Why your veterinary practice should implement telehealth

"Hey, Doc, I think I've got something in my teeth." ikostudio/stock.adobe.com

All recent evidence points to the fact that pets hold a huge place in our hearts. In fact, a 2016 survey conducted on behalf of the Human-Animal Bond Research Institute (HABRI) showed that 98% of pet owners consider their pet to be part of the family.

For veterinary practices, this means that clients are willing to spend money on pet health care and are likely to consult Dr. Google or other sources about their concerns before contacting you. When they do contact you, they may send a text or Facebook message to ask a “quick” question rather than making an appointment.

It should come as no surprise that telehealth-the use of video and text messaging platforms to engage, diagnose and treat patients-is such a hot topic today. According to Adam Little, DVM, associate professor of practice at Texas A&M University College of Veterinary Medicine and cofounder of FuturePet, understanding trends in pet ownership can help prepare your practice for the next evolution of client communication.

“The world has changed and one thing we know for sure is that it will continue to change,” Dr. Little said at Fetch dvm360 conference in San Diego.

Pet ownership today

Pet owners coming into your practice have higher expectations, stronger biases and far more options than ever before, Dr. Little said. Additionally, the time it takes for them to get information is decreasing. “What used to take hours and a great deal of effort now takes seconds and can be found in their pocket,” he said. Armed with this newfound knowledge-regardless of whether it is accurate or complete-people are challenging authority figures in a range of areas.

Pet care is big business, and pet owners are speaking with their wallets, Dr. Little said. According to the American Pet Products Association, pet owners spent $72.56 billion on pet care and related services in 2018. Yet according to the American Animal Hospital Association 2015 State of the Industry report, most pets receive only about one-quarter of the care they should receive over their lifetime.

What's more, the group that is willing to spend the most on their pets is the group that makes up the largest segment of today's pet owners: millennials. In the same HABRI survey, 41% of millennial pet owners said money was “no object” in making decisions about their pets; only 36% of Gen Xers and 21% of baby boomers agreed.

The other major factor shaping the way we care for pets today is technology. Wearables and in-home virtual devices enable people to view their pet's behavior and activity at any time and provide data on an unprecedented scale. In addition, smartphones allow people to communicate instantaneously, and that's what they have come to expect.

The profession as a whole is making changes based on this new world of pet ownership, Dr. Little noted, and practices that want to remain competitive must “address the needs of today's pet owners, lower the barriers to accessing support and drive more efficient, profitable and client-centered interactions.“

The way to reach more pet owners, Dr. Little said, is to be as easy as Google. That means recognizing that a trip to your practice may be too difficult, expensive or time-consuming for some pet owners and being able to offer an alternative way to answer their simple questions quickly.

“By offering high-quality, personalized, accurate guidance and advice, telehealth services may be able to provide owners with an option between random Google searching and visiting the practice,” he said, “and there are many new and emerging telehealth services to choose from.”

In fact, Dr. Little noted, your clients may already be working with these companies without your knowledge through a number of avenues:

Employer benefit: WhiskerDocs serves more than a million pet owners through their employers.

Pet insurance: Most pet insurance companies include access to at least one telehealth service.

Subscription: Integrating wellness plans and telehealth allows practices to meet the demand for simplified and budgeted pet health care.

A la carte: Pet owners pay to access a telehealth veterinarian, with prices varying depending on the service requested.

“Freemium”: The owner can ask a certain number of questions for a set amount of money, or the initial consult with a veterinary professional is free but, if deemed necessary, talking to a vet will require payment.

Telehealth models

Dr. Little explained that there are currently two paths practices can take to incorporate telehealth. They can use, buy or license software that enables the practice to offer telehealth services to clients, or they can contract with an outside company that will offer advice when your practice is busy or closed.

Telehealth and the AVMA

The AVMA's position on telehealth has remained static: It is OK for veterinarians to provide triage and advice without having an established veterinarian-client-patient relationship (VCPR). With an established VCPR, practitioners can engage in true telemedicine, plus or minus prescriptions.

