Telemedicine a possibility for an IM hospitalist?

[Meerkatology]

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i'm wondering if anyone is currently employed as one or has looked into this.

i'm looking to live overseas for a few years due to family reasons and looking to see if this is a
possibility for an IM hospitalist, more specifically a nocturnist.

 

[chessknt]

i'm wondering if anyone is currently employed as one or has looked into this.

i'm looking to live overseas for a few years due to family reasons and looking to see if this is a
possibility for an IM hospitalist, more specifically a nocturnist.

It is definitely possible however usually not if you live overseas. Usually you cover multiple states with this type of work and variety exists there--some states disallow remote care if the physician is not located in the USA or has to be licensed in the location they are providing care from.

 

[gutonc]

i'm wondering if anyone is currently employed as one or has looked into this.

i'm looking to live overseas for a few years due to family reasons and looking to see if this is a
possibility for an IM hospitalist, more specifically a nocturnist.

I can't vouch for the veracity of the information in this link, but it seems reasonable.

Bottom line is that Medicare won't cover you, Medicaid might (state dependent), commercial insurance might (carrier dependent) and states may or may not let you.

 

[Splenda88]

You might also consider a PT job that is 1 week on and 3 weeks off.

 

[WIFEL585]

As someone who strongly dislikes the 7 on/7 off model and at this point in my career searches exclusively for PRN, per-diem, locums, telemedicine, freelancing type stuff etc, I tried looking for telemedicine jobs for 3+ months and came up empty handed. Not impossible but expect to spend a huge amount of time searching. It helped doing some telehospitalist stuff during training also but ultimately these remote jobs are much, much harder to find.

If you somehow were to find one, you’d also need to spend a significant amount of time (I’d imagine 3-6 months at least) dealing with the extensive multi-state licensing requirements and credentialing for virtual medicine.

 

[Meerkatology]

based on the replies it seems a pure telemedicine job from abroad is probably rather slim chanced.
perhaps locums work is more suitable for my situation 🙁

 

[Nocturnist]

based on the replies it seems a pure telemedicine job from abroad is probably rather slim chanced.
perhaps locums work is more suitable for my situation 🙁

Both hospitals I work at utilize telemedicine for remote cross coverage. Some of my colleagues do the minimum inpatient shifts required for them to be credentialed and make up the bulk of their salaries from remote work.

That said, I was once on vacation in a different state when a few shifts became available and made the mistake of casually asking the scheduler if they can forward my pages to my cell because I didn't bring it on vacation...and she promptly informed me I cant do remote work out of state.

Why do they care if i'm just across state line? I dont know. But I can't imagine being out the country would be kosher.

 

[AlbinoHawk DO]

i'm wondering if anyone is currently employed as one or has looked into this.

i'm looking to live overseas for a few years due to family reasons and looking to see if this is a
possibility for an IM hospitalist, more specifically a nocturnist.

You'll have a hard time because if you're overseas, many insurance companies, including Medicaid may not pay you

 

[MD46]

You'll have a hard time because if you're overseas, many insurance companies, including Medicaid may not pay you

can you use a VPN?

 

[gutonc]

can you use a VPN?

If you wanted to commit Medicare fraud, yes.

 

[Nocturnist]

If you wanted to commit Medicare fraud, yes.

This is only relevant if youre actually billing, I would assume? Because I've never in a decade had to nor been asked to bill for any cross coverage (remote or in house). I know home hospitalist programs are up and coming and maybe folks who do them can comment- obviously you're billing an H&P when you do the face to face admission but can you bill for a progress note/subsequent visit when you round on them remotely?

Does anyone know if there any actual law or regulation stating that a provider must be in the same state or even country as their patient? They must be credentialed in the state the patient is receiving the services in, sure- but if credentialed and never billing, why would they care where I'm physically located? I dont recall ever even seeing it in a bylaw and no Google search has revelead an answer.

I haven't given up on my retirement plan of cross covering remotely from a beach in Hawaii yet...

 

[gutonc]

This is only relevant if youre actually billing, I would assume? Because I've never in a decade had to nor been asked to bill for any cross coverage (remote or in house). I know home hospitalist programs are up and coming and maybe folks who do them can comment- obviously you're billing an H&P when you do the face to face admission but can you bill for a progress note/subsequent visit when you round on them remotely?

Does anyone know if there any actual law or regulation stating that a provider must be in the same state or even country as their patient? They must be credentialed in the state the patient is receiving the services in, sure- but if credentialed and never billing, why would they care where I'm physically located? I dont recall ever even seeing it in a bylaw and no Google search has revelead an answer.

I haven't given up on my retirement plan of cross covering remotely from a beach in Hawaii yet...

How do you think people get paid for this?

The law about licensing is correct. The rest of it is mostly policy. However, CMS is kind of a stickler for this and there are some insurance companies that won't pay for care from outside the US either (it's definitely in the small print). There are also some states where even telemed requires presence of the physician in the same state.

Seems stupid, but that's what happens when you let lawyers practice medicine.

 

[Nocturnist]

How do you think people get paid for this?

The law about licensing is correct. The rest of it is mostly policy. However, CMS is kind of a stickler for this and there are some insurance companies that won't pay for care from outside the US either (it's definitely in the small print). There are also some states where even telemed requires presence of the physician in the same state.

Seems stupid, but that's what happens when you let lawyers practice medicine.

How do I think people get paid for what? Cross coverage, or home hospitalist?

Me getting paid for my shift is the hospital's business, hospital getting reimbursed is theirs. Cross coverage is a non productive shift, but somebody's got to do it and you hope the in house admitters make up for it by being more productive. For home hospitalist, I literally don't know the rules surrounding billing and reimbursement if I've never touched the patient.

 

[gutonc]

How do I think people get paid for what? Cross coverage, or home hospitalist?

Me getting paid for my shift is the hospital's business, hospital getting reimbursed is theirs. Cross coverage is a non productive shift, but somebody's got to do it and you hope the in house admitters make up for it by being more productive. For home hospitalist, I literally don't know the rules surrounding billing and reimbursement if I've never touched the patient.

Why would they pay you to do overnight cross-coverage from Tahiti when they can pay an NP 1/3 of that to actually be in the hospital.

 

[DrMetal]

when they can pay an NP 1/3 of that to actually be in the hospital.

Shhh! Bite your tongue, keep that on the down-low. We're already steam-rolling towards that model.

 

[HemeOncHopeful19]

I've seen tele-ID consults and tele-Neurology consults

I was not impressed