine firms have removed the need for insurance, drastically cutting their administrative burdens. Patients can opt for a subscription model or pay per consult. No more out-of-network expenses for a consult or prescription.
Working for a telemedicine firm has benefits and limitations. Here are few things to consider:
- Corporate telemedicine companies are hiring, even as the pandemic begins to wind down.
- Firms prefer experienced physicians, but facing growing demand, they need more doctors.
- Patients are more concerned about access to healthcare than access to a specific physician.
- Part-time telemedicine consults fill downtime for new physicians trying to build a practice.
- Physicians who work for telemedicine companies control their availability.
- The companies offer a competitive salary, without the burden of marketing, billing, or scheduling.
- Telemedicine will not be limited to COVID. It’s become part of the healthcare system.
- Telemedicine firms are a new business entity. Expect them to make changes in structure, pay scales, and appointment quotas.
- Doctor on Demand apps bring direct pay models into the mainstream. It’s a challenge to conventional billing practices and insurance providers.
- Telemedicine firms may require multiple state licenses. Expanding the geography of the patient base is key to making more money. Unless the company pays for the licensing fees – it’s expensive and takes months for applications to be processed.
- Telemedicine consults require a “webside manner” to build patient rapport. It requires practice. Phone consults can be done but pay much less than video calls.
Despite any limitations, telemedicine is here to stay.
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