Video Correction: Indiana belongs in category 3 (Must Have “Seen/Acquaintance with” the animal). It was previously in category 4 (Must Have Examined or Physically Examined Animal).
The VVCA proudly presents MarkFive, the first in a series of short videos by Mark Cushing, Founder and Managing Partner of the Animal Policy Group, and co-founder of the VVCA. A once per week video series, MarkFive will quickly get you up-to-speed on policies that govern veterinary telemedicine. Get ready to engage on these hot topics as we move into the VVCA’s Mighty Network, launching soon!
Below is a lightly edited transcript of the video.
Hello and welcome to Mark 5: Policy Off Leash. This is the first in a series of video casts where I will discuss virtual care or telemedicine policy of interest to you that the United States faces across the country.
Today is our first session and we’re going to go right to the basics. How does it work in all of the states concerning the VCPR (the veterinary client patient relationship) and telemedicine? The answer is we don’t have one rule because veterinary practice acts are set up by each state legislature and every state is different. Understand that, but don’t feel picked on if you’re in veterinary medicine because every profession in the United States is regulated at the state level, not the federal level.
So, as a backdrop, human medicine faces these same questions – what do we do about creating the doctor client patient relationship? They started thinking about it 30 years ago and now 49 states (all but one) allow a doctor-client patient relationship to be started through a digital or virtual tool (meaning the doctor’s not in the same place).
Veterinary medicine, as we all know, didn’t get serious about telemedicine until 2016 so we have a long way to go.
The laws governing veterinary telemedicine and the VCPR fall into one of seven categories and we’ll go through each one. We have included very handy, easy to follow maps in the video and you can see your state and where it fits.
The first category, which you could put on one extreme, is where the state practice act has no reference to and therefore doesn’t even define or use the term VCPR. That is the case in Connecticut, Michigan, and in the District of Columbia. So there’s three jurisdictions that fit that category.
Absolutely NO VCPR via telemedicine
Let’s go to the other extreme. We have eight states where the veterinary practice act spells out, unequivocally with no doubt, you cannot create a VCPR through telemedicine. We’ve got some big states there including California, Illinois, and Texas.
Must Have “Seen/Acquaintance with” the animal
The third category is an ambiguous one. Of course I’m a lawyer so I am naturally drawn to ambiguity, but the language of this category is interesting. What it says is that in order for a veterinarian to create a VCPR with a pet, the client and the patient must have been seen or the veterinarian must have become “acquainted with” the animal. There’s no definition of what “seen” or “acquainted with” means. You might say, “well, those are common terms so why would you need a definition?” That’s not not a bad point, but couldn’t you see the animal through FaceTime, Zoom or some other telehealth App? Couldn’t you become acquainted with the animal physically through one of these video options? Those issues haven’t been addressed by any of these states and there are seven that fit in that category. But I’ll predict to you that we will see these definitions changing now that telemedicine has become so much more popular.
EDIT: Indiana takes a unique approach and falls more into category 3, needing to have seen or be acquainted with the animal.
Must Have Examined or Physically Examined Animal
The fourth category is a hard line.
25 24* states (nearly half of the states) fall under this bucket. The veterinarian must have examined or physically examined the animal. There’s no question what states mean by examine. They mean that you’re in the same room with the animal, you can touch, hold and place your hands on the animal as part of an examination. No ambiguity there.
*EDIT: Indiana takes a unique approach and falls more into category #3 above.
Time limits on When Animal Last Seen
The fifth category applies to those 25 states where six of them have put an actual time limit on how long your VCPR lasts. Remember, a VCPR means a veterinarian should not begin providing medical care for a pet until this is in place. So it’s not just academic or theoretical. Those six states basically say your VCPR lasts for one year. That’s a tough rule. Why is that tough? Because that means if you see a pet in January, for the rest of that year you can engage in telemedicine and you can provide all the medical care and advice that pet needs whether the pets in your clinic or not, or you’re going to their home or not. But come the next February and your client calls you up and is on FaceTime and wants to talk about some condition, some limping or some problem with their cat or dog, then you’ve got to make that client come into the clinic as a legal matter.
Do I think all veterinarians do this in those states? No I don’t. For good medical reasons, I think they care for the pet and if the person can’t come in or it’s difficult to come in – they make their own judgment. But the law says otherwise so those six states are in an interesting category.
Oklahoma is the first to step out
The sixth category has only one state in it. And it’s the state that’s actually stepped up and said you can use telemedicine to create a VCPR, that’s Oklahoma.
It’s not surprising that it’s Oklahoma because back in the day with human telemedicine, Kentucky and Oklahoma were two of the vanguard, or early progressive, states. They did it for the reason why telemedicine was brought into human medicine and now, frankly, into veterinary medicine in the first place. What’s that reason? Access to care. In rural states like Oklahoma you might be 60, 70, 100 miles from a clinic and it’s not going to work to say you can’t get care for your pet or animal if you don’t get in a car or truck and drive that distance. So Oklahoma recognizing the rural nature of much of that state does officially permit telemedicine VCPR.
The last category is an odd category. Two states, New Jersey and Virginia, in healthcare codes (broader laws governing health care practitioners on the human side) allow you to use telemedicine if you’re going to prescribe an opioid or controlled substance.
That may seem backwards, or may seem completely out of line with veterinary medical practice acts, but in those two states veterinarians are swept into the definition of health care provider practitioner and specifically may take advantage of that exception.
There you go! Hopefully you saw your state and you understand where it fits. Things could change, and we’ll talk about that because they did change under COVID which we’ll discuss on our next session on Mark 5: Policy Off Leash.