While telehealth has been in place for decades, many providers have especially turned to it during the COVID-19 pandemic as a way to replace face-to-face visits to ensure access to healthcare, treat non-COVID-19 patients, and help maintain cash flow. Many speculate that though sparked by the pandemic, telehealth will become the wave of the future and will remain in high demand even after the COVID-19 threat subsides.
In response to the outbreak, Congress temporarily lifted restrictions that previously limited Medicare reimbursement coverage of telehealth services to rural beneficiaries presenting at a healthcare facility. Now, under rules promulgated by the Centers for Medicare & Medicaid Services (CMS), Medicare covers telehealth services without regard to geography or patient location. Also, CMS has expanded coverage for communication technology-based services, including certain telephone-only services. With these announcements, the Trump Administration urged state and commercial payers to follow suit.
Recognizing the intense demand for telehealth services and the fact that more payers are reimbursing for such services, how are health systems meeting this demand and compensating their providers? As with any payment to providers, a variety of facts and circumstances that may materially affect compensation requires keen attention to the total compensation paid to the individual, the specialty of a provider, the types of services it provides, and any other relevant factors.
Telehealth Historical Compensation
Prior to the pandemic, only 52% of providers who furnished telephonic call coverage[1] (i.e., physician consults via telephone) received compensation for those services, according to the SullivanCotter 2018 Physician On-Call and Telemedicine Compensation Survey Report (SullivanCotter Compensation for telephonic call coverage services included the following: an hourly rate for time spent consulting (40% of reported physicians), a flat rate per consult (30% of reported physicians), 100% of a specialty’s unrestricted call rate (20% of reported physicians), or a percentage of the specialty’s unrestricted call rate (20% of reported physicians).[2]
By contrast, 100% of physicians providing telemedicine call coverage[3] (i.e., physician consults via audio and video) were compensated for those services. Similar to telephonic compensation, physicians providing telehealth services were compensated in one of the following ways: flat rate per consult (38% of reported physicians), hourly rate for time spent consulting (31% of reported physicians), 100% of specialty’s unrestricted call rate (23% of reported physicians), percentage of specialty’s unrestricted call rate (23% of reported physicians), or payment based on work relative value units (wRVU) (15% of reported physicians).[4]
Telehealth Industry Data
Today’s prevalence of telehealth warrants consideration of various compensation methods to help best meet an organization’s immediate and possible future needs. To help guide such decisions, PYA has summarized several methods (not all-inclusive) and presents the following industry data examples for consideration.
A health system might consider these compensation methods in recruiting independent physicians to provide telehealth services or, in certain circumstances, to supplement an employed physician’s current compensation formula in times of need. Regarding the latter, organizations should carefully consider any additional payment, especially if telehealth services replace a face-to-face visit for which a physician’s compensation model already contemplates through a productivity component or otherwise.
Hourly Rate for Time Spent Consulting
Depending on items such as the clinical need required (i.e., acute versus chronic) and the duration of the service provided (i.e., one-time service or multiple consults required), an hourly rate for the invested physician time may be appropriate. For physician specialties particularly impacted by COVID-19, average median national benchmark hourly rates are presented below.[5]
| Specialty Impacted by COVID-19 |
Approximate Average Median National Benchmark Hourly Rates |
| Internal Medicine | $129 |
| Family Medicine (without OB) | $125 |
| Infectious Disease | $135 |
| Pulmonology | $186 |
| Critical Care | $203 |
| Noninvasive Cardiology | $250 |
| Psychiatry | $134 |
| Hematology/Oncology | $220 |
Flat Rate Per Episode
Another reasonable approach may be a flat-rate-per-episode payment. MD Ranger reports median telehealth per-episode[6] payments of $200 both for stroke and “all types” (i.e., all specialties reported providing telehealth services). However, it is important to note that such benchmark data may be impacted given pandemic market demands and reimbursement changes, just to name a few factors.
