Can you work fully remotely in neurology?

[Neurogeneral]

If you don't mind, are you able to mention any details of your contract? I believe it important for others to know what they are receiving is fair or unfair. Thanks.

$1000 per 12 hr shift and then an additional $140 per every new consult. $90 per routine eeg read.

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[Captain_Falcon]

$1000 per 12 hr shift and then an additional $140 per every new consult. $90 per routine eeg read.

So what do you normally clear in a typicsl shift overall?

 

[Phantom Spike]

For those doing teleneurohospitalist work, may I ask how you bill your consults? Do you use the usual CPT codes? I ask because on another thread there was a comment that those who had been doing pure teleneurology were having a hard time getting subsequently credentialed at hospitals were they wanted to physically round, and I was wondering if it was because they could not produce traditional patient logs that were based on CPT codes. I asked there but did not get an answer.

 

[Postictal Raiden]

$1000 per 12 hr shift and then an additional $140 per every new consult. $90 per routine eeg read.

That’s an extremely good pay compared to mine (in-person NH)

I make about 2k a shift (24 hours but don’t have a set time to come to/leave the hospital).
I see about 8 consults daily (including acute stroke codes) and another 8 follow ups. Read about 2 routine EEGs.
I get a handful of calls from the ED when I’m at home

If I were paid same rate as yours, I’d probably make 550k working week on week off

 

[Neurogeneral]

I have been told approximately 10-13 new consults for 12 hour shift. So that’s approximately $2600 per shift plus $ for eeg reads.

Now, this is just me purely estimating based on the information they have been given me….I will see when I actually start working there what type of compensation I actually bring home.

And I have been told we bill using CPT codes for tele-neurohospitalist work. I am not sure if they do this for purely tele-stroke though.

 

[Postictal Raiden]

I have been told approximately 10-13 new consults for 12 hour shift. So that’s approximately $2600 per shift plus $ for eeg reads.

Now, this is just me purely estimating based on the information they have been given me….I will see when I actually start working there what type of compensation I actually bring home.

And I have been told we bill using CPT codes for tele-neurohospitalist work. I am not sure if they do this for purely tele-stroke though.

Does this job provide any benefits (401k contribution, health/dental/vision insurance, life insurance, malpractice, tail, CME money)?

 

[Telamir]

Unlikely.

 

[deathmerchant]

$1000 per 12 hr shift and then an additional $140 per every new consult. $90 per routine eeg read.

I have been told approximately 10-13 new consults for 12 hour shift. So that’s approximately $2600 per shift plus $ for eeg reads.

Now, this is just me purely estimating based on the information they have been given me….I will see when I actually start working there what type of compensation I actually bring home.

And I have been told we bill using CPT codes for tele-neurohospitalist work. I am not sure if they do this for purely tele-stroke though.

That sounds like a good gig. Is it a smaller company because the rates seem to be quite good. $2600 for 10-13 patients comes to be about $200-$260 per consult! One of the offers I had was $1000 per shift plus $140 per consult after the first 7 consults. So 13 consults would be more like $1800. Another company offered $100/hr plus 25per RVU. Sometimes night shifts pay more.

 

[Neurogeneral]

That sounds like a good gig. Is it a smaller company because the rates seem to be quite good. $2600 for 10-13 patients comes to be about $200-$260 per consult! One of the offers I had was $1000 per shift plus $140 per consult after the first 7 consults. So 13 consults would be more like $1800. Another company offered $100/hr plus 25per RVU. Sometimes night shifts pay more.

The thing to keep in mind is that figure ($2600) would include seeing all the follow ups as well. It’s a 7 am to 7 pm schedule.

It’s a medium sized telemed company. And no offered benefits to me as of now but that could change if I become full time.

 

[xenotype]

That sounds like a good gig. Is it a smaller company because the rates seem to be quite good. $2600 for 10-13 patients comes to be about $200-$260 per consult! One of the offers I had was $1000 per shift plus $140 per consult after the first 7 consults. So 13 consults would be more like $1800. Another company offered $100/hr plus 25per RVU. Sometimes night shifts pay more.

