In California, pending vet telemed bill invites key debate over Vet-Client-Patient-Relationship definition

A significant piece of legislation for veterinary telemedicine is making its way through the California legislature, with a committee hearing scheduled for July 10. The legislation still needs to pass a Senate vote, and TCR will be covering it, including but not limited to stakeholders, lobbyists, and key policy debates.

According to an ASPCA survey of a representative sample of U.S. pet owners, over the past the two years, about a quarter of respondents said they were unable to access veterinary care, with over 40 percent saying they couldn’t afford it.

During the pandemic, North American veterinary practices offered more telemedicine options, with an increase from 4 percent to 30 percent of practitioners surveyed, according to the AVMA Veterinary industry thought leaders like attorney Mark Cushing, a founding partner of the Animal Health Policy Group, have consistently argued that telehealth solves urgent, crisis-level challenges in the veterinary profession such allowing more clients to access more affordable care. It’s a growing industry, with approximately 18 percent of all projected revenue through veterinary work to come from online consultations and exams by 2030, according to data collected by Straits Research, a global market researcher.

Does Pet Insurance Cover Your Virtual Vet Visit?

There is no policy language on its website to indicate that Trupanion, one of the largest U.S. pet insurers, currently covers virtual vet visits through its U.S. core subscription products. Trupanion spokesman Michael Nank, who is reportedly part of the latest round of layoffs announced on Wednesday, did not return TCR’s email seeking comment about coverage of virtual visits. Neither Mr. Nank nor founder and CEO Rawlings have returned TCR’s phone and email requests for comment regarding reports of Mr. Nank’s dismissal.

Nationwide, another large pet insurer, offers a subscription-based telehealth service for its policyholders. Whether Nationwide covers virtual visits was also unclear from examining the website. Spokesperson Karen Davis has also not reuturned TCR’s email seeking comment.

As for pet insurer Lemonade, virtual visits are generally covered under eligible conditions, according to its website, but only if the insurer has added-on a “Vet Visit Fee” to his or her policy.

New California Legislation Would Remove VCPR Requirement

Each state is different in its allowances and what a veterinarian can do during a telehealth appointment.

Currently, California is one of the strictest states, allowing for veterinary telemedicine only after a VCPR [veterinary-client-patient-relationship] is established in-office. And the veterinarian can only give advice virtually on ailments the patient was first seen for during an in-office visit.

Generally, all appointments need to be conducted by a veterinary professional licensed in the state in which the patient is in, and most states require what’s called a VCPR —a veterinarian-client—patient-relationship — to be established in-person. Current exceptions to the VCPR requirement include Michigan, Delaware, Connecticut, Alaska, and the District of Columbia, where legal definitions of “VCPR” .  Virginia does have a definition and allows for a VCPR to be established virtually.

AB1399, co-authored by Assemblymembers Lisa Friedman and Josh Lowenthal is backed by many of the leading California animal welfare and shelter programs across the state, including co-sponsors The San Diego Humane Society and the ASPCA.

“[The bill is] aimed at increasing access to care in veterinary medicine,” San Diego Humane Society’s President and CEO, Dr. Gary Weitzman said. “We are at a crisis point in the profession and as a consumer too, it’s incredibly difficult to access care.”

“I think it’s going to have bipartisan support, to be candid,” said Assemblymember Lowenthal, one of the bill’s co-authors. “There’s also momentum for this, because it’s refreshing to see the veterinary associations came to the table in Arizona.”

Lowenthal was referring to a similar bill the Arizona governor recently signed into law with bipartisan support. “We are hoping to see that same level of engagement here,” he said.

Vet Trade Groups Oppose Telemed Bill That Would Upened VCPR

The American Veterinarian Medical Association (AVMA), the vet industry’s main trade association, and its California affiliate (CVMA) have, for the most part, taken positions opposing any telehealth legislation that removes the requirement of an in-person VCPR.

“Dr. Teller is completely supportive of the AVMA’s position on the necessity for establishing a VCPR in-person before engaging in telemedicine,” AVMA spokesman Mark Rosati said in email statement to The Canine Review.

“I could only provide telemedicine if I’d seen your dog within the last twelve months, and only for the condition in which I saw her,” said Dr. Jennifer Scarlett, Executive Director of the San Francisco SPCA, and a supporter of the bill.