Unrestricted Call Coverage Rate
The third way health systems can consider compensating physicians for telehealth services is through traditional unrestricted call coverage rates. Such an analysis might begin with health systems considering benchmark data reported by multiple national compensation surveys.[7] Weighted average daily (i.e., 24-hour period) rates reported by these surveys are presented below. [8]
| Specialty Impacted by COVID-19 |
Approximate Weighted Average Median Daily Unrestricted Call Coverage Rates |
| Internal Medicine | $464 |
| Family Medicine (without OB) | $427 |
| Infectious Disease | $338 |
| Pulmonology | $772 |
| Critical Care | $1,137 |
| Noninvasive Cardiology | $605 |
| Psychiatry | $548 |
It is important to note that if an unrestricted call coverage rate is utilized to compensate physicians for telehealth services, an organization will want to consider whether the physician will also bill and collect for patient services provided during the identified time period and the burden of the call coverage services provided. For example, a lower burden call coverage arrangement may warrant payment at a percentage of the total 24-hour period rate.
wRVU Payment
An additional approach health systems could consider is a productivity-based compensation model based on personally performed, modifier-adjusted wRVUs. Compensation per wRVU rates could be developed using benchmark data (and then make adjustments when the facts and circumstances warrant) reported by multiple national compensation surveys. Average median national compensation per wRVU benchmark data is presented below.[9]
| Specialty Impacted by COVID-19 |
Approximate Average Median National Benchmark Hourly Rates |
| Internal Medicine | $55.31 |
| Family Medicine (without OB) | $51.66 |
| Infectious Disease | $57.66 |
| Pulmonology | $63.24 |
| Critical Care | $91.19 |
| Noninvasive Cardiology | $64.03 |
| Psychiatry | $70.14 |
| Hematology/Oncology | $100.71 |
We have summarized this market data to illustrate options that may be available, but guidance on telehealth compensation will likely continue to evolve over the coming weeks and months. Further, as with other financial arrangements initiated with referring physicians during the COVID-19 pandemic, when the Stark Law blanket waiver is relied upon, it is important to maintain documentation as a best practice to meet its record requirements.
If you have additional questions related to telehealth and physician compensation, or need clarity on the latest COVID-19 guidance, visit our COVID-19 hub, or contact one of our PYA executives below at (800) 270-9629.
[1] Per the SullivanCotter 2018 Physician On-Call and Telemedicine Compensation Survey Report, telephonic call coverage is defined as the “coverage for consultations provided to a treating physician…via telephone with no obligation to present to the hospital.”
[2] Percentages will not sum to 100% due to a respondent’s ability to report multiple categories per the SullivanCotter 2018 Physician On-Call and Telemedicine Compensation Survey Report.
[3] Per the SullivanCotter 2018 Physician On-Call and Telemedicine Compensation Survey Report, telemedicine call coverage is defined as “coverage provided by physicians…for remote consultations to a patient…via video conference with no obligation to present to the hospital.”
[4] Note, percentages will not sum to 100% due to a respondent’s ability to report multiple categories per the SullivanCotter 2018 Physician On-Call and Telemedicine Compensation Survey Report.
[5] Compensation benchmark data from Arthur J. Gallagher & Co., Medical Group Management Association, SullivanCotter, and Associates, Inc., and the American Medical Group Association.
[6] Per-episode is defined by MD Ranger as a payment made to a physician for a patient seen or each procedure performed (excluding compensation for provider availability, which may or may not also be paid).
[7] Compensation benchmark data from Arthur J. Gallagher & Co., Medical Group Management Association,
and Sullivan, Cotter, and Associates, Inc.
[8] SullivanCotter hourly rates converted to daily by multiplying by 24 hours per day. There was insufficient data reported by the surveys to report similar data on the specialty of hematology/oncology.
[9] Compensation per wRVU benchmark data from Arthur J. Gallagher & Co., Medical Group Management Association, SullivanCotter, and Associates, Inc., and the American Medical Group Association.
Disclaimer: To the best of our knowledge, this information was correct at the time of publication. Given the fluid situation, and with rapidly changing new guidance issued daily, be aware that some or all of this information may no longer apply. Please visit our COVID-19 hub frequently for the latest updates, as we are working diligently to put forth the most relevant helpful guidance as it becomes available.
