“You can get past the dead end. You can break through the ceiling. I did and so have countless others.”

Creating a Telemedicine Practice

The easiest and cheapest way to start a side business is doing it via telemedicine. It fits perfectly into The Elite Nurse Practitioner Model. Telemedicine continues to gain more and more traction as millennial’s get older and people realize how pointless most in person medical visits really are. It is a growing field and nurse practitioners can be on the front lines utilizing this modern day technology.

So why is telemedicine such a great practice model for the nurse practitioner? One answer: INDEPENDENT PRACTICE AUTHORITY. You can live in a very restrictive state and practice independently online in other states such as Washington, Oregon, Arizona, etc… You do not need a supervising physician. Repeat this with me, YOU DO NOT NEED A SUPERVISING PHYSICIAN. This automatically saves you thousands of dollars a year.

The skies the limit with telemedicine for the nurse practitioner. Setting up a telemedicine practice is relatively easy compared to a brick and mortar business. The four essentials are:

1. Personal computer. (Do not operate a telemedicine practice from a tablet. It would not be as efficient as an actual computer.)

2. Cell phone.

3. Website. (Go Daddy is very simple and priced well. You can literally design a good looking website on Go Daddy within 2-3 hours.)

4. Online marketing strategy. (Marketing will be your biggest and most important expense. MARKET MARKET MARKET your service.)

Outside of standard business items such as a LLC, bank account, etc… that is all you need for a telemedicine practice.

You might be asking yourself “Well what about an EMR?” and that is a valid question. It is optional. If you are running a cash practice you really don’t need one. Word documents filed in a folder on a secure google drive would suffice for a small startup telemedicine practice. There are multiple free HIPAA compliant video platforms out there as well.

If you don’t mind paying $50 a month, you can go with a very basic EMR. I use one called Simple Practice. As its name implies, it is very simple. The telemedicine video chat is built in. It also has point of sale features on it. It is a worthwhile expense in my opinion.

If you accept insurance you will have to comply with all their bogus rules and regulations for reimbursement. There are a multitude of items you must comply with when taking insurance and using telemedicine. These really add onto your expenses. I recommend avoiding insurance when using telemedicine. It will complicate a relatively simple process. If you want to know what the requirements are, they are easy to find online and beyond the scope of this article since I do not advocate for it.

That is essentially all you need to start a telemedicine practice. I started one with $8,000 with $6,000 of that going to marketing the hell out of it. Otherwise the actual foundation of your practice should not cost you more than $2,000-$3,000 at the most. Monthly operational costs would be around $100 while marketing costs could be as much as you want to spend. Remember something about telemedicine: it is all about how you market your service to potential patients. This is how you build your patient base!

You must utilize multiple marketing channels with social media being a huge component. Avoid paying people to market for you. It is very easy to learn. You must set aside a healthy marketing budget during the startup planning of your telemedicine practice. Be prepared to drop multiple thousands of dollars to get the word out. If you don’t have this in your budget then continue to save before launching.

The biggest challenge an aspiring nurse practitioner entrepreneur will have when starting a telemedicine practice will be the service niche. This is VITAL to your success. Outside of marketing, your service niche is the most important part of your business. Do not create a telemedicine primary care office or urgent care. This is overdone and you will fail. Think outside the box like the guy who created the online erectile dysfunction telemedicine practice. Men love a robust erection and do not like going to a doctor’s office. It was a stroke of genius in my opinion. That practice probably makes millions by simply doing a 10 minute phone visit and prescribing a 6 month supply of Viagra or Cialis. So think outside the box here!

Another significant startup cost will be licensing. You need to get licensed in every state you want to practice in. This can add up quickly but overall most NP licenses will cost you $200-300 each. A worthwhile expense seeing you can make that up with 2-3 patients.

If you want to implement The Elite Nurse Practitioner Model into your life, but you live in a restrictive state, then starting a telemedicine practice could be a way around that barrier! Begin brainstorming a service niche and get a telemedicine practice up and running. You will be very surprised how relatively easy it can be!

