Can Doctors Earn More with Telemedicine in 2021?
The key marker of business success is measured by earnings after expenses. This return of investment (ROI) is a long-standing dispute amongst health policymakers, insurers and health technology lobbyists in many countries like the United States. Till date, there have been widespread acceptance and mass population demand for telemedicine coverage in their urban and rural communities. Healthcare professionals too have realised the ROI potential of investing the appropriate infrastructure (be it technology, licensing and upskilling) to maintain gainful income, and to ultimately cover up losses from pandemic lockdowns by making more money with a career in Telemedicine.
With the world advancing at an unprecedented pace due to the advancements in technology, it is hard to imagine life without the use of smart devices and computers. Above that, the recent global pandemic has forced people, even the elderly, to employ the use of these technologies. Nowadays, it is difficult to find a product or service that is not available at your fingertips – whether it is just groceries to be delivered at your doorsteps or professional physician consultancy.
What is Telemedicine?
Doctors consulting people over the phone is a service known as Telemedicine. Giving a diagnosis for an illness over the phone had seemed like an impractical idea even a few years ago. This is mainly due to the fact that the doctors cannot check for a pulse, read your heartbeat or measure your blood pressure without being in physical contact with you, the concept seemed to be impractical. While these limitations still persist in modern telemedicine, with people becoming more used to the concept of telecommunication using smart devices, they are opting for this option nowadays.
The doctors, consulting over the phone, can protect themselves from contagious diseases that they would have had to subject themselves to if they had consulted physically. Above that, they can have flexible work hours, save themselves the time and trouble of commuting and have all the benefits of working remotely. Given that physicians have a lot less opportunities for remote work when compared to professions like Software Engineering, the figures are worth opting for.
How much are Doctors Paid in Telemedicine?
Telemedicine platforms follow various payment models, differing from country to country. The classic model is Fee-for-Service whereby the provider is reimbursed per virtual services on a per patient agreement, this is a common model for smaller practices or from individual providers who may be running their own direct pay (cash-based) private practices which is now going virtual with their own telehealth service.
Larger institutions such as major hospital systems, have capitation contracts where their healthcare professional staff receive a capped remuneration salary on a monthly basis (irrespective of number or nature of telehealth visits) with a bonus if a certain quota is met.
Actual remuneration is usually paid by insurers and/or public funds as part of health sector budgets. Each telehealth practice in such examples are the implementation partners and therefore bill their services via appropriate medical billing.
To remain competitive and recuperate ongoing losses (from decreased elective, diagnostic, interventional procedures) many providers and practices usually have a hybrid payment model to accept direct pay, insurance claims and/or government grants to cover expenses – especially medical practice insurance plans, payroll, administrative costs, PR, marketing and rents.
When earning with telemedicine, the individual doctors are paid from anywhere between $15 to $100 an hour from popular telemedicine platforms. It all depends on whether the physician is working full-time, on the location of the physician (which state they are in and which patient originating site they are licensed to accept), their specialization and professional experience.
While the range does not give us a solid picture of how much a physician may expect to earn, depending on contractual agreements and tax structure, there are wide disparities in remuneration across states and across different countries. In the US, according to the Bureau of Labor Statistics, the average income of a physician is around 208,000 USD a year. On the other hand, the average income of a telemedicine consultant is around 192,000 USD annually, as of 2020.
Since the beginning of 2021, there are still issues with payment parity i.e. equal reimbursement in virtual care and in-person care amongst many providers.
Which Speciality Earns the Most with Telemedicine?
Due to the remote nature of virtual care, patient interactions that require mostly communication based management are the highest in demand and the most practical. For this reason Dermatologists, Mental Health specialists, ObGyn and most cases in Internal Medicine can managed remotely. Other practices such as Radiology, Physical Therapy and Orthopedics have great potential as adjunct follow up for a continuity of care package.
Actual earnings per visit however varies widely as mentioned before. A particular specialist may be of high demand but due to other factors, reimbursement may not be at par with usual Pre-Covid In-Person care. There are many reasons related to hesitancy of insurers and even some direct pay patients to value virtual visits to be of equal quality rather than a physical clinic visit.