To the bill’s proponents, it makes sense that California is trying to change the current regulatory environment, and to be a template for the rest of the country.

“That really is the question here: Why is such a progressive state, with so many people…why we are so far behind in California?” asked Dr. Weitzman in an interview with The Canine Review. “There is more than one reason. In general, we in veterinary medicine are about ten to twenty years behind our human medicine counterparts anyway, so it’s not a surprise that telehealth exists in human medicine, [but not veterinary care.] But California in particular, we are a highly regulated state, that’s part of the reason this is being opposed, [the idea] that regulations will weaken [care] and care will be harmed with the relationship between the veterinarian and his or her client. It’s about regulation,” he said.

However, advocates see the possibility that seeing clients outside regular business hours, or at their home office through video chats on days they are not in the hospital could be a boon for many vets’ time management and business.

“We wanted to be on the vanguard to making that easier,” said Dr. Weitzman about the flexibility telemedicine would afford veterinarians’ schedules.

Other Telemedicine Players Push Ahead

Regardless of state regulations, the veterinary telemedicine industry is moving forward to make access available. Companies such as Vetster, AskVet, and Pawp have national reach with monthly subscription services that include video chats and a 24-hour advice line. Others, such as TeleVet, are for veterinarians to integrate telemedicine into their clinic routines.

And Chewy, an online pet product marketplace, is starting to offer vet services—without the ability to prescribe medication or diagnose illness, while Walmart recently announced a partnership with Pawp, making subscription services available for its customers.

“We need to expand access, especially since with the experiences we’ve had since COVID, that telehealth is a very safe tool we can use, and we should apply it now,” said Assemblymember Lowenthal.

Yet, on-going care with one veterinarian isn’t what these companies offer, nor are they necessarily able to offer it, as most vets with a long-standing client will ultimately want to see the pet in-office sometimes, depending on the situation. Dr. Scarlett believes there is room for both within a veterinarian’s practice.

“[It’s] based on what I can visually observe and then also get from the owner,” she said about seeing a patient, which may apply in-person as well as through a video portal. “We have to trust our veterinarians. Not everything is going to be treatable by telemedicine or appropriate. And let us use our experience and our license and our certification to make that decision, just as we make that decision in the exam room, just as we make that decision on what diagnostics we make,” she said.

“We are left scratching our heads,” said Dr. Weitzman. ““It’s a proven practice in human medicine, even when dealing with patients who are nonverbal. In human medicine, sometimes the patient doesn’t have the words to tell you what hurts or doesn’t,” he said, and yet telehealth has become an integral part of many patients’ lives.”

Dr. Scarlett concurred. “It’s used in human medicine for nonverbal patients quite successfully through the use of a caretaker,” she said.

But lower cost isn’t the only factor in why telehealth may work well for certain clients, said Dr. Scarlett. Telemedicine also allows the pet owner to meet the professional on their terms.

“I mean, imagine the person who’s homebound and worried about their animal,” explained Dr. Scarlett. “Instead of having to call a neighbor and go through all kinds of machinations and spend hours waiting and stressing out about trying to get an appointment or emergency visit, to be able to have a vet meet you online and say either ‘this is something that we can treat at home or let’s watch it for X amount of time and go ahead and make your appointment,’ like, the relief to clients, I think, is enormous to know that they can contact a licensed California vet and get the guidance that they need,” she said.

For Assemblymember Lowenthal’s constituents in Long Beach, Carson, Signal Hill and Catalina Island, the possibility to access care remotely is seen as a lifeline, especially for Catalina Island residents.

“It effectively is a rural community that is completely cut off with tough weather or other circumstances,” he said. “And for the thousands of people that live there having access to telehealth for animals is vitally important. There is demand from the residents, [they] are speaking up about this,” he said.

“They’ve had telehealth during COVID, and it provided an incredible amount of relief for them. To get on a boat that takes an hour in either direction that’s shut down when there are things like wind or regular rain, to be able to get medical care via Zoom has been a game changer for them,” he said. “I think it would provide a tremendous amount of relief in rural communities overnight and instantaneous.”

The bill passed Assembly vote on May 31.

Dr. Scarlett said the vote cannot come soon enough. “The time has come,” she said. “It’s used in other countries. It’s used in other states. There’s really no excuse not to move our profession forward.”