He got a really good offer. 1800-2000 per shift is going to be typical of competitive offers from big companies, and some bad offers will be lower (1200-1500 per shift).

 

[Phantom Spike]

Based on what I am told/have heard it is not necessarily common at all, but based on common sense the risk is high. I've been quoted somewhere between 1 in 3 to 1 in 6 odds of a lawsuit over a 5 to 10 year period, which is higher than the average 1 in 6 lifetime rate for most neurologists.

As for non-competes this is highly state dependent. One should never assume the non-compete will not be enforceable when signing an agreement, especially without speaking to an attorney knowledgeable in physician contract law in their state.

I wonder if that's also true of locums, which has sort of the same setup. With any shift-based practice, such as locums or teleneurology/telestroke, or even outpatient locums, if you see a patient once and the patient ends up with a complication or bad outcome when someone else has taken over the service, you might end up named in the lawsuit although your care might not have been a factor.

 

[Neurogeneral]

Speaking to more teleneurologists recently, I have learned that it is apparently true that the liability risks are higher. It is not uncommon to be named in multiple lawsuits after several years of doing this. It’s a reflection of the higher risk of acute stroke, poorer quality of the contracting hospitals and referring physicians, inability to follow the patients, being force fed multiple acute consults at once from multiple different hospitals, and the fact that you can’t be there on the ground.

Especially if you are not someone very strong or seasoned in acute stroke, you gotta be very careful and discerning about which company you sign on with and make sure they are not pushing unsafe levels of volume on you.

 

[Phantom Spike]

Is it feasible to live outside the US and do remote teleneurology work? From what I hear most companies do not allow it. But legally, is it possible? As long as the physician is licensed in the state that the patient is located in, that should be fine, shouldn't it?

EDIT: Okay, going back to the first few pages on this thread it looks like it can be done. No company I have spoken to has said they allow it, though. Does anyone have any further information on where such jobs can be found? And I wonder if it adds to your liability. You would need to maintaon a US practice address, I imagine.

 

[ProReduction]

Is it feasible to live outside the US and do remote teleneurology work? From what I hear most companies do not allow it. But legally, is it possible? As long as the physician is licensed in the state that the patient is located in, that should be fine, shouldn't it?

EDIT: Okay, going back to the first few pages on this thread it looks like it can be done. No company I have spoken to has said they allow it, though. Does anyone have any further information on where such jobs can be found? And I wonder if it adds to your liability. You would need to maintaon a US practice address, I imagine.

It is Medicare fraud to bill for any Telehealth service performed off U.S. soil. So if you are outside the U.S., it is cash only or you are complicit in a crime. The minute this changes, every Tele company can outsource physician services to India or anywhere else they desire

 

[Phantom Spike]

It is Medicare fraud to bill for any Telehealth service performed off U.S. soil. So if you are outside the U.S., it is cash only or you are complicit in a crime. The minute this changes, every Tele company can outsource physician services to India or anywhere else they desire

But physicians would still need to be American board-certified and hold licenses in the states that the patients are located in, so would it be that easy for the teleneurology companies to outsource?

Also if I understand correctly, the teleneurology companies bill the hospitals and not the insurance companies, so perhaps the insurance-mandated (and Medicare-mandated) prohibitions do not apply? I am not sure if the hospitals then bill Medicare/commercial insurances or are willing to just pay for the service without reimbursement to keep the patient in-house.

 

[ProReduction]

But physicians would still need to be American board-certified and hold licenses in the states that the patients are located in, so would it be that easy for the teleneurology companies to outsource?

Also if I understand correctly, the teleneurology companies bill the hospitals and not the insurance companies, so perhaps the insurance-mandated (and Medicare-mandated) prohibitions do not apply? I am not sure if the hospitals then bill Medicare/commercial insurances or are willing to just pay for the service without reimbursement to keep the patient in-house.

