The VVCA is back with a new episode of MarkFive: Policy Off Leash. Today Mark dives in to 2 states that recently made regulatory changes allowing a telemedicine VCPR to be established. We welcome your questions and comments below.
Below is a transcript of the video.
Greetings and welcome to season two of MarkFive podcasts back hopefully by some popular demand. But the same subject is virtual care. And now we’re beginning to see the season of adoption of new and progressive telemedicine reforms across the U.S.. And today we’re going to talk about two states that just stepped up in the last month. And it’s important that we all know what happened and what they decided to do. The laws themselves are important, but how they decided may be more important for the future of virtual care in the United States. So, what do I mean? Well, if you have a law in this country, in one of the states, it’s something that’s been approved by the legislature. Every state has a legislature, and every state has a veterinary medical board. Now, there’s quite a difference between those two bodies and that difference. We’re going to explore a little bit and you’ll feel like you’re in a political science class, but it’s going to make sense to you, I hope, in just a few minutes. Legislatures, of course, are full of people that run for office. They campaign, they’re elected, they raise money. They make accusations about their opponents. They defend accusations from their opponents — it’s pretty intense contests. And if you live in America and haven’t been asleep for the last two, four, six, eight years or actually two hundred years, you’ll know what I mean.
Veterinary Medical Boards, of course, are appointed by Governors. They don’t campaign, they don’t run against each other, they don’t compete with each other. Legislators, once they get to the legislature and they’ve won an election, they vote to decide who has the positions of the most power, who gets to chair a committee. If you chair a committee, you get to decide if legislation gets hurt or not. And there is a Senate and a House in all states but Nebraska, and they have to figure out how to get along. And very often in legislatures and I’ve worked with them, I hate to say, but at least for 40 years, often good ideas and good laws that are about to become law get kicked to the side and you don’t know what happens because two politicians made a deal or maybe two politicians can’t stand each other or they’re both planning to run for governor or some other office, and one has the power to stop somebody else’s bill, even if he doesn’t care about that bill. Also, legislatures meet in most cases every year, but sometimes as short as two months or one month and only 10 states go for most of the year, and they’re in a big hurry to do something with thousands of bills to consider … and you don’t have the kind of consideration and the thoughtful, deliberate looking at options that you might prefer.
And I’ll tell you, in the case of veterinary medicine or pet health care, very few states, I’m sure I could count them on one hand, and I wouldn’t need all my fingers. Very few states have even one veterinarian in their legislature. The US Congress, for example, has only one veterinarian, Kurt Schrader from Oregon. Now, that makes a difference because they don’t have any experience, they do represent the typical Americans, which is 65 percent or 70 percent that own a pet, and that’s important. But that’s not really seeing it from the side of the veterinarian and what goes into being a doctor, veterinary medicine or veterinary technician? Let’s go look at veterinary state boards. All American state veterinary boards have a majority of members who are licensed veterinarians, virtually all include one or more veterinary technicians or nurses, and they all have a member of the public. So, they don’t meet in short bursts of time, they typically meet every month or every quarter, they take a lot more time to make decisions. It’s I can’t say not political at all, that basically it’s not very political. It’s a much more reasoned decision. And that’s what’s exciting about what two states just did. Let me tell you about what happened. Both New Jersey and Michigan State Veterinary Medical Boards adopted a comprehensive set of regulations that are now law in those two states. Two states that add up to about 20 million Americans and a lot of veterinarians and certainly a lot of pets, they have adopted a comprehensive set of laws allowing for the telemedicine VCPR. Allowing, contrary to what is typically the rule in the US, for a veterinary client patient relationship to be created, to be started, through telemedicine rather than an in-person visit inside of a clinic. So, let’s dive into what Michigan and New Jersey just did and consider what this might mean for the future of virtual care or telemedicine in the United States.
What I want to do is compare New Jersey and Michigan, because they’re not quite twins, but they’re almost, they’re certainly siblings and they’re very close to each other. And you’re going to see that these were thoughtful, quite reasoned, interlinking set of guardrails or guidelines related to the use of a telemedicine VCPR, they don’t appear to be political decisions. And what I like about this and what I am going to be promoting and I think VVCA will be promoting around the country, is to encourage legislatures to do what Arkansas did — they directed their veterinary medical board if they so choose — to create Arkansas rules regarding telemedicine. And I think that’s a path that we could follow in many states. And we’d be much happier with the outcome, in large part because it would allow veterinarians, it would allow pet owners, it would allow vet techs and vet nurses to be at the table and to be heard. And the decision would be made by people that understand the day-to-day nature and the day-to-day needs and challenges of veterinary practices.
