A year ago I shopped around for telemedicine software to start a private telemedicine practice. I came across a few options but they were either cumbersome, expensive, or only available to large medical groups.

From all of the telemedicine services I have used, I haven’t found a single one which I liked and even though about designing my own. Fortunately, I stumbled on a VSee which finally met all of my criteria. Starting a private telemedicine service is now achievable for even the solo physician without much of an upfront cost.

Starting a Private Telemedicine Practice

Pricing was very important to me. I don’t mind paying a lot of money once I have income coming in. Early on, however, when I have few patients to see, I’d rather work with a more bare-bones software and have the option to upgrade in the future.

VSee thought about this and their pricing reflects it. Starting at $0, with no gimmicks, and going all the up to $500/month.

What matters to me is that I’m not ignored as a customer; definitely don’t want to be ignored because they have larger clients. I don’t want to get booted to a slower server and get shitty customer service. That’s the feeling I had when I reached out to American Well and other telemedicine platform providers.

On the other end of the spectrum are the charlatans. You can make software look rather glamorous but its functionality can be shit. I don’t want something that crashes all of the time or promises and never delivers. Such is the experience I had with HealthTap.

Criteria for a Good Telemedicine Software Service

Software. A private telemedicine service doesn’t need to be as bloated as Epic’s HealthConnect. We need simply functionality. A video visit with a patient, a chat service, and a place to order medications. Ideally a way to document the visit.

Chat service. Unfortunately, many telemedicine softwares don’t allow a chat function. You can do a video visit and you can use your cell phone to complete a call – that’s it. Chat is a big feature and often requested by younger individuals or those who want regular access to their provider.

Compliance. I don’t want to worry about whether the software meets all the new guideline changes per telemedicine regulations. And I don’t want to have to pay annual upgrade fees which some telemedicine software services charge.

Support. I want someone whom I can reach out to if I don’t know how to use a certain feature or if I need help with troubleshooting. I don’t want to send a nebulous customer service request with a shitty auto-responder.

VSee as a Company

VSee has big-name clients such as Walgreens, MDLIVE, Seton, and DaVita. They have even done work for NASA. I like their branding because they keep it simple. They offer an all-inclusive telemedicine platform without the bloat.

They are a startup company but a mature one with plenty of investment funding. They have their own staff, specifically their own in-house engineering team. If you’re starting a private telemedicine practice then this is the kind of company you want to do business with.

Other companies buy certain pieces of a telemedicine platform and stitch it together. The problem is that they can’t service it properly. They cannot make custom changes and they can’t grow with the customers. VSee can make all the changes you like as long as you’re willing to pay for it and it’s in-line with their vision.

VSee as a Telemedicine Platform

There are 4 aspects to a telemedicine platform. When starting a private telemedicine practice you can either piece all of these together or just shell out the $ to have it all in one integrated system.

1. secure communication
2. scheduling
3. charting
4. prescribing

1. Secure Communication

VSee offers both a video visit or a text chat option. The video is in HD and uses great compression to decrease the bandwidth needs.

Of course, you don’t have to use the video. You can opt for a phone call. You can use a fancy-shmancy software like InContact to place Call-ID blocked calls or you can simply use *67 on your cell phone.

You want your text chat to allow for images to be uploaded. This has been a very popular option for the few chat-based telemedicine services out there. Patient can upload snapshots of a rash or their face or their child’s eye discharge. And yes, eventually someone will upload images of their poop.

Some doctors use text messaging to communicate with their patients. This isn’t acceptable by most states. It’s a risk I wouldn’t take.

2. Scheduling

The whole waiting room and scheduling thing is a big deal. You need an appointment software and a way for patient to pay you for your services. You need to keep track of previous visits and book appointments well in advance. Patients should be able to cancel and change appointments based on your calendar availability.

3. Charting

They don’t mention the charting much; not sure why it’s downplayed. It’s probably one of the most ignored aspects of a telemedicine platform. Many telemedicine software providers don’t bundle any EHR capabilities with their software. If they do, it’s a whole different add-on.

The charting on Vsee is straightforward. You can fill out PMHx, PSHx, Med Hx, Social, and a full SOAP note. It’s a free-text window and you can use your own software to dictate into it.

I’ll make some video recordings of this in the future as I test it out more.

4. Prescribing

The prescribing is intuitive. I login to my clinic portal and either click on the patients as I’m completing their visit or I click on the e-Rx tab and select a patient and prescribe the medications.

The software allows for controlled substance prescribing and even allows you to search controlled substance databases for each state. Very cool.

Marketing

I will write a lot more about VSee and I’ll include some videos for you guys as well. It’s already capable of doing everything I need a telemedicine software to do. For the price it’s unbeatable. But the software isn’t enough to start a private telemedicine service, you also need to market to potential customers.