This is how it plays out. Doctor X is an independent contractor TeleNeuro with HyperCorporateTeleNeuro (HCTN). HCTN provides services for Rural Hospital Center (RHC). RHC submits claims to Medicare based on encounters provided by Doctor X through HCTN to RHC, then pays HCTN in cash, then HCTN pays Doctor X in cash. HCTN has a default line built into their note template that is automatically checked and reads something like "I, Doctor X, was within the United States when completing this Emergency TeleNeurology consultation". It is January and doctor X signs up for a March shift. March is approaching, and Doctor X wants to go to Mexico for the week, but has his Tele shift. Doctor X sees patients from his hotel in Mexico via their Wifi and either forgets to uncheck the box stating he is in the U.S., that RHC needs checked in order to submit Medicare claims, or worse leaves it checked knowing that nobody is auditing these things in any meaningful way. Either way, RHC submits a fraudulent claim.

So yes, Doctor X and HCTN are not submitting the claim directly to Medicare, but RHC is. You can't tell me that is not fraud on Doctor X and HCTN part.

 

[Phantom Spike]

RHC submits claims to Medicare based on encounters provided by Doctor X through HCTN to RHC, then pays HCTN in cash, then HCTN pays Doctor X in cash. HCTN has a default line built into their note template that is automatically checked and reads something like "I, Doctor X, was within the United States when completing this Emergency TeleNeurology consultation".

Does this step happen? I'm not saying it does not, but I have worked locums jobs where the client hospitals wanted me to do neurology consults but didn't bother to bill for my services; to them it was more important to be able to keep the patient in-house and bill for the admission, imaging and lab work and not have to transfer the patient to another facility for "neurology evaluation". I wonder if something like that happens with teleneurology, at least on the acute/inpatient side. Again, I don't know, but I had the impression this might be the case and if others (especially those who earlier suggested that some companies did allow teleneurology work from abroad) could chime in, that might help clear it up.

 

[Neurogeneral]

You can’t bill telemedicine services for Medicare/Medicaid patients while being physically present outside of the USA. Having said that, there are a couple of companies that are okay with their teleneurologists doing the job from overseas. Most are not okay with this however.

 

[Phantom Spike]

So would it be safe to perform teleneurology outside the US for one of the companies that allow it, presuming that they are not billing Medicare/Medicaid patients or have taken some other steps to prevent insurance fraud? Or is it simply not worth it? Are there reputable companies that allow it?

 

[Neurogeneral]

When I interviewed with Telespecialists a couple of years back, they touted to me that one of their neurologists does his/her shifts while on a boat in Europe. I was told by a neurologist who worked there that Medicare/Medicaid were not being billed for patient encounters and the hospital just ate the cost of the consult. I don’t know if this is still the case though….

 

[ProReduction]

When I interviewed with Telespecialists a couple of years back, they touted to me that one of their neurologists does his/her shifts while on a boat in Europe. I was told by a neurologist who worked there that Medicare/Medicaid were not being billed for patient encounters and the hospital just ate the cost of the consult. I don’t know if this is still the case though….

There is no way that this is still the case. I've worked with three different TeleNeuro companies, and all redesigned their notes over the last two years to make them insurance billing friendly for their "clients" (the local hospitals). TeleNeuro is hypercompetitive and oversaturated with companies, so any company that is costing the local hospital any money in lost opportunity to bill for services will see their contract given to another company that is billing friendly.

Yes, 6 years ago Tele was more like you describe, when everything was cash to Tele company, cash to TeleNeurologist and you could take call from a boat in Europe. Nothing good in medicine lasts more than 5 years. Ever.

 

[Phantom Spike]

There is no way that this is still the case. I've worked with three different TeleNeuro companies, and all redesigned their notes over the last two years to make them insurance billing friendly for their "clients" (the local hospitals). TeleNeuro is hypercompetitive and oversaturated with companies, so any company that is costing the local hospital any money in lost opportunity to bill for services will see their contract given to another company that is billing friendly.

Yes, 6 years ago Tele was more like you describe, when everything was cash to Tele company, cash to TeleNeurologist and you could take call from a boat in Europe. Nothing good in medicine lasts more than 5 years. Ever.

