Remote monitoring of ICU patients through ICU telemedicine (tele-ICU) has increasingly gained a foothold in the United States. Most of these tele-ICUs consist of a facility-based central hub that contracts with individual hospitals to remotely cover their ICUs. These facility-based hubs then contract with physicians to enable them to provide remote coverage to the hospital. Physicians spend their shift in the “command center” and receive a direct payment from the facility (rate reported, $160-$200/h in 2007)1 independent of the type of services rendered (surveillance or intervention) to the patients being monitored. The physician is providing a service to the facility that benefits both the facility and the patients. Fundamentally, the physician is reimbursed for work by the facility (in a sense, Medicare Part A dollars) instead of by the patients (Medicare Part B dollars). This is similar to a number of physician reimbursement models that exists across the health-care system (employed model, trauma call, moonlighting arrangements, hospitalists). Currently, physicians are not able to directly bill patients for these services. There are a number of reasons why creating a professional fee billing process (ie, billing the patient) should not be considered.