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Telemedicine Update, Any feedback?

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  • Zaphod Zaphod 
    Participant
    Status: Physician, Small Business Owner
    Posts: 4986
    Joined: 01/12/2016

    I haven’t done telemedicine, but we get a ton of medical advice calls in our ER asking what a rash is and should they come to the ER. I agree telemedicine is not terribly useful, and it’s depressing that Big Medicine is obsessed with it as some kind of miracle, but it’s really great to be able to tell patients that they should call the telehealth line (and pay for it, instead of getting free advice from us) if they can’t decide whether to come to the ER or not.

    At best, I think telehealth functions as a triage system. At worst, it’s just z-pack dispensing.

    Click to expand…

    Big Medicine is obsessed or is it tech companies? Of course they are, new entrants looking for a new way to skim that scales.

    #180502 Reply
    fatlittlepig fatlittlepig 
    Participant
    Status: Physician
    Posts: 434
    Joined: 01/26/2017

    It amazes me that FLP can go to sleep at night or get out of the house in the morning, with such extreme aversion to any form of risk.

    Click to expand…

    nah, not really into high risk low reward type endeavors. you have to think that the type of patients who would seek out a telemedicine encounter is likely looking for something.

    #180554 Reply
    Liked by Zaphod
     ebotrd 
    Participant
    Status: Physician
    Posts: 10
    Joined: 10/25/2018

    I dont know. You can actually usually get some exam and RR and HR and temp through telemed. And IMHO general appearancr and interaction is the most important objectively whether through telemed.or in.person. Recently asked out biller what our clinic gets for typical 99213 URI simple-type visit. Said dependes on insurer but typical is around $38. Makes $28-$30 look pretty good for telemed which is typically more focused with single chief complaint and less awkward to try to limit it to that vs “oh by the way doc” that we constantly deal with.
    I’m just a dozen or so patients in but most disappointed in the EHR interface. Appears most PMH etc is up to the patient and is often lacking/incomplete as I assume they have No guidance as they might have from an MA in real office.
    Would love any input you all have on how to maximize tax deductions and max saving strategies for this or my other 1099 income. I assume I can save 20% in self 401k and deduct reasonable business expenses. Anything else?

    #180891 Reply
     familydocPA 
    Participant
    Status: Physician
    Posts: 42
    Joined: 03/03/2017

    Unfortunately there lots of opinions here being thrown around here without any basis in fact.

    To those concerned about the risk – that’s a joke to me.  First off, this is pretty simple stuff we’re dealing with. Most people are not so obtuse to think that if they are really sick that they can get away with a phone call.  For the rare ones that are, that’s why we ask about warning signs and symptoms and document.   The stuff we discuss is really low acuity, and you hold the ultimate trump card – anything remotely suspicious and you can make your official recommendation be that they get seen.

    All that being said, if you’re really concerned about risk, just look at the track record.  Teladoc provides 1m/3m malpractice coverage.  Unless something has changed since I got credentialed, neither Teladoc nor AmWell have ever had a single malpractice case brought against them.

    With regards to the time, it all comes down to efficiency.  I used to take 10-15 minutes per encounter, but now that I’ve done several hundred, they go much faster. It’s like anything else – you figure out a system that works for you.  I typically spend between 5-8 minutes on the call, and can usually document while I’m on the phone.

    Most patients are very grateful for the service.  It’s really hard to talk to a doc to answer even a simple question; being able to get one on the phone within 5 minutes is a great service.  I am extremely reluctant to prescribe antibiotics and some people do get upset with me, but to be honest that is the minority.

    It’s an easy gig, good for a couple of bucks while I would be otherwise just watching TV.  Same exact thing that I used to have to do for free (taking home calls for my primary care office).

    #181054 Reply
    Liked by Sports DOc
     Kencufc 
    Participant
    Status: Physician
    Posts: 21
    Joined: 08/12/2017

    I think my average visit time is more like 8 minutes.  I typically document during that time so face to face time is about 5-6 minutes. Typical diagnoses are mainly URI, sinusitis, UTI, viral gastro, flu, and some chronic med refills. Each company I work with sets a goal of less than 40% visits without an oral antibiotic. Starting out I was surprised to see my % was more like 70%!  I hadn’t worked in a clinic in 3years so I did some education and got my % Down to 35% or so.

    #183398 Reply
     Panscan 
    Participant
    Status: Resident
    Posts: 376
    Joined: 03/18/2017

    I think my average visit time is more like 8 minutes.  I typically document during that time so face to face time is about 5-6 minutes. Typical diagnoses are mainly URI, sinusitis, UTI, viral gastro, flu, and some chronic med refills. Each company I work with sets a goal of less than 40% visits without an oral antibiotic. Starting out I was surprised to see my % was more like 70%!  I hadn’t worked in a clinic in 3years so I did some education and got my % Down to 35% or so.

    Click to expand…

    So almost half the time the company is ok with you giving abx? That seems ludicrous to me. Do half the people with similar symptoms that go to ED end up with abx? That would seem high to me, and then we would assume telemed patients have a much lower probability of having an actual bacterial infection. Not to mention the ED can do labs and make sure nothing looks horrible to indicate something scarier.

    #183403 Reply
     Panscan 
    Participant
    Status: Resident
    Posts: 376
    Joined: 03/18/2017

    I dont know. You can actually usually get some exam and RR and HR and temp through telemed. And IMHO general appearancr and interaction is the most important objectively whether through telemed.or in.person. Recently asked out biller what our clinic gets for typical 99213 URI simple-type visit. Said dependes on insurer but typical is around $38. Makes $28-$30 look pretty good for telemed which is typically more focused with single chief complaint and less awkward to try to limit it to that vs “oh by the way doc” that we constantly deal with.
    I’m just a dozen or so patients in but most disappointed in the EHR interface. Appears most PMH etc is up to the patient and is often lacking/incomplete as I assume they have No guidance as they might have from an MA in real office.
    Would love any input you all have on how to maximize tax deductions and max saving strategies for this or my other 1099 income. I assume I can save 20% in self 401k and deduct reasonable business expenses. Anything else?

    Click to expand…

    How do you get HR and temp? Sure you could observe RR although I doubt that’s as easy as seeing someone in person.

    #183405 Reply
    LocumGuy LocumGuy 
    Participant
    Status: Physician
    Posts: 1
    Joined: 01/20/2019

    I am going to start doing telemed consults, I’ve got 5 state licenses. Any idea where I can find prescription “guidelines” and SOAP note templates?

    Thanks!

    #183399 Reply
     StarTrekDoc 
    Participant
    Status: Physician
    Posts: 1568
    Joined: 01/15/2017

    Time yourself next time you’re in the exam room for an outpatient encounter. You’ll probably be surprised. Time yourself also on the time it takes for you to cut off the patient on hpi.

    For a 99213, you should be done fairly quickly especially with templates in play. The reimbursement is in line of real life …cutting out the overhead.

    Most of these are typical diagnosis at the door stuff and you’ll quickly realize the need for more urgent care hands on, stethoscope on the chest exam requirement. If you miss the warning signs of a septic person on the video a decent few questions…you’re probably in the wrong line of work.

    #183423 Reply
    Liked by Zaphod, HikingDO

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