48 Responses

    1. Great idea in theory. One problem I can foresee is that people will want to use their insurance or they can go to the health department and have it done for free. Another limitation would be obtaining lab work. Doing lab work over telemedicine complicates its because: You must send orders in for lab work, most people will want to utilize their insurance, and you need to get results. It sounds like it should be fairly straight forward but sometimes it can be a real headache because of these reasons.

      1. why is it hard to get labs via telemedicine? can’t patients use their insurance for labs even if you’re cash pay? thanks

  1. Hi!
    Thanks for this informative article, I do really want to open my own telemedicine business. I am in Florida, a very restrictive state, but as you said I can practice in another state. I’m wondering how intense you think the marketing would be since I don’t know anyone in another state? I want to apply for my license in NY to start off. Thoughts? Thank you.

    1. The marketing is going to be as intense as any other business starting in a fresh market. Word of mouth referrals will happen but it will take 6-12 months before that happens. So you need to expect that marketing will be your number one expense. Setting up the business itself is easy, but developing a marketing strategy will be your toughest obstacle. I do not know about NY other than it is a densely populated state. Expand your horizons, look at other NP independent states and figure out what your market is going to be for the service you provide.

      1. New York is a complicated state for telemedicine. I have a license there. It is a big ticket item if you want to practice there through a telemed company. If you want to keep your telemed business independent, start with another state. The collaborative issue is strange. (You have to have a relationship to practice, very informal, but still required.) And you can’t get malpractice as an individual practitioner.

  2. I assume you will still need a Dr for collaborative support in states that do not offer full practice authority like TN correct? How would I go about finding one?

    1. You will need collaborative physicians in any non independent state. Which is why you should venture into those states. Having a collaborative physician does nothing but increase your monthly expenses. There are services online for collaborating physicians or simply ask some you know or other NPs who use them. I cannot assist with specifics since I do not advocate for it.

    1. Not at this time. They can be expensive and often times cumbersome if you have a multiple provider practice like I do. We are a very specialized telemedicine practice therefore scripts are just called in. If you have a high volume practice then e-Rx would be necessary to help with workflow. Remember, you want your expenses as low as possible. Creating a Low Overhead Practice

    2. Good information, thank you. My only question is the use of a personal computer. Wouldn’t you need to be HIPPA complaint ? How are you able to ensure this on a personal laptop?

      1. The EMR you utilize will be HIPPA compliant. Do not store anything on your personal computer, problem solved.

  3. Great info helpful.. I have been looking into this and call an app company to start one but cost 40k more than I want to spend and I could not figure how profitable the app would be. Question, I do I need an LLC to start or just build a go daddy site? Please email me at gart875777@aol.com. Thanks

  4. Just found you, you are a breath of fresh air. 1yr into NP world and I am a bit burnt out and I’m now on an extended vacay thinking of my next move. Change jobs for sure, but what will change?
    In Telemedicine in another Full practice state, I am currently in a collaborative state,
    > how do you write prescriptions if not escript?
    >How do you ensure you are only taking pts from the state you are licensed in?
    Interested in Telehealth
    But have so many ideas bouncing off my mind right now, men I have been reading your blogs since I woke up, can you imagine
    > I already have a registered LLC whi h I never gir a Tax I.D for. Can I use that, and make some changes, I registered it with my state many yrs ago, but never used it, it was a med legal entity, as you know that’s saturated. may need to change the email address.
    Thank you

    1. 1. I just call the scripts in. Once volume increases then go with an escript services.
      2. Have them upload a copy of the DL into your clinical portal. Often times they will have an address on file too. This is something you do not need to worry about often.
      3. I would suggest registering a LLC in Wyoming or Nevada for privacy purposes and operate under it.

      You sound like you need quite a bit of direction, shoot me an email through the consulting tab if you want to schedule a one on one telephone call.

  5. I am currently working in an endocrinology practice primarily with diabetics of all kinds. since there are so many free/insurance covered services for this demographic would this be a non starter niche ?

    1. Diabetic treatment is a difficult cash niche. Like you said, it is a covered service. Medical niches really need to focus on non-covered services. Now, when it comes to diabetic care, how many diabetics have one on one concierge care from an experienced provider that they can talk with on a daily basis? That could be a niche. Your target market would be individuals in higher income brackets. There are plenty of people with disposable incomes that would pay you for 1 on 1 diabetic care. Guarantee it.

