The most common telemedicine arrangement is referred to as a “hub-and-spoke” arrangement. This involves an originating site (usually a rural hospital) with patients in need of care and a distant site (usually a larger health system) employing or contracting with specialists who deliver care.
In some cases, a health system will have physicians on-call to respond to a telemedicine encounter. At first, this telemedicine on-call arrangement appears to be very similar to a typical call arrangement for an emergency department. However, utilizing per diems reported in benchmark surveys to determine a telemedicine FMV on-call rate is not exactly appropriate. It is important to remember that call coverage rates published in surveys like MGMA or Sullivan Cotter mostly represents emergency department call coverage. If you are using these survey on-call rates for telemedicine on-call arrangements, the data will likely need to be adjusted. Emergency department call coverage benchmarks are commensurate with the burden of responding in person to the emergency department to perform a consultation, surgery, or other procedure. In a telemedicine arrangement, the on-call physician can likely deliver the consult or examination at his home, office or over the telephone, which is much less burdensome than having to come into the emergency department. In this case, the per diem on-call rates published in the compensation surveys should be discounted to account for the diminished burden.