In most countries, telemedicine providers have voiced dissatisfaction with payment schemes which are far below expected compared to the perceived value of distanced virtual care
It can be argued that high demand services from the patients’ side do not always correlate with the actual earnings given to the provider. Whether in fee for service or in hybrid capitation agreements. The mass adoption of telemedicine, via online healthcare apps or integrated care packages with many health systems, is a welcome digital transformation for many patient populations such as the elderly and chronic disease patients. The issue of poor provider reimbursement is a cause for concern in the context of sustainable healthcare innovation.
Is there a way for Telemedicine Providers to Earn a Sustainable Income in 2021?
7 Ways to Make More Money in Telemedicine
Increasing income in a competitive field (especially in healthcare) requires investment in value-based innovation in the business model and the actual high yield services to the appropriate customer. Doctors who are truly motivated to continue a high ROI career in Telemedicine may still be able to adapt their care practices and professional skills to accommodate different methods in adding value to their virtual patient experiences.
The following 7 practical tips will help guide Doctors to integrate unique proven methods in increasing their revenue streams while still being able to provide much needed clinical services to their communities.
1- Join Major Telemedicine Groups
Almost every health system has adopted some manner of telemedicine in their service model. The private sector has been leading the charge in healthtech innovation when it comes to quality audio video channels, cybersecurity standards, EHR platforms and patient engagement and follow up methods. Most major telemedicine platforms have partnerships with the public sector hospitals and are often eager to onboard many qualified specialists in their systems.
Such companies have various payment schemes related to full-time, contractual or even part-time arrangements, with certain hourly rates or virtual visit quotas. Most provide the necessary insurance coverage to provide the necessary protection from adverse patient experiences.
Provider reimbursements are usually on par with industry standards, and are fulfilled by their insurance providers.
2- Improve your Clinical Skills Coverage
Many providers have taken the initiative to upskill themselves to remain relevant and competitive in the job market. Integrated Functional Medicine is a unique certification course that may add value to many healthcare professionals. Some Insurance companies and Hospitals have shown interest in adequate reimbursement provided that such certification is present and relevant to the care provider’s skills.
In the US, state regulations on insurance coverage tightly controls who may avail regular healthcare services and as well as telemedicine services. Many payers insist on identifying the originating site of the online patient, to ascertain that the patient is approved for telemedicine reviews by their own online providers.
There is great variation in inter-state coverage approval which may pose a significant challenge to reaching a sustainable number of virtual visits, at the usual reimbursement rates. The IMLCC (Interstate Medical Licensing Compact) is a unique opportunity for US Doctors to enable them to expand their service coverage to neighbouring states or a wider network of participating state medical bodies.
In other countries, healthcare providers attain significant value by virtue of regular upgrades in recognised postgraduate training and credentialing in their respective skills. Many healthcare professionals are aware of the inherent value addition of acquiring more specialist degrees, to enhance their professional authority in a particular medical field.
Such activities are often a practical (although expensive) method in gradually being able to earn more income by either increasing their consultation fees or to bill for higher rates to thrid party payers.
3- Increase your Professional Fees
Service-based professionals often increase their fees commensurate with changes in market demands. In the free market setting, pricing strategies reflect the added customer demands for their unique services, or as a way to keep up with rising overhead costs (especially inflation).
Healthcare professionals remain hesistent to increase their consultation fees, possibly due to inherent fear of negative pushback from the patient community, medical insurance providers or as is often the case, industry ignorance on value-based pricing guidelines.
In most medical fields, there is an industry culture to not consider financial models in healthcare services, as most doctors are employed wholly or part-time by major medical institutions, who are responsible for their remuneration.
Private practice doctors reflect their fees based on the immediate vicinity of their community, and their ‘willingness-to-pay’ for direct pay cash-based models. In certain communities, price-sensitive stakeholders may not agree to any changes in fee structure due to their own perception of healthcare as a traditionally low-priced commodity versus other tangible consumer goods and services (eg. entertainment, housing, recreation).
Assuming that certain specialists may be of short supply in a community, reasonable price increases may initially be met with some patient customer pushback, as is normal in the free market economy, when a certain number of stakeholders who do agree to the new price, vouch for the added value in the new package, then a new cost price standard can be set.
