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Emergency Medicine Telemedicine Job

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  • Emergency Medicine Telemedicine Job

    My friend is working from home as an emergency physician.  The hospital he works for is across the country.  That hospital wants to get their door to doc times down, so they hire telemedicine EM docs to use a video camera and high speed connection to do a quick screen on patients when they arrive.

    He explained that the triage nurse texts him on his mobile phone when there is a patient to be assessed, then he jumps into his study and closes the door so the kiddies don't interrupt his patient encounters.  He does a quick patient screening assessment and enters some orders to get the patient started, then writes a brief medical screening note in the hospital EHR through his secure, remote connection.  The nurse picks up his initial orders and the patient goes into the queue to see a physician or APP who is physically present at the bedside.

    They pay him $150/hr for this work, which sounds kind of low for per diem EM work, but he is at home while performing this work.  He says at times it is non-stop, patient after patient, but at other times there is significant downtime to play with the kids.

    Is anyone else doing any kind of similar work?  Are there more high level telemedicine jobs being created?  Does $150/hr sound like a reasonable wage for a board certified EM doc to do this kind of work?

    He said he has been contemplating taking the kids abroad for some interesting travel and living experiences while continuing to work remotely, but so far his spouse is not buying in to his idea.

  • #2
    Interesting idea. I like that he is just 1 part and not the primary provider. But for now I'll keep my day job due to the increased pay and more satisfaction from seeing some critical cases to their completion.

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    • #3
      I cannot answer your specific questions (of course) but wonder about his professional liability coverage. Does he have specific coverage and the necessary waivers for this activity? I’m not even sure if I’m using the correct terminology ops: but that is the concern that comes to mind after reviewing this fact pattern. Hoping others will chime in as this situation is sure to become more prevalent.
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      • #4
        Telepsych is growing explosively. Some companies are growing 500-800% per year. Medicare reimbursement is dicey. Patients mostly love it and outcomes are comparable. It's far more efficient to spread one doc's time across multiple institutions than to have three at three different ones.

        Yet I wonder what the future of psychiatry is. If basically rural, small, and community mental health basically goes 100% tele in the next generation. All docs live in Seattle, Manhattan, and LA; they supplement their income by exporting their skills to smaller communities across the country; and those patients never see a live body again. It's kind of sad.

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        • #5
          That sounds like a pretty nice gig to me. No procedures or running codes for 150/hr. And can be done at home or any where in the world you please. Not bad.

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          • #6




            I cannot answer your specific questions (of course) but wonder about his professional liability coverage. Does he have specific coverage and the necessary waivers for this activity? I’m not even sure if I’m using the correct terminology but that is the concern that comes to mind after reviewing this fact pattern. Hoping others will chime in as this situation is sure to become more prevalent.
            Click to expand...


            He has the usual malpractice insurance, and he is licensed in the state where he is providing telemedicine patient care.  So I don’t think there are issues there.

            As far as patient billing, he is not billing when a physician follows him to examine the patient as the bill is submitted by that doc.  And when an APP sees the patient, the visit can be billed at 100% rather than 85% because the patient was also “seen” by a physician.

            Another interesting aspect of this is the limited physical exam that can be performed via telemedicine.  Visual examination is good with a high resolution camera, but those crackles in the lungs cannot be detected with his current set up.  The bedside nurse can help, but this is quite different than the usual doctor patient interaction.

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            • #7







              I cannot answer your specific questions (of course) but wonder about his professional liability coverage. Does he have specific coverage and the necessary waivers for this activity? I’m not even sure if I’m using the correct terminology but that is the concern that comes to mind after reviewing this fact pattern. Hoping others will chime in as this situation is sure to become moreprevalent.
              Click to expand…


               

              Another interesting aspect of this is the limited physical exam that can be performed via telemedicine.  Visual examination is good with a high resolution camera, but those crackles in the lungs cannot be detected with his current set up.  The bedside nurse can help, but this is quite different than the usual doctor patient interaction.
              Click to expand...


              A big downside is going to be the additional testing from that standpoint. I've never been a big fan of "provider in triage". It usually leads to somebody shotgunning labs in the front end hoping to speed everything up by having all the labs done for the back end provider to dispo. What invariably happens is there will be some unnecessary testing (i.e. d-dimer) that will come back abnormal that the back end provider has to deal with which usually leads to more testing/cost.

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              • #8
                Interesting side hustle.  You definitely could make more as a board certified EM doc moonlighting somewhere, but the working from home is obviously appealing.  I would worry about the liability of any abnormal test results that were ordered under my name that weren’t addressed by the next provider.

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                • #9
                  Psych seems 100% suited for telemedicine. You can actually do an appropriate, complete specialty-specific exam without laying hands on the patient. Lots of psych patients struggle with lack of access to care, and part of that struggle is rural/inability to travel to their psychiatrist. My friend does telepsych and loves it; the patients "show up" at a higher rate, he can help people who otherwise couldn't access care, and he gets to pick his kids up from school before finishing work for the day.

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                  • #10
                    I have a client doing tele psychiatry and the rate is similar to what you outlined.

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                    • #11




                      I cannot answer your specific questions (of course) but wonder about his professional liability coverage. Does he have specific coverage and the necessary waivers for this activity? I’m not even sure if I’m using the correct terminology ???? but that is the concern that comes to mind after reviewing this fact pattern. Hoping others will chime in as this situation is sure to become more prevalent.
                      Click to expand...


                      I would imagine that his exposure is minimal to be honest. Unless he screws up on something dangerous AND time sensitive he really would be hard to nail. If he's an experienced EM doc he might overall stroke codes a bit and be more aggressive about moving pts / questionable EKGs back.

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                      • #12
                        He should verify the legality of performing his role while outside the country.  I do a form of teleneurology and am not permitted to do so while outside of the country.

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                        • #13




                          He should verify the legality of performing his role while outside the country.  I do a form of teleneurology and am not permitted to do so while outside of the country.
                          Click to expand...


                          I wonder what the basis is for this. Is there something about your decision making that changes across borders?

                          It's likely someone worried about security or connection issues, but it's also equally likely that it is someone restricting movement out of an overzealous fear of something that is not likely.

                          Administrators get you (and get their cut) no matter what you do.

                           

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                          • #14




                            He should verify the legality of performing his role while outside the country.  I do a form of teleneurology and am not permitted to do so while outside of the country.
                            Click to expand...


                            Do you know the basis for this restriction?  Is this out of country restriction based on the rules of your employer, or the rules of some regulatory body?  It would be interesting to know the source.

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                            • #15







                              He should verify the legality of performing his role while outside the country.  I do a form of teleneurology and am not permitted to do so while outside of the country.
                              Click to expand…


                              Do you know the basis for this restriction?  Is this out of country restriction based on the rules of your employer, or the rules of some regulatory body?  It would be interesting to know the source.
                              Click to expand...


                              I don't know the basis but this also happened for a client who did tele-psychiatry from Asia. He told me something changed in the regulations, requiring him to return to the states to continue.
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