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Emergency Medicine Telemedicine Job

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  • Avatar Dr. B 
    Participant
    Status: Physician
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    Joined: 09/05/2019

    I am looking for an Emergency Medicine telemedicine position. When I did a search your post came up.  Any tips on how to find something similar to your friends job? Thank you.

    #243854 Reply
    q-school q-school 
    Participant
    Status: Physician
    Posts: 2629
    Joined: 05/07/2017

    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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    sounds like some dystopian novel.

     

    #243864 Reply
    q-school q-school 
    Participant
    Status: Physician
    Posts: 2629
    Joined: 05/07/2017

    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.

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    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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    our telemedicine setup is different.  the nurse at the bedside holds some electronic stethoscope to the lungs and the heart.  we are told it is very high fidelity and reliable.  does anyone still do percussion or palpation?   lol

     

    #243865 Reply
    Avatar ZZZ 
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    Status: Spouse
    Posts: 697
    Joined: 06/18/2018

    Great to see all the creative ways admin thinks of to game the system and improve their metrics of choice while doing nothing to really improve patient care.

    Instead of appropriately staffing their ER, this place is paying some guy sitting at his computer at home to be a glorified triage nurse doing a cursory webcam exam — but doing so as an MD so they can report ‘amazing’ door-to-doc times.

    As a side benefit, this allows that ER to bill for physician visits because he’s willing to put his name on a chart…then they just have midlevels actually see the patient and do the work of a physical exam. When can we have another thread about how midlevels are taking over?

    #243868 Reply
    Avatar Panscan 
    Participant
    Status: Resident
    Posts: 1076
    Joined: 03/18/2017

    If people make actual clinical decisions on remote auscultation that is extremely sad and negligent IMO.

    All this remote crap is a joke

    #243877 Reply
    Liked by ZZZ
    mr_boo_jangles mr_boo_jangles 
    Participant
    Status: Physician
    Posts: 14
    Joined: 09/02/2019

    Tele ER medicine….they didn’t teach me that in residency….so, so many questions….what could possibly go wrong?

     

    #243882 Reply
    Liked by ZZZ
    Avatar EM->CCM MD 
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    Status: Physician
    Posts: 76
    Joined: 07/23/2017

    Panscan – we do tele-icu work. First off, I assume you’re a radiologist. If this isn’t the work you do, I don’t know why you feel qualified condemning it. The setup we have is pretty incredible – I think it is actually probably better than the stethoscope I use when rounding due to the amplification and noise cancelling.

    I think the setup in question is a little messed up, but that doesn’t mean we should throw the baby out with the bath water. There are critical access hospitals with only GPs, or maybe some support, but not intensivists – if they ship everything out, they’ll be losing money and likely close the doors. Or maybe it’s not about the money, but having a qualified intensivist aid with setting up the vent and choosing antibiotics absolutely saves lives. Some of the places we remote into don’t have another hospital within an hour. I don’t know why we wouldn’t support things like tele-psych – it totally makes sense.

    #244000 Reply
    Avatar Dilaudidopenia 
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    Status: Physician
    Posts: 206
    Joined: 05/22/2016

    For the physician, this side hustle sounds great provided all the malpractice I’s and T’s are dotted and crossed.  I’d totally take $150/hr to do this at home while watching sports, feeding the baby, doing laundry, etc.  There are s*** hole EDs in NYC paying this for live coverage seeing 2+ pph.

    For the field of EM and medicine overall, this is a scam.  Not the telemedicine part.  “Provider in triage” as discussed above is just a way to tinker tinker with the metrics.

    I guess it’s cool to have an educated doc doing it rather than a midlevel who is ordering inflammatory markers for cough and plain films for back pain, oh and d-dimer on EVERYONE.

    #244300 Reply
    Liked by wonka31
    Avatar southernerdoc 
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    Status: Physician
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    Joined: 03/10/2019

    Your friend needs to be advised that this may not meet EMTALA screening since he/she cannot perform a physical exam on the patient.  Therefore, if something bad happens, the facility may have an EMTALA violation and he/she may be sued in federal court over an EMTALA violation.  CMS recognizes telemedicine for stroke, psychiatry, etc., but the waters have been untested for screening examinations.  This may be overcome by a joint assessment with a nurse if the hospital bylaws designate a nurse as capable of performing a screening exam.

    Furthermore, unless you have specific insurance for telemedicine or your current carrier specifically authorizes it, then it’s not covered.  Most insurers hate telemedicine because it’s new and untested.  Therefore, they cannot accurate assess risk.

    #244359 Reply
    CordMcNally CordMcNally 
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    Status: Physician
    Posts: 2806
    Joined: 01/03/2017
    All this remote crap is a joke

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    Strap yourself in because this isn’t going to go away anytime soon. Everything is moving more towards tele-*insert field*.