Doctors employed in a major medical institution may not have the same degree of pricing flexibility due to complex contractual agreements, human resources policies or the mere absence of any viable professional body who may lobby for a salary increase. Often in such cases, specialists may have to search for employment in a different hospital in a another city or country.
4- Start your own Telemedicine Practice
The COVID-19 Pandemic was a true watershed moment for doctors to exercise their entrepreneurial mindset. When faced with the sudden realisation of impending financial ruin, due to furloughs from their hospital employers, lockdowns which will decrease their patient turnover from outpatient and elective procedures and the collapse of their usual assets (eg. rental properties); many doctors have taken the initiative to start their own online business, especially by converting their brick-and-mortar practice into a virtual telemedicine practice.
Many have experienced great demand for telemedicine from their communities, but were pleasantly surprised by the potential from diaspora communities from around the globe.
The nature of most telemedicine practices vary in quality and structure depending on the IT infrastructure of their patient communities, technical literacy, access to digital payments and existing communication portals in their networks. There are case studies of the most basic telemedicine platform to be nothing more than a WeChat/Whatsapp group, a Facebook Page, An e-commerce platform pivoting to video based communications or their websites retrofitted with a payment gateway (with Stripe or Paypal integration), a basic scheduling system leading to a Zoom meeting.
Besides the lean startup model example above, many bespoke software providers also provide customisable dashboard systems for patient tracking, data management, shift management and other add-ons to provide a more robust holistic model for larger care capacity.
Either processes require an initial investment in resources and time into acquiring the appropriate IT infrastructure, medical malpractice coverage, medical licensing, cybersecurity measures, tech support, negotiate new payment contracts, mobile app development, social media marketing, customer experience and ofcourse designing a scalable and competitive business model to cover the costs (corporate taxes, sales tax, insurance coverage, payroll, digital marketing and others).
Assuming that the practitioner or medical group is keen to take on the responsibility of the telemedicine development, this may be a suitable method to diversify practice revenue in certain settings.
5- Offer Remote Patient Monitoring (RPM) by Medical IoT devices
The main challenge of telemedicine is the inability for routine physical examination for first time patients. Healthcare entrepreneurs and medical device manufacturers have devised many innovative and integrated medical devices to assist virtual care providers to remotely check certain biomarkers in their patients, prior to or during a scheduled online session.
Medical IoT devices may help measure the patient’s cardiovascular, blood sugar, body weight changes, sleep habits, physical activity levels and even subjective cognitive measurements in a connected home health digital solution. Other health and wellness related remote patient monitoring measurements are currently in development and approval by medical device regulators.
Many virtual care practices have pre-approved RPM solutions under their remote care package for certain patients, such as chronic disease populations. Most patients are willing to utilise such IoT devices to manage their health and wellbeing remotely and under their own data control.
Practices that have the ability to provide approved at-home healthcare services, via approved RPM devices may be able to leverage increased revenue by direct selling to patients or by partnering with medical device manufacturers and medical insurance providers to leverage increased reimbursement, provided there are evidence-based protocols on their ability in healthcare cost containment, or at least to keep vulnerable patients away from crowded (potentially contagious) waiting rooms.
Such methods are a worthy model to improve practice revenue, provided that specific devices meet the necessary regulatory standards in patient safety and the patient population is willing to purchase or agree to the coverage plan.
6- Expanded Patient Coverage Networks
Much like traditional brick-and-mortar enterprises (eg. small local businesses), a point is reached where the catchment area for eligible patients becomes saturated, restricted or even decreased (due to lockdown initiated mass migration of urban populations to rural areas). Even if a steady flow of patients can be arranged via existing telehealth agreements or a reopening of most clinics, increasing overhead costs may make it difficult to keep financially solvent.
As differences in payment parities amongst some American insurers or insurance providers in other countries are still not reimbursing adequately to the providers, there is a risk of physicians opting out of telehealth practice if there is a low incentive structure.
In the US, there are challenges to extending medical coverage to citizens residing in other states, even with telemedicine. Certain states are negotiating with their immediate neighboring states to collaborate on shared coverage plans as part of exisiting telemedicine insurance coverage plans.