When marketing your practice you want to think about CAC – customer acquisition cost. Sure, you can run a Facebook Campaign which will target the exact patient you want but it might cost you $30 per patient in ads.

It’s not a bad idea if you are charging more than $30 per patient. But before going for traditional marketing, it’s good to have a business plan.

• What’s the patient volume you want to see?
• What kind of patients do you want to see?
• Do you want to see repeat customers?
• Do you want to build a brand or piggyback on someone’s else brand?

You don’t have to figure all of this out right away. But a starting point will help you figure out a good business model. A framework, at the very least.

Targeting Patient

Your target patient might be the young person who has a cold or needs their birth control medication refilled. But everyone is going after that market – easy, cheap to advertise to. This drives down how much you can charge for each patient.

The patient I would want is the chronic diabetic or the homebound elderly person with multiple medical problems. They are hard to market to because they don’t use SM (social media) and are likely not going to pick up the phone if you call.

When targeting ads online you might spend a lot of money per person if there is a huge pool to have to choose from. But if you specialize in PCOS and join a free FB group as the physician expert then you will have access to a huge audience.

Untapped Markets

Everyone is afraid of the chronic pain patients but the government is throwing a lot of money at the opioid epidemic. If you can put together a comprehensive plan for a patient to wean off of opioids then you might have a very large customer base to choose from.

The patients who live out in the middle of nowhere are the cash-cows for many large medical groups serving those populations. Telemedicine would be the kind of competition they would hate. You can give out 100 old cell phones which you can have donated through the local government. There is your chronic disease patient population.

• Primary care
• Sports medicine
• Physical therapy
• Mental health
• Speech therapy
• Gynecology
• Nutritionist
• Allergist
• Endocrinology
• Pediatrics
• Oncology

All these are untapped markets. The physical exam is critical, you are correct, but the patient who wants to be seen now and doesn’t want to go in for that exam will find someone to service them. If it’s not you it will be another doctor.

There is no mainstream pediatric telemedicine service – blows my mind. I recently did a consultation call with a pediatrician who was about to sell his practice and move to another state. We came up with a brilliant telemedicine solution for him.

If you need more ideas then hit me up, I’ve got an endless list.

Malpractice Insurance

Not every state requires you to have malpractice insurance. Research it before you start. But don’t go buying expensive malpractice insurance until you know exactly what kind of practice you are going to have.

Many of the better insurance providers will also give you a steep discount when you’re just starting and not seeing a lot of patients. They will ramp you up as your volume increases. I have talked to the Doctors Company before and they are solid.

VSee Pricing Options

I’ll briefly review the various pricing options for VSee so that you know what you get with each. There are 4 prices structures:

• Free
• Plus ($49/month)
• Standard ($199/month)
• Advanced ($499/month)

Free

Your patient gets a custom website link to use to schedule a visit with you. They get intake forms, consent forms, and they can initiate a secure chat with you.

Patients can’t schedule an appointment with you ahead of time and there is no payment gateway. So you will have to use your own billing method.

You can do video calls, secure patient messaging, screenshare, and file sharing.

You won’t be able to do any documentation. So if you have your own EMR then this will work well for you. E-prescribing isn’t available either, you’ll just have to call the pharmacy or send a smoke signal.

You get email support but there is no live support. If something goes down then they’ll get back to you based on where you are in the que.

You don’t get to do any health device integration. So if your nerdy patients wants to import all sorts of health data from their personal health device, not happening.

Plus – $49/month

All the basics of the Free Plan are included but now the patient gets to schedule their own appointment. And you can now use a payment gateway to accept payment. Yay, money.

If you want to hire associate providers to help you with your platform then you’ll be paying this $49 per provider. At this level you can now schedule different providers for different shifts using their scheduling software.

Still no charting, no e-prescribing.

Standard – $199/month

Nothing standard about this bad-boy. You get all the goodies from above. And you also get a custom logo branding. You’ll have to provide the logo.

You can now customize your intake and consent forms. You also get to play with some cool tech toys. If you have certain types of cameras then you can integrate it with VSee. Great if you’re doing a high-end concierge practice.

You get a dedicated live support team and a telehealth consultant who will help you setup your practice and grow with you.

But – still no charting, no e-prescribing.

Advanced – $499/month

At this price point you get everything. If you can dream it up their engineers will work with you to integrate it. You finally get charting (an EHR) and e-prescribing.

This is the plan I have. Why? Because I’m a baller. For the amount of functionality you can’t beat this.

Here is an insider tip for all of my telemedicine homies: You can negotiate! Ask nicely and see if they will let you try out the Advanced package for a year at the Standard price. What do you have to lose? I have a feeling that they will let you try it. If you love it and you’re making money then keep it. Otherwise you can always switch between the plans.