Make the Call on Telemedicine

Telemedicine was born out of necessity. At least, that’s how Aaron Smiley, DVM, sees it. He started in equine practice in 2007 as a fresh graduate of the University of Illinois College of Veterinary Medicine. Telemedicine was the norm even then. He couldn’t serve as many clients without it. “We’d go to the office and take phone calls for an hour before going out on farm calls,” Dr. Smiley said. “We didn’t want to waste time driving out to a farm if we could solve it over the phone. It was such a big investment of the doctor’s time.”

When Dr. Smiley moved to mixed-animal practice, he served frugal farmer clients in the Amish community who always wanted to know if a visit was required or whether they could administer medication or treatments themselves. He said they respected the need for a veterinarian but, “They didn’t want to spend more money if they didn’t need to.”

Now working in suburban Chicago, Dr. Smiley is back to feeling that telemedicine is more for veterinarians, who are pressed for time every day in practice and might need support from other folks to field questions and handle some issues outside the building.

The same necessity that drove Dr. Smiley to telemedicine early in his career led brick-and-mortar practitioners to ponder during the pandemic:

• Can we assess and educate over a video or voice call?
• Can we answer questions via email or text?
• Can we get paid for it?

TIP 1: Don’t Forget You’re Worth It

If clients are inside your practice, you have a procedure for catching fees and invoicing them. But over the phone? On text messages? Not necessarily.

“Vets have created a cultural norm where we’re so good at telemedicine that we forget it’s worth something,” Dr. Smiley said.

He worried that his wealthy suburbanite clients would balk if he started charging for telemedicine. Instead, they did the opposite. A telemedicine appointment costs the same as an in-person visit.

Other telemedicine veterinarians might charge less than a physical visit; some even do it for free. But your brain is worth money. It’s your education and expertise that sorts through vital signs, diagnostics and treatment plans. You can’t do much of it virtually, but you can do some of it. It’s worth a fee.

TIP 2: Don’t Get Caught Up on Video

Dr. Smiley started life doing telemedicine over the phone and through email and text messages, not a FaceTime or Zoom camera in sight. It’s easy to forget in a world of video calls that video is helpful but not always necessary and isn’t crucial to making a telemedicine visit worth the money.

Likewise, video or a dedicated smartphone app makes tracking appointments and billing easier, but it’s not the only way. Even if you don’t charge for the service, telemedicine contacts, especially through nonemergency asynchronous communication like email and text, could be sorted by a veterinary technician and managed quickly to determine one of the following:

• “Let’s chat on the phone.”
• “You should rush in.”
• “It’s not a big deal.”

“We got into the pandemic and everyone thinks telemedicine is live video chat,” Dr. Smiley said. “But that might be the last thing a busy doctor can do. And why have a live video chat if the animal needs to come into the clinic? It’s an even bigger waste of time.”

When you sign up for a live video chat, everybody needs to be dressed nicely and ready for the camera.

“Americans love SMS texting, and my international friends love WhatsApp,” Dr. Smiley said.

Use whatever format you and your clients prefer, and set up protocols for charging for your time.

TIP 3: Don’t Forget About the Convenience

Today’s consumers pay extra for convenience. (DoorDash?) You can imagine client conversations like these:

• “I understand your cat stresses out when it comes into the clinic, and you want to avoid that. What if we set up a short telemedicine appointment over the phone and you send me some pictures beforehand?”
• “I understand you don’t want to wait five days for an appointment, so what if we see you and your dog virtually and figure out whether you need to come in sooner rather than later?”
• “You can’t get in for your checkup to see how the medicine’s working? No problem. What if we schedule a video call and try to avoid the trip? Your smartphone camera might show me what I need to see.”
• “Your cat is stressed, but we just saw her, and her blood work looked great. If this is the only issue, and it sounds like it might be a behavioral problem, what if we schedule a 30-minute consultation with the doctor to discuss what you could change at home to try to fix the problem?”

The takeaway: Busy clients might pay the same fee or more for trusted expertise before a possible visit involving more detailed diagnostics and treatment.

Dr. Smiley’s approach: “I won’t charge two exams for the same problem if we start with the virtual exam.”

As for specialists, he said, board-certified veterinary professionals are in extreme demand these days. Asynchronous communication means nonurgent cases can loop in specialists behind the scenes at your practice to answer questions faster.

“The client doesn’t need to take off work to see the ophthalmologist,” Dr. Smiley said, so charge for the expertise as appropriate and make things easier for the pet owner and your team.

TIP 4: Don’t Assume Your Practice Act Covers You

You want to comply with your state’s laws. However, the rules governing telemedicine in your state might differ from those a colleague follows one state over. Check with your local veterinary medical association or state board, read your state’s practice act or explore the telehealth guidelines published jointly by the American Animal Hospital Association and the American Veterinary Medical Association.

“A lot of these ideas are not just legal but recommended,” Dr. Smiley said.

Then consider what you’re comfortable with regarding remote diagnosis and recommendations.

“It’s easy to be complacent,” Dr. Smiley said, and think you need to physically see every animal in person every time.

However, he said, “I always ask practitioners to ask themselves: ‘What do you need to come to that diagnosis?’”

The bottom line is this: You don’t need to go from Dr. Brick and Mortar to Dr. Digital in a day. Start where you are today.

First, inventory the telemedicine you and your team already do. Then think about how to make the service more efficient. If you want to pay for an off-the-shelf mobile app or telemedicine service, try one and then turn it off if it doesn’t work out. Your clients won’t feel abandoned.

HOW TO GET STARTED

Dr. Aaron Smiley, a founding board member of the Veterinary Virtual Care Association, served on the task force that prepared the AAHA/AVMA Telehealth Guidelines for Small Animal Practice, released in 2021. In a section titled “Integrating Telehealth Into Your Practice,” the guidelines recommend these seven steps:

• Identify a telehealth champion.
• Determine needs and opportunities.
• Develop service plans.
• Design the workflow.
• Prepare your team and clients.
• Implement your program.
• Evaluate and improve.

The complete guidelines are at bit.ly/3m2B8Jy.

VIDEO WORKS FOR HER

Hannah Lau, DVM, got her first job out of veterinary school at Adobe Animal Hospital in the Bay Area. Then she moved cross country to her dream job and found out she missed Adobe.

She’s now in Virginia and oversees a virtual off-site team for her former hospital. Veterinarians and veterinary technicians handle video appointments seven days a week and respond to live chat on the website. In addition, they answer questions, send records to other hospitals and handle client education.

How often in your hospital do you rush to show clients how to trim a pet’s nails or give fluids at home? What if someone could follow up virtually, without the practice rush, show clients how something is done and answer all the questions?

“We make it an extension of the in-house experience, not outsourced,” Dr. Lau said. “We don’t charge for basic queries on the website, but if we need a video visit, that’s a fee.”

Off-site team members mean on-site veterinary professionals don’t need to take time out of their busy days to field text messages, chat queries and video calls.

“Telemedicine has its strengths and weaknesses,” Dr. Lau said. “You can’t do abdominal palpation, but I can sometimes show a client how to check for a basic orthopedic problem or neurological problem. They become my ears and ears on the camera, and almost all clients seem eager and interested to be a part of this.”

Not every practice can have full-time, dedicated veterinarians on the line, but could some associates take a half-day at home?

“Look at the telehealth you’re already doing,” Dr. Lau said.