There has been a lot of talk in the veterinary profession about telemedicine, particularly since the start of the coronavirus disease 2019 (COVID-19) pandemic. But does it really live up to the hype? According to telehealth expert Aaron Smiley, DVM, chief of staff at Devonshire Veterinary Clinic in Anderson, Indiana, and president of the Indiana Veterinary Medical Association, it does.
Although veterinarians are good at offering free telemedicine services, they aren’t so good at monetizing their remote expertise, Smiley said at a recent Fetch dvm360® virtual conference. But incorporating telemedicine into your practice not only saves you time, it generates new revenue and makes clients happy.
During his lecture, Smiley outlined telemedicine’s benefits and explained how to incorporate paid telehealth services into your clinic, using real data to support his claims.
Why telemedicine is efficient
With so many people fostering and adopting pets during COVID-19, teams at many veterinary clinics are burning the candle at both ends to match the high demand, said Smiley. But how can you take care of clients who have been with you forever and accommodate new ones with this large influx of patients? Smiley says the answer is asynchronous, paid telemedicine.
Asynchronous telemedicine involves interacting with your clients conveniently and efficiently via a telehealth app, such as Medici, Airvet, PetDesk, and others. Instead of being glued to your computer, you are receiving client images, videos, and messages at different times throughout the day, allowing you to juggle other appointments and work-related tasks.
“Most of the time, we think of telemedicine as being synchronous, sitting down at a computer and doing a video consult with a client,” said Smiley. “But veterinarians do not have to do consults this way. On the human side, insurance companies require synchronous telemedicine for reimbursement, but veterinary medicine does not have that constraint.” If you’re looking to convert to paid telemedicine, use asynchronous telemedicine, he advised. Don’t schedule time for live telemedicine video chats, he explained. “Veterinary patients do not ‘perform’ well on demand, clients are busy, and most veterinarians do not have extra time in their calendars to block out synchronous telemedicine appointments.”
About half of Smiley’s daily case load is managed via telemedicine. “That’s a big chunk of my practice that’s remote,” he said. “Telemedicine is a supplement to traditional practice and will never replace a physical exam but it does help us to meet the needs of many of our clients and patients.” Asynchronous telemedicine is also efficient for your front desk staff. Instead of your receptionist going back and forth with clients on the phone about medical concerns that they cannot directly answer, asynchronous telemedicine allows clients to contact the doctor directly.
How and when to use telemedicine
Veterinary telemedicine is not new. Generations of veterinarians have offered it to their clients since the advent of the telephone and it has proved to be a vital tool, said Smiley. Here are some specific medical recheck issues for which he uses paid telemedicine:
- Diabetes. Offer to interpret glucose curves.
- Seizures. Ask owners to send you a message or video of any seizure after you start medical management.
- Arthritis. Monitor arthritis therapy with a video of the animal moving in its “natural” environment.
- Heart failure. Ask the owner to send a video of the animal breathing to appreciate the resting respiratory rate.
- Allergies. Reevaluate seasonal allergies with pictures and videos of the animal.
- Deep pyoderma. Recheck the animal with a video or picture of the infected area to confirm that therapy is effective.
Sometimes, when veterinarians discuss diagnosing patients remotely, there is a fear of the worst-case scenario. Smiley calls this the “what-if” game. What if I miss something? What if I need a diagnostic test such as blood work? What if the client doesn’t tell me everything I need to know? Smiley’s argument is that he uses the same medical knowledge for remote and in-person exams. He collects a history, observes the pet, talks to the owner, and then uses those building blocks to create the most appropriate plan for that patient. “If you’re going to play the what-if game for virtual exams, you have to ask the same questions of yourself for the in-person exam,” said Smiley, adding that the complexity of treating a live animal ensures that veterinarians will never be able to fully satisfy every what-if question, regardless of the type of exam or number of diagnostic tests.
Telemedicine by the numbers
Smiley examined 2560 telemedicine cases with clients with whom he has an established veterinarian-client-patient-relationship. Here is the breakdown of the types of cases:
10% courtesy tele-triage with technicians/nurses
17% dermatology
12% gastroenterology
9% test results
7% postsurgery rechecks
1% toxicosis
1% cardiology
2% hospice
3% dentistry
3% neurology
4% pain management
4% urology
4% ophthalmology
7%: respiratory medicine
“This is what you are doing in small animal practice every day,” said Smiley.
Here’s a look at some of the conditions Smiley diagnoses remotely:
- Uncomplicated diarrhea. The dog is bright and alert, and the owner has a history of feeding something they ought not to.
- Uncomplicated vomiting. Similar to uncomplicated diarrhea
- Uncomplicated otitis. A video with the flash on typically allows good visualization of the vertical ear canal. If a cytology is needed, you can ask the owner to schedule a nurse or technician appointment and have the results sent back to the doctor and owner through the telemedicine app.
- Arthritis. Veterinarians can diagnose arthritis (especially in cats) better with a remote exam because animals are more comfortable at home and do not hide their pain as much.
- Fleas. A picture of caudal dorsal alopecia is almost pathognomonic for fleas.
How long it takes and what it entails
Telemedicine consults can seem to take an inordinate amount of time, but remember, it’s all asynchronous, said Smiley. The average length of 1 of his consults is about 272 minutes. That may sound like a lot, but it equates to him sending about 12 messages and the client sending 9 messages. Again, these messages aren’t always back to back and might be stretched out over the course of a few days, he explained. It depends on how busy the client is and how busy you are. Additionally, Smiley receives an average of 1.5 videos and 2.5 photos per telemedicine consult.
You’re worth it
The biggest impediment to paid telemedicine is that veterinarians don’t always realize that they are worth it, said Smiley. “When veterinarians forget their worth, they become blinded to the high value animal owners place on their medical expertise. Veterinarians revert back to the misconception that a client will only pay for services when they are rendered in person,” he said. “But it’s not true. You are worth it, and your clients are willing to pay for it.”