This is very disappointing.

 

[Aldertonghen]

This is very disappointing.

Probably best to do locums for 4 months then spend the other 8 months on a boat in Europe.

 

[Telamir]

I wish I made as much as you think I do in 4 months.

 

[Giovanotto]

Bummer, was hoping to eventually move back to my home country and work tele.

 

[Postictal Raiden]

Probably best to do locums for 4 months then spend the other 8 months on a boat in Europe.

I actually know someone who does that.
4 months of locum work is about 250-300k.
This income goes long way in many other countries

 

[Phantom Spike]

I actually know someone who does that.
4 months of locum work is about 250-300k.
This income goes long way in many other countries

Do they have a home base/office in the US?
I suppose you could also do teleneurology when you're in the US for a few months. But it would require some kind of US support system.

 

[Telamir]

If by 4 months you mean 16 weeks of work then yeah maybe. If you wanna work them in a row and get demolished I guess that’s possible. You also need a job that pays pretty well, and have very little if any cost/expenses. I worked 21 weeks this year and with travel etc I feel like that was at the upper limit of my sanity.

Then again, I like my house, my things, and my dog so if I didn’t have a permanent home and no pet it’d be easy to just dive into locums and work a ton.

 

[Postictal Raiden]

Do they have a home base/office in the US?
I suppose you could also do teleneurology when you're in the US for a few months. But it would require some kind of US support system.

This person was originally living in the US and working full time here but decided to relocate overseas. They still have their house in the US.

 

[Phantom Spike]

If by 4 months you mean 16 weeks of work then yeah maybe. If you wanna work them in a row and get demolished I guess that’s possible. You also need a job that pays pretty well, and have very little if any cost/expenses. I worked 21 weeks this year and with travel etc I feel like that was at the upper limit of my sanity.

Then again, I like my house, my things, and my dog so if I didn’t have a permanent home and no pet it’d be easy to just dive into locums and work a ton.

I suppose one could stay at an Extended Stay or short-term housing of some kind for those 3-4 continuous months that you do locums/teleneurology in the US, but that sounds dreadful.

 

[MC47]

$1000 per 12 hr shift and then an additional $140 per every new consult. $90 per routine eeg read.

Do you mind share what company you utilized?

 

[deleted1154289]

I`m currently in my vascular neuro fellowship and have interviewed with several Tele companies in the last month. Just out of curiosity is there anyone here who currently works for or has worked with Blue sky or AccessTele (SOC) in the past? Would really appreciate any info if possible.

 

[Giovanotto]

Recently interviewed with a telestroke company. These are the going average rates/volume for a full time employed position (15 shifts/month, where 5/15 are "overnight", 12 hr shifts):
250K base salary (0-11 patients)/ 180 total shifts a year, 1389 dollars per shift
+ productivity of 475 dollars if youre seeing 13-15 patients/shift.

So about 1850/shift assuming youre seeing 13 patients per shift

Total is 333k per year.

 

[Itsarainbow]

Recently interviewed with a telestroke company. These are the going average rates/volume for a full time employed position (15 shifts/month, where 5/15 are "overnight", 12 hr shifts):
250K base salary (0-11 patients)/ 180 total shifts a year, 1389 dollars per shift
+ productivity of 475 dollars if youre seeing 13-15 patients/shift.

So about 1850/shift assuming youre seeing 13 patients per shift

Total is 333k per year.

That's about $155/hr. There are CRNA at my hospital making $200/hr. This shouldn't be the case.

 

[Neurogeneral]

That's about $155/hr. There are CRNA at my hospital making $200/hr. This shouldn't be the case.

Teleneurology doesn’t pay all that well in many cases. I work part time teleneurohospitalist making a flat rate of $175/hr for 8 am to 5 pm shifts. There are of course, some small bonuses for seeing a lot of patients but they don’t really move the needle in terms of total compensation. Even if you work full time at some of these companies, benefits may not be subsidized btw.

