The Original Telemedicine

Everyone is enamored with the advent of telemedicine and the rise of companies supporting video-conferencing between patient and physician.

What seems to be forgotten is that doctors have been using telemedicine for decades. Our technology? The plain old telephone.

Many of us doctors spends hours each day in consultation and follow-up with our patients using the phone.
Our group was in the process of setting up a pre-anesthesia clinic–with all the attendant staffing, office supplies, and space requirements. And then we decided that at least 95% of business-at-hand could be conducted over the phone (the occasional patient who needed to be seen in person is then scheduled for a face-to-face evaluation).

So what advantage do the current companies offer? Video? Nope, Facetime offers that over the phone.

The real difference is that physicians can now charge for their video sessions. As soon as CMS (Centers for Medicare and Medicaid Services) allows us to charge for our time on the phone, I’ll bet that many Zoom users go back to the ease and efficiency of our old stalwart…the phone.

So, I’m long Apple, AT&T, and Verizon (to name but a few).




Are you betting that companies like AT&T and Verizon can and will grow faster than Teledoc and Zoom? I know none of know the future for sure, but that seems like a crazy bet to this investor. I mean, there was a time when we all called a telephone number and knew exactly where that phone would ring, now when dialing that number you may have no idea where that phone may ring. Video now allows a “visit” where maybe a physician can also do a bit more diagnosis with their eyes. I think the world may be evolving beyond a simple call when the situation calls for it.



<< Are you betting that companies like AT&T and Verizon can and will grow faster than Teledoc and Zoom? >>

I own T and VZ as value plays (stable companies with a good dividend). However, I do think that the value of Zoom, etc., is currently overstated.

<< I think the world may be evolving beyond a simple call when the situation calls for it. >>

Videoconferencing is great when there are multiple people engaged. One-on-one…not so much in my opinion. At least not anything that Facetime can’t do.


The real difference is that physicians can now charge for their video sessions.

The real difference is that NOW we can make more money on TDOC and ZM than on AT&T and Verizon. :innocent:

Denny Schlesinger


Facetime is only approved for tele-health right now because of Covid. I assume it’ll be disallowed once the environment changes. Zoom is approve and HIPAA compliant.

I may be wrong but I don’t think you can Facetime on an Android.

Mobile Operating System Market Share Worldwide - April 2020
Android 70.68%
iOS 28.79%
Samsung 0.17%


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That’s right. It’s only for apple products.

Alan, that was my argument against TDOC. People claimed they had some kind of most or advantaged, I didn’t see how it was different from an office calling a patient. Basically, TDOC is no better than the web sites selling male enhancement drugs or cannibis that are “doctor prescribed”. You get matched up with some doctor trying to make some part time money. As with Uber, Lyft, and other delivery services, I didn’t see how that model could ever be profitable.

I am also unsure why a video chat needs to be HIPAA compliant but the telephone doesn’t. What about Facetime audio?


TDOC is different. Not every doctor is trying to be a part of this network. They can basically work from anywhere instead of having a physical office. It’s like consulting on the side in addition to having their own practice.

I might have misstated before. What they’re saying is the doctor can charge for video consults. Usually they don’t or can’t charge for 2 min conversation about something on the phone unless it was an office visit. Now they’re saying they’re counting these video chats as office visits so the doctors can charge the insurance.

It is easier to have televisits be reimbursed in the current climate (not 1:1 billing though) given there is no alternative for many and hospitals need to remain solvent and to have a system to respect time of providers. I would imagine that once hospitals reopen for routine care, they themselves will encourage patients to return to the clinics and many patients will be happier to be seen in person than over the televisits. Having done around 100 televisits since this all started, I genuinely feel there is apprehension from insurers, patients, providers alike regarding if televisits are an equal or preferable alternative to in person medical care. This is a very different industry that is sluggish to adopt new things to begin with, with additional medicolegal concerns, privacy concerns with sensitive medical information being shared over video, and I genuinely feel that many do not find the televisits platform to be preferable to traditional clinic visits.


I genuinely feel that many do not find the televisits platform to be preferable to traditional clinic visits.

I am sure this will be true of some clients, but don’t be surprised if there is a significant permanent shift. Compare the time investment of having to drive to where the doctor is, wait in the waiting room for some unknown time, spend 10-15 minutes with the doctor (with often no actual physical examination of anything), and then having to drive back to home/work) vs a 10-15 minute Zoom or telephone call … especially if there is the ability, as there is now in Epic, to precede the visit with a message which can include documents. The local primary provider has done that plus a shot clinic with separate entrance for quick, isolated injections plus a drive-in lab for routine blood work and the like.


My wife has had 2 doctor appointments via video. The large hospital system uses a Google product (Google Meet?) and we understand that it is HIPPA compliant.


I have lots of doctor friends who were skeptical of Teladoc as an investment 4 years ago. They would wonder why anyone would want to consult with a doctor they didn’t know, compared to seeing their own family doctor. Teladoc stock is now a 16-bagger compared to its March 2016 price.

Thousands of company employees covered by an insurer like Aetna are also covered by Teladoc. Teladoc’s customers are large health insurers and gigantic, self-insured Fortune 1000s like Bank of America. If you’re a BofA employee, you may get a health insurance card that says Aetna, but, in reality, BofA itself is paying the cost of your emergency room visit. Aetna is just acting as a management company in that case.

Teladoc makes money in at least 2 ways. First, they charge the health insurer a fixed subscription fee per insured person (member) per month, even if said member never calls their doctors. This fee ranges from under a dollar to a couple dollars per month per member, depending on the size of the insurer. With 20 million+ members, those add up, and provide a source of recurring revenue for TDOC.

They also gets $49 per visit (phone or video), from which they pay a portion to the doctor. Based on their gross margins, I estimate they keep about 30% of this fee.

Patients rate the service as excellent. Suppose you have a child coughing at night, and you need a prescription right away, and your primary care doc can’t give you a next day appt (this happens all the time). Just call 1-800-TELADOC, and the doctor will come on the line right away. Most consults are still by phone, not video. The doc then creates an electronic prescription order, and you can then pick up the medicine right away from the nearest pharmacy.

The health insurer (or the self-insured Fortune 1000) just saved $1,000 compared to you taking the child to an emergency room. This was all true even before the Covid situation, and the virus has basically blown up demand for these visits by 50%. So if they were doing 2 million visits during Q1 this year, we’d expect to see 3 million visits in Q2.