It's important to note, Dr. Little said, that the definition of VCPR varies by state. Whether a valid VCPR is present may depend on, for example, how much time has passed since you last saw the patient in practice or what condition was diagnosed during the last veterinary visit.

“It's a little messy right now,” he said, “but it is imperative that veterinarians looking to provide these types of services in the context of a VCPR understand the VCPR regulations in their state, particularly when it comes to making a diagnosis and prescribing medications.”

Software as service

With this model, the clinic licenses software (for a fee) from companies such as Medici, Teletails and TeleVet. The practice sets the scope of services it will offer via telehealth (rechecks only, for example), hours of availability and associated fees. Because this is a service you offer to existing clients, the veterinarian-client-patient relationship (VCPR) is already established (see sidebar "Telehealth and the AVMA").

This model offers practices control and customizability. They can choose among a variety of features, such as notes, scheduling, video recording and payment processing. And the practice is responsible for implementing, marketing and managing the service.

On-demand services

With on-demand telehealth, provided directly to consumers by companies such as whiskerDocs and GuardianVets, veterinary professionals who are not affiliated with your practice augment your team when you're not available. These companies primarily provide triage and general advice.

Because these are non-VCPR relationships, on-demand telehealth services can lead to broken experiences, Dr. Little said. “There may be broken links in the flow of information from the partner back to the practice,” he said. “Ultimately, a lot of the value in these services is the ability for the relationship to be connected and strengthened through each interaction. If summaries of those calls aren't incorporated into future appointments, or if clients expecting a call back from the primary care clinic to book an appointment aren't given one, it can reflect poorly.” In addition, the client must pay for both the call to the telehealth service and the visit to your practice, leading to a broken cycle of care.

The benefits of telehealth

Telehealth can be used as a continuation of care with existing patients and clients or as a way to initiate care with new ones, Dr. Little said. But with any new technology come challenges and opportunities. Implementing a new model of VCPR dynamics will require new tools and training to set the stage for success.

“One of the best advantages is that telehealth can augment the existing VCPR by directing clients to the appropriate level of care for their pet,” Dr. Little said, noting that the majority of concerns for which pet owners would typically seek the services of an emergency veterinarian are not true emergencies and can be resolved with a trip to their primary practice.

Telehealth also drives engagement. Much of a typical veterinary visit is devoted to administrative tasks, including front desk paperwork and obtaining the patient history. Rather than only having time in last 30 seconds of a hurried 15-minute visit to introduce new concepts and try to sell something to a client, the added communication that comes with telehealth provides a sense of the client's needs and opinions before they come in.

“Telehealth allows you to focus more on building client relationships and driving compliance,” Dr. Little said. By communicating with the pet owner outside the office, you may learn that an owner doesn't want to vaccinate his pet or that he doesn't understand the need for year-round parasite prevention. “With telehealth, when the client is in the office you're prepared to have these conversations,” he said.

Your future is in your hands

In many ways it's a new world for veterinarians. Deeper relationships between people and their pets, increased pet spending and investment in the industry, and the digitization of pet care are propelling veterinarians to rethink their approach to client communication and patient care. Clinics that are most successful are those that incorporate telehealth regularly, not sporadically, into their practice. When done right, telehealth can be a boon to any veterinary practice.

How frequently are you asked by friends, family or acquaintances to provide veterinary advice because the pet owner can't access or doesn't want to bother their veterinarian, or because they don't want to or can't pay for veterinary care? This so-called hidden telehealth makes veterinarians feel anxious, stressed and frustrated because they don't know the pet (or in some cases the person). “You want to offer support but you are not charging for time and knowledge,” Dr. Little said.

There are three primary reasons why veterinarians should feel justified in providing advice-and charging appropriately for it-via telehealth:

Immediacy: The pet owner can talk to someone right away about their concerns instead of having to wait for an appointment.

Interpretation: The client can send videos or photos of their pet and receive an expert opinion about what's going on.

Accessibility: Clients have access to medical expertise on demand, and with most services the client receives personalized reports and summaries after a call.