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    DIY Telemedicine


    Select a business model

    Physicians have a choice as to how they want to practice telemedicine: They can integrate it into their existing practice or they can partner with companies that offer such services.

    Those who decide to integrate telemedicine into their existing practices to treat their own patients will have to select and then implement the technology, policies, and processes to make it work for them, Tennant says.

    Although that’s the route many physicians take, practices can work with companies that provide all the infrastructure to enable video visits, Sharp says. 

    “The company either takes a larger portion of the reimbursement or requires a monthly fee or something like that. But the advantage is they provide everything out of the box for you. And they [tailor the site’s branding], so you put your own practice logo on it,” Sharp explains.

    Health IT experts say these services allow physicians to treat both their own practice’s patients and possibly non-practice patients who seek services through the company’s own network. 

    Goel says he sees companies structure their payments based simply on per-patient visits. The prices under this model range from $50 to $100; companies may charge a technical fee on top of this. Goel says practices can establish a fee schedule to charge patients higher amounts, to ensure they make a profit, but he notes reimbursement models don’t support such pricing. As a result, such telemedicine services are used primarily in concierge practices. 

    Thomas says practices should:

    • Evaluate the company’s reputation as well as its business and/or clinical model.
    • Consider the platform’s ease of use, set up and training/education for the platform; software features such as security, e-prescribing, billing, mobile app capabilities, EHR integration.
    • Weigh the costs associated with it, including marketing, training, technical assistance, maintenance, professional licensure or malpractice fees against the expected income derived from it.

    Similar to advice usually offered for other new business arrangements, health IT experts say, physicians should ask if a company will allow the practice to pilot a program before signing a long-term contract.


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    Determine objectives

    Practices need to know why they want to offer telemedicine services and articulate how and where they want this to work within their practice, Waldren says.

    “Are you going to use it for off-hour calls? To offload some regular visits? To make it convenient for patients?” he asks.

    Determining these objectives helps practices make smarter decisions when it comes to choosing the technology and building the policies and procedures for telemedicine, he says. For instance, a practice that wants to use telemedicine to connect patients with their own physicians might require just a secure video connection.

    On the other hand, a practice using telemedicine to treat patients with chronic conditions might want a more robust system with functions such as dashboards for managing patient data that the entire care team can use.


    Review regulations

    Regulatory requirements for telemedicine vary from state to state, according to Waldren. For example, some states require physicians to have an existing relationship with patients they treat via video visits, while others don’t. Meanwhile, some states require parity between telemedicine and equivalent face-to-face visits to ensure the medical services physicians offer virtually mirror the quality they offer in person.

    Similarly, physicians should review their malpractice policies to ensure their coverage extends to telemedicine services. Telemedicine service coverage can vary from payer to payer and from state to state.

    The Center for Connected Health Policy offers resources to help physicians sort through rules and regulations as well as the state-by-state variances among them. (Find them at
    bit.ly/CCHPCA-policies.) There are also state and regional telemedicine groups that offer guidance on such issues. 

    Similarly, practices need to work with payers to ensure they use the right codes for reimbursement, as billing codes for telemedicine can vary depending on the services and insurer and may be different than the codes used for the same services when performed during an in-office visit, Thomas says.

    Next: Learn tech requirements


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