    “But investing isn’t about beating others at their game. It’s about controlling yourself at your own game.”
    ― Benjamin Graham, The Intelligent Investor

    #244367 Reply
    White.Beard.Doc White.Beard.Doc 
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    Status: Physician
    Posts: 936
    Joined: 02/06/2016

    Your friend needs to be advised that this may not meet EMTALA screening since he/she cannot perform a physical exam on the patient.

     

    How would this be an EMTALA violation? The patient gets seen by an on-site provider after this initial brief preliminary evaluation by the telemedicine provider in triage.

    Furthermore, unless you have specific insurance for telemedicine or your current carrier specifically authorizes it, then it’s not covered.  Most insurers hate telemedicine because it’s new and untested.  Therefore, they cannot accurate assess risk.

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    As far as my understanding goes, the facility where this telemedicine occurs is a large academic hospital that provides the telemedicine doc with full malpractice coverage.

    #244370 Reply
    Liked by wonka31
    q-school q-school 
    Participant
    Status: Physician
    Posts: 2629
    Joined: 05/07/2017

    Your friend needs to be advised that this may not meet EMTALA screening since he/she cannot perform a physical exam on the patient.

     

    How would this be an EMTALA violation? The patient gets seen by an on-site provider after this initial brief preliminary evaluation by the telemedicine provider in triage.

    Furthermore, unless you have specific insurance for telemedicine or your current carrier specifically authorizes it, then it’s not covered.  Most insurers hate telemedicine because it’s new and untested.  Therefore, they cannot accurate assess risk.

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    As far as my understanding goes, the facility where this telemedicine occurs is a large academic hospital that provides the telemedicine doc with full malpractice coverage.

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    It’s fascinating to me that despite all the resources and cheap labor that are usually present at large academic centers, they still need to turn to paying a remote physician to screen patients.

    #244400 Reply
    Liked by ZZZ
    White.Beard.Doc White.Beard.Doc 
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    Status: Physician
    Posts: 936
    Joined: 02/06/2016
    Splash Refinancing Bonus

    It’s fascinating to me that despite all the resources and cheap labor that are usually present at large academic centers, they still need to turn to paying a remote physician to screen patients.

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    There is zero need for this particular hospital to use telemedicine.  The academic medical center involved is ranked among the top handful of hospitals in the country.

    They are doing all things telemedicine in myriad areas not because of need, but because one of their goals is to explore and lead in the application of telehealth and new technology in medicine.  They are also hiring physician data scientists to advance AI use in health care, again because they want to stay on the bleeding edge of medical data science/AI applications.

    #244401 Reply
    Liked by jfoxcpacfp
    q-school q-school 
    Participant
    Status: Physician
    Posts: 2629
    Joined: 05/07/2017

    It’s fascinating to me that despite all the resources and cheap labor that are usually present at large academic centers, they still need to turn to paying a remote physician to screen patients.

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    There is zero need for this particular hospital to use telemedicine.  The academic medical center involved is ranked among the top handful of hospitals in the country.

    They are doing all things telemedicine in myriad areas not because of need, but because one of their goals is to explore and lead in the application of telehealth and new technology in medicine.  They are also hiring physician data scientists to advance AI use in health care, again because they want to stay on the bleeding edge of medical data science/AI applications.

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    That makes more sense.  It seems not that ambitious however, given the already robust use of eICU.  I guess I read the first post as more definitively stating the primary goal was to keep door to doc times down, rather than stay on forefront of technology or potential AI applications.   Obviously we only have limited information about the program; however, the initial description does not sound that ambitious (to me).

    Good luck to them however.

     

    #244413 Reply
    Avatar redsand 
    Participant
    Status: Physician
    Posts: 75
    Joined: 01/08/2017

    Interesting. I would wonder about the liability if your friend screens a patient, let’s say a young child with a fever with Tmax 104 at home. Maybe the telemedicine doc will order Tylenol, possibly ibuprofen. Then the APP is the only other “provider” to see the patient during the ED encounter and the kid has conjunctivitis and maybe edema of the extremities, and is sent home and what if there is a bad outcome from a missed diagnosis of Kawasaki disease or something.

    I’m not saying this would happen, and I’m not saying that in this particular telemedicine setup it is likely to happen, but there is going to be more than just this permutation of telemedicine for ED physicians (or insert your specialty of choice). I am just trying to think of a possible negative outcome and what is the possible risk of a physician who sees the patient early on in the ED course, doesn’t have the opportunity to fully evaluate or see the patient because of telemedicine, and then has to bear the risk of someone else’s ability to generate an appropriate assessment and plan, and the physician is liable for supervision but the telemedicine setup doesn’t allow for supervision time.

    #244420 Reply

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