A relatively new state regulatory bill has been passed in the form of the Interstate Medical Licensure Compact (IMLCC) which will allow for expansion of existing agreements amongst participating states.
As of 2021, only 29 States are covered by eligible providers who qualify for the IMLCC. The stringent application process may dissuade certain physicians from applying and qualifying for the licensure. It is hoped that expanded coverage to all remaining states and greater collaboration from the federal bodies may allow for sustainable expansion into rural areas too.
In the European Union, most member states have a physician and patient compensation plan which allows for public fund reimbursement to allow for expanded coverage to EU citizens.
In health systems with less stringent regulations, there is great opportunity for expanded telemedicine coverage by virtue of utilising existing smartphone communication applications such as Whatsapp, IMO and extensive social media marketing. These forms of lean virtual practices have provided much needed virtual healthcare guidance to developing countries and vulnerable populations.
However, concerns were raised from false provider credentials, improper digital marketing content that may not communicate the practicalities of telemedicine (especially cross-border), low margin business models, poor provider reimbursements and perhaps the difficulties from not providing a sustainable value-based professional brand to maintain effective (and frequent followup) patient engagement.
7- Leverage Global Virtual Practice Platforms
A unique opportunity may arise with online marketplace models i.e. a digital secure platform which can connect users who are requesting specific tasks, to verified service providers who have the necessary skills. Ideally this ‘Amazon-like’ digital health platform would provide access to a vetted network of service providers to users who can assess the available provisions, fees, testimonials and consumer protection too.
The platform/marketplace main functions would be in lead generation, customer management, secure digital payment processing, buyer/seller insurance, quality control and various administrative tasks for smooth seamless virtual transactions.
Many such platforms exist in many healthcare systems, allowing qualified and appropriate providers to ‘display’ their credentials, availability and consultation fees. Patients may view the list of providers who are available for direct booking and consult online, via secured telecommunication platforms. Many online digital health marketplaces attempt to provide global access to patients from various countries using zoom with patient data being shared via email or whatsapp.
Due to the unregulated nature of such online activities there are widespread concerns about physician credibility, data privacy, online fraud and the overall business model which may be focused on price-sensitive out-of-pocket payers. As with most telemedicine platforms, an absence of a value-based pricing model does not allow for adequate physician reimbursement and a sustainable online business model.
Digital health platforms have great potential in expanding telemedicine coverage beyond just Tier 1 cities, but theoretically even to international markets – provided the doctors speak the same language.
Can Telemedicine Providers Earn Better on VIOS?
The above pointers highlight the basic fundamentals of a robust online business. They demonstrate the core concepts of a scalable digital business which is primarily centered around specialised services.
According to Dr Ismail Sayeed (Founder of ViOS, Inc.) – A global platform can be successful if the following activities can be made possible:
- Partnerships with established market players and products (there is no point in reinventing the wheel)
- Ensuring that appropriate high yield services are placed at the top of the value proposition i.e. what customers actually want and are willing to pay for.
- Value-based pricing to position the organisation as a premium authority in the market
- Be the industry expert in a field, so as to be the main gatekeeper in the value chain
- Offer unique value additions, which will justify the higher pricing strategy
- Enhanced coverage to the global market, with particular focus on markets and niche demographics with high purchasing power eg. affluent urban populations with brand value-based loyalty-centered consumer behaviours
- Leverage the influence of specialised professional networks and platforms, who can handle the nuances of seamless business processes eg. sales and marketing, bookkeeping, automated backend processes, cybersecurity, taxes social media management.
Here at ViOS, Inc, we aim to leverage the global patient community, especially expatriate and diaspora populations, to allow Telemedicine Providers to earn a sustainable remuneration for their high demand virtual care consultations, in our digital health co-op platform.
Through value-centered operations, the qualified healthcare professionals can effectively establish a zero-cost virtual presence in a global digital health platform, with clear guidelines of providing specialised services that our patient population desires.
Are you a medical specialist, looking to open your own virtual practice?
Apply today and earn a decent income while making an impactful presence in global digital health
Start your own Virtual Clinic