So, both of them allow what we would call a telemedicine VCPR. But I have to make clear, Michigan is one of the few states that doesn’t use the term VCPR, but basically, they allow a veterinarian to start a relationship through telemedicine means. Now each of them had a requirement, which again, I think was very thoughtful, that the telemedicine engagement between the pet owner who’s in some other location with their pet and the veterinarian in some other location, that it has to be through a real-time video exchange where the veterinarian can see the pet. Number one, it’s not through emails, it’s not through a text, you can use that afterwards, but to get started, they want a veterinarian, of course, to be able to see the pet. They also want there to be a means to have any medical records or any diagnostic information exchange if that’s available. Another safeguard.
The next one is they want to make clear that if a veterinarian uses telemedicine and VVCA feels so strongly about this as anyone, you need to have privacy protections built in to protect the pet owner and pet, as well as to protect the veterinarian.
Next, they rely on the veterinarian’s judgment, and they directed the veterinarian to pause and think through whether they know enough and whether the circumstances with the pet allow for a good decision to be made through telemedicine. That’s not a dangerous thing. That’s not a negative thing. That’s a smart caution. It’s basically saying you need to make a decision, the veterinarian, based upon your judgment and training. Am I in a situation with this pet and do I know enough that we can begin a relationship? I can begin to treat or be helpful and guide the pet owner and whatever decision needs to be made.
They also make it clear that the standard of care, the legal standard of care that the veterinarian is bound by, is no different in a telemedicine engagement than it is in person. It’s not like you can lower the standard if it’s in person or lower it if it’s telemedicine, they’re the same.
They require in both cases that the pet owner provide written consent to the telemedicine exchange. So they want the veterinarian to tell the pet owner, we’re talking, I can see you, I can see your pet. We can go all the way through with this. You have a choice, by the way. You have a choice whether you want to continue via telemedicine or come into the clinic. But I want you to sign — I want you to understand, if we do it through the telemedicine means, I want you to sign off on that. That’s another thoughtful step that gives the pet owner some power in the relationship and I think it respects the pet owner because it’s their decision as to whether they go forward.
And finally, on the issue that that will probably take up as much as the debate across the country as any. They took different approaches on one issue, which had to do with prescriptions. Can you do a prescription, that is prescribed medications, based upon a telemedicine engagement rather than in-person examination? These are the same issues human medicine faced in state after state, and they’ve addressed it. Michigan said you can, and they said you can because Michigan has had a law on the books for some time that covers every health care practitioner in that state: doctor, chiropractor, dopa nurse practitioner, veterinarian. And it allows for prescriptions if you have a telemedicine start to the relationship. And I think the Michigan Veterinary Medical Board properly didn’t believe it had authority to change that statute. And if the legislature wants to change it later, of course they could. But the Veterinary Medical Board didn’t change it, so, they made it clear that you can prescribe if you’ve decided it’s appropriate and you know enough about the pet through telemedicine.
New Jersey took a different course, and it did find that was scheduled to dangerous controlled substances, a certain category of medications that trigger concerns that people have regarding opioids and the like, that that requires an in-person examination. That’s what they did.
Now, we’re not at VVCA predicting or saying that every state has to do the exact same thing that Michigan and New Jersey just did. But we now have two major states, two politically very powerful states with a lot of voters, a lot of pets and, you know, I think between the two of about three to four thousand veterinarians, that telemedicine should go forward. And if it’s convenient and makes sense to start a relationship that way. Now it’s the law in both of those states. I think it’s going to have a significant impact on the rest of the country because these are large states and because they are the action of a veterinary medical board and I hope that’s a path that we now follow in state after state, whatever the outcome is — to have a group of experts pull in stakeholders in a more calm, not time sensitive process, and make a good decision.
So, again, nice to be back with MarkFive podcasts. I’m sure we’ll see you soon on another virtual care topic.