 

[Postictal Raiden]

That's about $155/hr. There are CRNA at my hospital making $200/hr. This shouldn't be the case.

333k for this work load is not bad. Are they going to provide benefits (health insurance, 401k, etc)?

 

[ProReduction]

Recently interviewed with a telestroke company. These are the going average rates/volume for a full time employed position (15 shifts/month, where 5/15 are "overnight", 12 hr shifts):
250K base salary (0-11 patients)/ 180 total shifts a year, 1389 dollars per shift
+ productivity of 475 dollars if youre seeing 13-15 patients/shift.

So about 1850/shift assuming youre seeing 13 patients per shift

Total is 333k per year.

This is really unfortunate to see. This is about $154/hour and < $143/patient. This is akin to 2016 TeleNeuro pay.

In 2020-2021 demand for TeleNeuro surged. Tele companies overpromised and underdelivered like Elon Musk. Every company was understaffed. "STAT' cases were not being seen in < 5 minutes as every company promised. More than 1 of the large national TeleNeuro companies started offering $350 or more per STAT case seen by physicians that were not scheduled to work that day, usually called "overflow" or "back-up" consults. Things were looking really good for TeleNeurologists.

Then a flood of right-out-of-residency and fellowship Neuro grads were hired by all the companies, including a huge number of DOs. One company hired 20 new grads. This swung the momentum right back to corporate TeleNeuro. Those $350 consults are gone.

I am not blaming new grads for choosing a Tele-only career right out of training if it is best for their "career". However, nobody from my generation ever considered a Tele-only career right out of training. Nobody. We all used it as a supplement in addition to our in-person day jobs. This gave us immense leverage because none of us were employed by the Tele companies and whenever they would threaten us with "fill this open weekend/holiday shift or else" we would simply say "or else what?". If the pay was not in-line then shifts would go unfilled.

 

[Hockeyfan23]

How much are you non tele neurologists actually making? Not sure why there’s a bunch of negative discussion on tele salaries. I see higher volume than many I’m sure but don’t feel over worked or burnt out at all. I work half the month and am on par to make around $500k this year. I work for one of the bigger companies and there are plenty of $350 overflow calls all day every day. I just took two myself today. Making $700 in a little over an hour of work isn’t bad at all. I make a lot more than most of my fellowship trained residency friends. Just curious to hear others paths.

 

[ProReduction]

How much are you non tele neurologists actually making? Not sure why there’s a bunch of negative discussion on tele salaries. I see higher volume than many I’m sure but don’t feel over worked or burnt out at all. I work half the month and am on par to make around $500k this year. I work for one of the bigger companies and there are plenty of $350 overflow calls all day every day. I just took two myself today. Making $700 in a little over an hour of work isn’t bad at all. I make a lot more than most of my fellowship trained residency friends. Just curious to hear others paths.

You are being compensated as you should in-line with the demand for our services starting in 2020-2021. However, it seems that trend is reversing as new grads are being low-balled with new Tele offers. You also have to know that if your company can find a new fellowship grad to do the exact same job that you do for 350k instead of 500k, that is the direction they will go. New grads are understandably money hungry + have no business acumen. The outcome is they will take jobs for less than their worth and it drags all of us down in worth along with them.

 

[Neurogeneral]

Tele-neuro used to be an exclusively acute (stroke) service. Over the past couple of years, companies also started offering non-acute rounding consults/follow ups. With the panademic over, I heard that the routine (non-acute) teleneuro consults can no longer be billed to insurance/medicare/medicaid. Hospitals are now instead having to pay out of pocket for these consults. The contracting hospitals are now paying the minimum they can to get these consults seen. So that could be reflected in the lower compensation being offered in many (but not all cases).

I was talking to a neurologist who used to work for SOC who said that before they merged with Access Physicians to become Access Telecare, it was the golden period for compensation. Many of the stroke neurologists were raking in high six figures with benefits. After the merger, though, things changed drastically and there was an exodus of most of the senior teleneurologists and then a hiring spree of likely mostly fresh grads.