    1. Just a standard professional liability policy is fine. You can go through CM&F group or Berxi. Just make sure they telemedicine is covered.

  6. Do you think ADHD is a good niche or service to offer via telemedicine?
    I worry it’ll come with huge liability

    1. The problem is that the medications are controlled. I think it is a great idea, I do not think there is much liability to it, but you are going to have to wait for the DEA telemed licenses to be released!

        1. You cannot rx controlled substances via telemedicine without 1 in person encounter first. The DEA will begin issuing telemed licenses to counter this dumb law soon.

  7. I’m curious on how to start telemedicine practice on my own, though there is alot of competition with insurances now that most clinics offer telemedicine as adjunjct, what’s a good strategy ?

  8. Hello there! Bought your telehealth couse, but still have a question. If I live in Florida and get a license in WA, I can only provide care to patients in Washington and Florida….correct? So then my marketing would have to be only to those 2 places? Not sure why this is so confusing 🤔 lol! Thank you!

    1. Yes, you can practice in the states you have a license in and you will only advertise in those states, which is easy to do with online advertising!

  9. Looking to start up a telehealth for mens health and after hour primary/sick visit. When setting this up do recommend consulting with an attorney? I’m not thinking it is a must, but a good idea to have a relationship already established.
    Thank you in advance!

    1. Jeffery,

      It is not required. In terms of just establishing with an attorney, I think it is a good idea to have one in the background just in case you need to consult with one as a business owner. Honestly, I haven’t consulted with mine in like 2 years… It is not necessary as long as you are doing everything correctly, as explained in the telemedicine course.

  10. I currently own a brick-and-mortar outpatient mental health practice in CO. I am planning on moving to LA soon. My business is currently set up as an LLC. Can I just use that same business license and business name and just switch my patients over to telemed as long as I apply for a license in LA??

    1. You can still continue seeing the CO patients via telemed as long as you maintain your CO license. You don’t need a LA license for the CO patients. If you are going to start a new practice in LA, then I would start a foreign LLC in LA and just have the CO LLC still be the parent company of that as you are already established. You will need a local LA business license for local patients and the local business.

  11. Hi there!

    I’m in a restricted practice state and have my heart set on Oregon for telepsych opportunities across state lines, however I’m going in circles to find concrete info regarding the ability to do so. The Medical board has specifics related to MDs, PAs, and acupuncturists of which only MDs can apply for a “telemedicine active” license and see patients without having to reside in Oregon. Nothing regarding NPs. No specifics through OSBN either that I’ve come across… do you have any insight on this? Feeling quite discouraged. Thanks! -Angela

    1. I would just contact the BON and ask them… each boards regulations are different but in general, the board of medicines regulations would be applicable.

  12. I am interesting in doing telehealth as a Psych Np but some psychiatric disorders requires some form of monitoring vital signs and labs. How do you safety monitor labs and vitals via telehealth for psych patients?

    1. Those types of patients could be difficult… There are limitations to telemed and that could be one of those limitations. Labs are simple = just order them and the lab sends you results. Vitals can be difficult and would require sending them to have vitals done occasionally at an outpatient facility. If you want to increase the logistics of your practice, then see these patients. If you don’t, then simply avoid seeing the patients that require more complex care. Choose your battles wisely….

      1. Just you are great! Thank you so much. I am interested in purchasing some of your courses. Is bundle pricing available?

  13. Great article! In the case of me having a Florida APRN license, if I added a Washington state license or New York APRN license (now that they are full practice authority) is that all I would need (in terms of NP licenses) to offer telemedicine visits to Florida residents (and NY residents)? I can see how I wouldn’t need a collaborating doc for the NY clients, but for the Florida clients I wouldn’t still need a collaborating MD? Thank you! (I’m am APRN/CNM looking to start a cash only telemedicine practice where I conduct consultations about contraception, fertility methods, sexual and reproductive health, childbirth classes etc.)

    1. As long as the visits in FL are considered primary care, then you don’t need a collaborator. All you need is an active license in the state you want to see patients in. Telemedicine is pretty simple and I go into more specifics in the telemed course just FYI.

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