The pandemic packed a punch, and today Mark Five tackles changes that were made to some veterinary rules, in response to the COVID pandemic. Are these changes here to stay? Listen in as Mark helps us understand these complex layers of change, which could promote reforms in the way veterinary medicine is practiced.
Below is a lightly edited transcript of the video.
VCPR and COVID-19
This is Mark Cushing. Welcome back to Mark Five: Policy Off Leash, where we discuss policies affecting veterinary telemedicine and virtual care.
The first series covered the basics where every state fits into the seven different ways that practice acts have laid out the connection between the VCPR and telemedicine. Today we cover one subject but it’s complex, which is how did COVID affect telemedicine VCPR policies?
We all know, of course, how COVID affected our life and our veterinary practices and that’s for another expert, that’s not what I’m going to focus on today but what did happen starting with the middle of march of this year. Let’s remember that COVID sort of entered our life possibly as early as January or February from a medical standpoint but the awareness of its scope and scale kicked off around the second week of march and since then 27 states, so more than half of the states in in America, 27 states (not by legislature, but by governor or public health department or veterinary medical board) took actions that affected they did something about telemedicine VCPR policy. We remember, of course, that once the COVID virus was viewed as potentially a widespread national emergency human health care was told “use telemedicine every way you can.” Because of social distancing needs, 27 states thought the same thing about veterinary care as well. So veterinary services as we know were declared essential — that was important right? If you’re not essential in most states you had to shut down, which has actually thrown a lot of American businesses out of business since then. Veterinary care across the country was deemed to be essential.
Three different types of actions were taken by these 27 states; let’s talk about them.
The first one and the most important in terms of impact we’re 17 states, and you’ll see a map that’ll show you those states and you can see whether you’re living in one of those states. 17 states suspended their restrictions on creating a VCPR through telemedicine; basically, opened it up under the circumstances consistent with proper social distancing and wanting to protect the safety of pet owners and, of course, veterinary staff and veterinary teams. That’s a wide mix of states it goes from east to west, north to south, large to small, blue states, red states and everything in between.
The next category involved 10 states and those states didn’t go that far but they did “encourage officially” the use of telemedicine if you have a VCPR in place. Now, you can argue that that wasn’t that tough of a stance and I’d say you’re fair there, they didn’t change anything they just encouraged people to use telemedicine. But actually, if you think about that, having the state government step up and say for care of pets and care of animals it’s important that you use telemedicine wherever you can reflected a belief that it’s good medicine because if they thought it was bad medicine, if they thought it was going to harm the pet, I don’t think a governor would have stepped up and even said encourage people to use it. So that’s interesting.
Then the next category was just a small number of states, 3:
California, Georgia and Minnesota who had pre-existing time limits which we talked about last week. Pre-existing time limits of 12 months on how long a VCPR was in effect. Remember if you saw a pet in January, the next year in February you couldn’t use telemedicine with that pet if you hadn’t seen it physically again. Only three states have that rule, but those three did take the step of extending the 12 months to 18 months. They did that so that if the 12 months was running out during COVID (and they didn’t really forecast how long COVID was going to last) they didn’t want to force you back into the clinic which could be unsafe for the pet owner or uncomfortable at least and the same for the staff.
So those are the three changes and again over half the states did something along those lines.
Where we are now is in an era of uncertainty about how long is COVID going to last, in a meaningful sense. I don’t mean until the very last person in America contracts the virus but when we have a sense that we are going to a different stage of life in this country and rules and regulations and protections other than COVID alert and a COVID emergency. So the question becomes: when we reach that point and some might think it’s soon, some may say it’s not so soon, will the policies go back to what they were before COVID started?
Which means in those 17 states are we back to traditional rules you can only establish a VCPR? Through in-clinic visits physical, examination by the veterinarian, even if the veterinarian’s comfortable doing it through telemedicine. The answer is we don’t know for sure but it is a good bet. Let me tell you that most states will say ‘well the orders are no longer
in effect we’ll go back to the prior status quo’ but I can assure you as well — the door is going to be open now after 6, 12, who knows how many months of using telemedicine. With no complaints about any harm, there will be a good debate in all those states: should we go back to that or follow human medicine’s lead and that’s going to be interesting. I think those 17 states are where you’re going to see the most activity before we go to the other 33. I guess and wonder if they’ll too get in line with human medicine.
The Veterinary Virtual Care Association, a 3600 member strong organization, that was begun during COVID and I was privileged to be one of the founders, has reached out to all those state veterinary medical boards and asked for evidence of any complaints that a pet was harmed or killed due to negligent use of telemedicine. Why is that important? Because we have a lot of theoretical debates about telemedicine, don’t we? People predicting what’s going to happen, people speculating what’s going to happen. I can tell you that now we have 6 to 8 months of an actual laboratory in these 17 states in the United States. We also have next door to us a 15 million population Canadian province, Ontario, where you all know Toronto is a huge city that anchors Ontario — they’ve permitted the telemedicine VCPR for three years. We have evidence from their version of the veterinary medical board, as recently as August of this year, for those three years there has not been one complaint, not one, that a pet was harmed or killed due to quote negligent use of telemedicine or the telemedicine VCPR. That’s very powerful data and the
Veterinary Virtual Care Association is eager to have the discussion about telemedicine policy and how to shift from speculation and predictions to actually looking at the data and evidence also from human medicine to see if it doesn’t make sense to expand its use.
Thanks for joining me. Next session we will tackle the question that’s on many veterinarians minds which is doesn’t the FDA, the Food & Drug Administration, doesn’t it set a rule out about telemedicine and VCPR?
Let’s see what the facts are there. See you next week. Thanks.
If you want more information or even more fun to engage in an extended conversation with your colleagues about these issues, go to the Veterinary Virtual Care Association or VVCA.org website where our 3600 member strong organization is engaging on all topics that concern telemedicine and virtual care for veterinary practices. Not just limited to the policies I’m discussing but how do you use it best, how do you implement it, how do you train your staff, what are the proper roles for all the staff members and actually importantly, how have pet owners reacted to it?