 

[Giovanotto]

333k for this work load is not bad. Are they going to provide benefits (health insurance, 401k, etc)?

yes. 4% match as well. And without a fellowship. Offers for in person are much better, but not everyone wants to live in "fly over" states. I'm struggling with this decision myself right now. All the neurologists in my area are boomer docs protecting their turf with dear life. Some have >1 fellowship.

 

[WhereMyLiberalsAt]

Then a flood of right-out-of-residency and fellowship Neuro grads were hired by all the companies, including a huge number of DOs.

 

[Hockeyfan23]

I finished residency in 2021 so I guess I’m technically a “newer” grad. At my company regardless of age or timing of residency completion, the contracts are the same. If you wanna work hard and see more patients you will earn more. Simple as that. I’m still waiting to hear from all these non-tele neurologists making much more money…

In regards to the billing that is also not exactly true. I feel we have actually increased the amount of hospitals we are billing for in the EMR compared to when I first started.

 

[Neurogeneral]

I finished residency in 2021 so I guess I’m technically a “newer” grad. At my company regardless of age or timing of residency completion, the contracts are the same. If you wanna work hard and see more patients you will earn more. Simple as that. I’m still waiting to hear from all these non-tele neurologists making much more money…

In regards to the billing that is also not exactly true. I feel we have actually increased the amount of hospitals we are billing for in the EMR compared to when I first started.

I am talking about the teleneurology group i work part time for. I asked about billing and was told that the non-acute consults are no longer billable and instead the hospitals just pay our company by the number of hours of typical work required to see all the consults (based on stats/average number of consults seen daily).

 

[ProReduction]

View attachment 378517

Derrrrrt deeeeee derrrrrrrrr!!!

 

[Itsarainbow]

I finished residency in 2021 so I guess I’m technically a “newer” grad. At my company regardless of age or timing of residency completion, the contracts are the same. If you wanna work hard and see more patients you will earn more. Simple as that. I’m still waiting to hear from all these non-tele neurologists making much more money…

In regards to the billing that is also not exactly true. I feel we have actually increased the amount of hospitals we are billing for in the EMR compared to when I first started.

What does your compensation look like?

 

[Hockeyfan23]

Please see prior posts above.

 

[Sidus1011]

Then a flood of right-out-of-residency and fellowship Neuro grads were hired by all the companies, including a huge number of DOs. One company hired 20 new grads. This swung the momentum right back to corporate TeleNeuro. Those $350 consults are gone.

The disdain for DOs is funny considering every recent grad now probably had to have completed their residency post-merger at an ACGME accredited site, whether that be MD or DO. Any flux in the market is more likely due to an increase in tele's exposure online.

 

[Giovanotto]

The disdain for DOs is funny considering every recent grad now probably had to have completed their residency post-merger at an ACGME accredited site, whether that be MD or DO. Any flux in the market is more likely due to an increase in tele's exposure online.

Yeah just ignore those troll comments. Some people find ways to feel better about themselves at the expense of others, nothing you can do about it. I'm much more interested in unity, and collective bargaining power instead of infighting, but hey, people continue to fall for political baits about immigrants and disenfranchised every single election so it really should not come as a surprise.

 

[ProReduction]

Yeah just ignore those troll comments. Some people find ways to feel better about themselves at the expense of others, nothing you can do about it. I'm much more interested in unity, and collective bargaining power instead of infighting, but hey, people continue to fall for political baits about immigrants and disenfranchised every single election so it really should not come as a surprise.

Everyone please relax. Nothing said was anti-DO. For those of us in Tele since the beginning, there simply were not many DOs in TeleNeuro. Maybe being a Doc-In-A-Box did not appeal to them. Maybe they gravitated to fellowships in fields other than Stroke/NCC. Who knows. The point was simply made that there is now a wave of DOs seeking to enter TeleNeuro right out of training. Whenever you have a larger growth in supply relative to demand (physicians:TeleNeuro jobs) then salaries will take a hit. That was the only point.