It’s been nearly a year since COVID-19 forced veterinary teams to think outside the box and provide their essential services in different, safer ways. Whether you’re waist-deep into offering a veterinary telemedicine service or you’re just beginning to open up to the idea, here are five considerations for every veterinary professional who wants to win with telemedicine.
When it comes to telemedicine, staying inside the blurry lines of the law must be considered as a veterinary practitioner. But it’s confusing because the law varies from state to state. It contains ambiguous language intended to allow for professional judgement while also opening the door for various interpretations. In addition, the governance structure is complex and often misunderstood. Here’s a quick review:
Veterinary practice act
Each state has a veterinary practice act that is typically regulated by a governmental agency. It is a state law that establishes the qualifications to practice veterinary medicine, the granting of licenses, continuing education requirements, and disciplinary measures. It also defines the scope of veterinary practice, including the requirements for establishing a veterinarian-client-patient-relationship (VCPR).
Many professions have similar acts, including human doctors, dentists, pharmacists, engineers, and architects. Changes to a practice act usually require legislative action: A legislator introduces a bill that is heard by committees, advocated by proponents, opposed by opponents, and voted on by legislators. Many states also periodically review practice acts. This is when the needs of the profession, consumer protection, and aspects of the law itself are open to assessment, and comments from stakeholders are sought. Following the assessment, a revised practice act goes through a legislative process to become the new practice act.
State veterinary board (SVB)
A state’s veterinary board usually consists of 5 to 10 veterinarians and public members serving in a volunteer capacity who have been elected or appointed to interpret and enforce the practice act. This is the body that establishes the qualifications for licenses, grants licenses to practice veterinary medicine, hears complaints, and issues disciplinary measures. They also provide rules and guidelines for clarity on operating within the state’s practice act. If the SVB receives a complaint about a veterinarian, it is the role of the SVB to review the merits of the complaint and apply it against the practice act requirements to determine whether disciplinary action is warranted.
State veterinary medical association (VMA)
A state’s veterinary medical association is usually a nonprofit organization led by a board of directors made up of volunteer veterinarians in the state. A VMA may also have a paid leader, and perhaps a staff. The VMA works to support veterinarians and the profession in the state with education, advocacy with animal welfare and veterinary-related bills, various services, products, information dissemination, and community building. Members pay dues to support the organization’s activities that advance the common interests of veterinarians.
When it comes to veterinary telehealth, there is an important distinction to be made concerning the VCPR. The practice act defines what must occur for a VCPR to be established, specifically whether a physical examination of the patient is required. In most instances (possibly with the exception of emergencies), having an established VCPR is a fundamental requirement of the law to practice veterinary medicine.
Most states do not allow a VCPR to be established using telehealth technologies. It is the state practice act that determines the scope of practice, including supervision requirements for specific diagnosing, prescribing, treating, and surgical activities.
Note that federal regulations require that a VCPR established through a physical examination must be in place to prescribe extra-label drugs. For that reason, it is essential that each veterinarian engaging in telehealth review their state’s practice act and decide their own approach to the requirements of their practice act. Most practice acts were enacted before the advent of telemedicine, and they allow for a veterinarian’s professional judgement, which means individual veterinarians must decide what is right for the patient and the client should a complaint arise. To date, there has not been a license revoked in any state for a virtual consultation.
When it comes to documentation of a telehealth visit, such as a phone call, two-way chat, or live video, the practice act will define what is legally required for medical records. There is no current requirement to record or transcribe any conversation with a client. However, should a complaint arise, the SVB will use whatever documentation is available to understand the veterinarian’s perspective.
#2: Platform selection
- Virtual payment
- The ability to incorporate pictures and videos into the chat
- Easy documentation
- Effective cybersecurity to protect the information being exchanged
- Live video
- Customization of hours/fees/autoreply
- Writebacks into your practice management software
- Think about your “why.” Why do you want to institute telemedicine? What problem are you trying to solve with a telemedicine platform, and what type of telecommunications will you need to solve that problem?
- Inquire with your existing communication platform or veterinary practice management system provider to see if a telemedicine feature has been added. Technology is quickly moving, and new features are being added to many platforms.
- Make a list of your must-have features.
- Review the platforms and determine which platform will solve your “why.”
- Gather information on each platform, such as cost, ease of use, flexibility, documentation, security, liability/consent, and integration.
