Can it be that 2021 is already closing in on the holidays and almost two years since the first COVID-19 case made national news from here in Washington state? The Pandemic has simultaneously become something we are weary of hearing about from a variety of daily news media outlets and something we cannot ignore as we brace ourselves to adapt and respond to the impacts it has had on every aspect of our lives. The veterinary profession has seen rapid paradigm shifts because of the Pandemic including the embracement of telehealth technology, enhanced safety measures with curbside check-in and video chat exams, and the loosening of state continuing education and licensing requirements. While these changes were initially implemented as a rapid means to enhance staff and client safety, we’ve now had enough time with these new normals to determine what will be incorporated long-term into how we practice.
In my own practice environment at a municipal animal shelter, we added artificial intelligence-based telehealth triaging program to assist us with caring for animals in our foster care program, whom we manage as an extension of the shelter medicine service. Telehealth has allowed us to provide a 24-hour based response to foster parents with new medical and behavioral concerns and gives them initial information about the signs they are observing. Based on the information entered, the system then uses an AI algorithm to determine the urgency level and sends an immediate notification to the veterinary staff on call. We also use this program to provide post-operative care to clients of our public spay/neuter clinic, many of whom do not have a regular veterinarian and who have transportation challenges. The integration of telehealth services into our practice has elevated the level of care we can provide and makes documentation and communication rapid, simple, and versatile. Pandemic or not, telehealth is here to stay now that we have come to rely on this technology for the daily delivery of care.
Telehealth ventures have enjoyed a wave of temporary modifications to the Valid Client Patient Relationship (VCPR) over the past 18 months which have allowed veterinarians to deliver services such as medication refills when access to care was often limited. Many state Veterinary Boards of Governors, including Washington’s own, put forth statements that the standard VCPR requirements would either be relaxed or not enforced for a specified period of time due to the Pandemic. The federal VCPR, which requires a physical exam in order to prescribe many drugs for animal patients, also temporarily relaxed the requirement. The AVMA states in Section III of the AVMA’s Principles of Veterinary Medical Ethics that in order to establish a VCPR:
(1) the veterinarian has assumed the responsibility for making clinical judgments regarding the health of the patient and the client has agreed to follow the veterinarians’ instructions;
(2) the veterinarian has sufficient knowledge of the patient to initiate at least a general or preliminary diagnosis of the medical condition of the patient. This means that the veterinarian is personally acquainted with the keeping and care of the patient by virtue of a timely examination of the patient by the veterinarian, or medically appropriate and timely visits by the veterinarian to the operation where the patient is managed;
(3) the veterinarian is readily available for follow-up evaluation or has arranged for veterinary emergency coverage, and continuing care and treatment;
(4) the veterinarian provides oversight of treatment, compliance, and outcome; and
(5) patient records are maintained.
Many state practice acts have adopted this seminal definition and require a physical exam to establish the VCPR along with timely visits.
It is this in-person requirement that is now coming under fire across multiple states, with a variety of private entrepreneurs and corporate veterinary medicine companies bringing requests to open state veterinary practice acts in an effort to modify the VCPR definition. There are obvious advantages to this proposal, including those that benefit us as practitioners such as expanded accessibility for clients, ability to dispense medications when appointment slots are not available, increasing clientele regardless of their physical location. But there are great concerns as well. Our patients cannot talk to us and tell us what they are feeling and thinking. We are severely limited without a hands-on review of their condition as there is simply no substitute for what we can learn from all our senses: what we see – yes – but also what we smell, feel, hear (hopefully not taste!) all inform our differentials and diagnoses and may not be noticed or reported by owners. Corporate practices are seeing and seizing the opportunity to expand business across state lines and beyond the exam room through the relaxation of the physical exam requirement, and there are already companies cropping up that are filling this telehealth space by employing veterinarians to answer questions and give advice online. Currently, companies are largely limited to just that – advice – but with legislative or regulatory changes, they could begin to diagnose, treat, and dispense medications as is now the norm in human medicine. Since 2016, nearly 100% of states have modified their human medical practice acts to allow telehealth for physicians including the establishment of a VCPR solely by virtual means and in some cases, across state lines.
Because of recent attempts to relax the VCPR in other states by telemedicine corporations and advocacy groups, the WSVMA Board of Directors took action and voted at their October 19, 2021 meeting to oppose efforts to eliminate the physical exam as a condition of establishing the VCPR.
The WSVMA works diligently to keep abreast of upcoming legal proceedings that may affect you as veterinary professionals and as business owners through its legislative advocacy program. As your WSVMA Board President, I want to hear from you about this topic and the benefits you see or the concerns you have around the opening of the Washington Veterinary Practice Act which would allow for changes in the definition of the VCPR. Does the possibility of no physical exam requirement change how you would practice medicine? Even those of us in non-private practice arenas can feel the ripple effects as these changes will broadly impact our profession.
By Dr. Jennifer Bennett, WSVMA President. She can be reached at [email protected].
Posted December 3, 2021