- Once you’ve researched your options, pick the platform that will help keep your business afloat.
As is often the case with technology, it isn’t really about how the technology actually works, it’s about what you do with the technology in your practice’s workflow. Technology is powerful when it can speed up a current workflow system to free up humans to do more meaningful work, reduce stress, generate revenue, or reduce errors. Otherwise, it’s a nice-to-have-bells-and-whistles piece that won’t really solve a problem.
Depending on the pain points in your practice, there are several options when it comes to implementing telehealth into your workflow.
- Lowest effort — Add telemedicine to replace phone calls with chat advice (e.g., questions from clients, followup on a case, etc.).
- Medium effort — Choose a digital coordinator—most likely a technician. This person will triage all incoming consults and escalate to the veterinarian—in-person or via chat—when necessary.
- High effort — Add scheduled telemedicine appointments for anything a doctor would normally see in person. The veterinarian could be remote, or the telemedicine appointments could be built into their schedule while at the practice. This requires a VCPR in most states.
The key is to choose an option that will speed up your workflow, minimize stress, or minimize errors. Remember: Start small, and then advance. It’s much easier to dip your toe in the water before you jump in the deep end with new technology workflows.
As veterinarians, we did not go to school to learn about marketing. But veterinary marketing is crucial for the success of your telemedicine platform. You may have the technology, and you may know how to use it, but if your clients don’t know about your telemedicine offering, it will not be successful.
Other ways to market your telemedicine services include:
- On-hold voice message
- Push notifications
- Email blasts
- At the bottom of the invoice
- Social media posts
- Visual displays in the hospital
- In puppy/kitten and new client packets
- Google Ads and local SEO
Ask your platform provider if they have digital or print marketing materials available for your use. Vet2Pet has many marketing tools for clients, including custom videos, social media content, stickers, posters, rack cards, buttons, counter mats, window decals, parking lot signs, and more.
If you market your telehealth services effectively, you’ll be a virtual care rockstar.
Revenue generated using telehealth technology can come in a variety of ways.
- Primary exams — This is the most straightforward way to generate revenue, and it’s often the first place your mind goes when thinking about revenue models. The client pays a fee—usually through the platform—to chat or video with the doctor. The most common approach is to charge 50% of the in-person exam fee, but there is no one-size-fits-all approach to direct charging for consults.
- Recheck exams — Many pet owners skip out on the charged recheck exam, which results in a missed opportunity. One of the biggest barriers to a pet owner coming for a recheck appointment is the time it takes to come in and confirm their pet is doing well. Reduce friction on the visit by converting it from in-person to two-way chat or video—you’ll increase compliance and capture the fee.
- Increase volume of cases seen — Telehealth enables the existing veterinarian to expand care to more pet owners without requiring more real estate or heavy investments of time. Two-way chats especially can be done more quickly and in tandem, while in-person appointments take more time and can only be done sequentially.
- Save time with focused visits — Telehealth can be used to eliminate some of the components of the exam, saving the in-person part of the exam for higher payoff activities. For example, a client could share a video of their Lab limping and toe-touching on the hind leg. Through two-way chat, the client could be educated about the recommendations for sedation and radiographs. The patient could be dropped off the next day and scheduled for discussion at pick up. By avoiding the initial in-person exam, this approach would cut out approximately 30 minutes.
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Dr. Stacee Santi, CEO/Founder Vet2Pet
Dr. Stacee Santi is a 1996 DVM graduate from Colorado State University and the founder of Vet2Pet, a technology startup that builds personalized custom apps for veterinary practices. With over 20 years of clinical experience in small animal and emergency practice, Stacee brings an “in the trenches” approach to innovation and solutions for veterinary teams. She has also served as a medical advisory consultant for NVA for 5 years, medical director for a general/ER practice in Colorado as well as current President of the Colorado Veterinary Medical Association. She can be reached at email@example.com.
Dr. Crista Wallis graduated from Kansas State College of Veterinary Medicine in 2000. She co-owns and operates Monticello Animal Hospital in Shawnee, KS, specializing in small animal and exotic animal medicine. Crista has a wealth of expertise and experience in the field of veterinary telemedicine and is excited to help Vet2Pet clients on their journey. She believes that if you put your best self out into the universe, a ripple effect of positive energy will touch all those around you!