on a nonemergency basis. Pet owners know that emergency clinics can be expensive, but without being able to speak with someone they trust, they may make the decision (to go or not to go to the emergency facility) without the benefit of appropriate advice. It is important to appreciate that such monitoring does not need to be constantly available, and that such teletriage can be provided when teams have the time and inclination to provide such services.
There are many other situations when virtual care is indicated. Monitoring pets receiving hospice care often lends itself to telehealth options. Nursing visits to the home of patients can also be augmented with such consultations, and nurses/technicians can add an additional level of expertise since they can provide hands‐on evaluation. For pets that cannot be easily brought in to the clinic for any number of reasons, telehealth provides one more way for them to still benefit from veterinary advice. Finally, nearly half of all pet owners are not currently bringing their pets to the veterinary clinic with any regularity, so virtual care removes one barrier to them being able to seek veterinary advice, as long as appropriate VCPRs are in place.
When considering fee options for virtual care, it is best to approach this in a team‐based manner so value can be built into the system from the start. Initially, virtual care might be offered during certain time slots in the day when there are appointment gaps. The fee can be based on what the time slot would typically command as a 10‐, 15‐, or 20‐minute appointment. Other options might include prioritizing a virtual visit over an in‐clinic appointment for a premium, if such a call could be accommodated in such an interval. For example, a client may want to hear from a doctor or nurse quickly, and be prepared to pay a premium for someone to schedule a virtual visit within a certain time frame (such as two hours, etc.). The same rationale can be used for premium pricing on consults after hours, on weekends, and in other instances where the client is being accommodated. Pricing can also reflect technology used, such as telehealth platforms, accessing wearables, etc.
Finally, not all telehealth consults need to be provided exclusively by doctors. For some virtual care, nursing staff may be appropriate experts.
For clients with pet health insurance (see 10.16 Pet Health Insurance), pet owners should check with the insurance provider to determine telemedicine coverage.
Blair Donaldson is a 3‐year‐old neutered male Dalmatian, who has been previously diagnosed with atopic dermatitis. He has been well controlled for the past several months with a daily Janus kinase inhibitor, but started scratching significantly in the last few hours. Since Blair had previously experienced pyotraumatic dermatitis (a hot spot) from his scratching, Mrs Donaldson immediately telephoned ABC Veterinary Hospital to bring him in without delay.
Julie, the customer service representative who answered the phone, was very concerned about Blair and recalled how tragic Blair seemed after his hot spot. Julie would book Blair for an appointment the next day, which was the first availability, but asked if Mrs Donaldson might be interested in a telehealth consult that could be scheduled for that afternoon, when Julie would try to create some time between existing appointments.
When Dr Green and Mrs Donaldson connected on that telehealth call, it was very apparent that Mr. Donaldson was concerned and was afraid of what Blair might do to himself if the scratching could not be curtailed.
Dr Green suggested that the likely culprit was ragweed pollen in the environment, which was wreaking havoc with many pets in the practice as the pollen count was at an all‐time high for the season. He advised that Blair be given a cool‐water soak for at least 10 minutes, gently toweled dry, and then a mild antipruritic spray be used on affected areas. During the bathing, Mrs Donaldson was to do a thorough check for fleas and other parasites, and verify with her husband that Blair's parasite control product had been administered on schedule. It was advised that Blair remain indoors with windows closed and air conditioner on and it was recommended that an over‐the‐counter antihistamine be considered (suitable products and doses were provided). It was unlikely that the antihistamine would have a major impact on the pruritus, but it might help a bit and also have some sedating effects which might make Blair more sleepy and less likely to do damage to himself. The plan was to repeat the cool‐water soak and spray before bedtime, but if Blair was not significantly more comfortable by then to give another dose of his allergy medication just this once to keep him comfortable overnight, and they would address whatever issues remained at the appointment scheduled for the next day.
Mrs Donaldson was relieved that there was now a plan in place, and felt the telehealth consult provided her with peace of mind, and she was more than happy to pay for the service.
Most aspects of virtual care must be carried out under the auspices of a veterinary–client–patient relationship.
Ideally, guidelines should be created for telehealth consults so that the entire hospital team is aware of what they are, how they should be scheduled, payment terms, and standardized medical record entries.
Remote monitoring will be an increasingly important aspect of virtual care, allowing veterinary teams to track certain pet indices from a distance.
All indications are that clients are prepared to pay for virtual care options, if veterinary teams make them aware of the possibilities.
Charging for virtual care is more a lack of a “will to bill” rather than unwillingness of clients to pay for such services.
2.5.8 Cautions
Telehealth solutions are still evolving, and regulations have not caught up with many of the applications that are possible with today's technologies.
Without a valid VCPR, any advice provided should be considered general and not specific to any patient, and should not imply any intended diagnosis or treatment recommendation.
Veterinarians considering being telehealth providers should be prepared to present their particular credentials, provide any service disclaimers, and specify what services they are able to provide, and the limitations of such telehealth consultations. If clients have pet health insurance and are hoping to be reimbursed for virtual care, they should verify that telehealth services are covered by the policy.
Practices preparing to offer telehealth solutions should seek legal advice before providing such services, or affiliating with companies providing those services. It is also worth checking with the insurance provider regarding any liability issues that could be associated with telehealth solutions.
The majority of human physicians engage in different forms of telehealth. It should be anticipated that this same trend will eventually happen with veterinary medicine as well.
Recommended Reading
1 Ackerman, L. (2019). Why should veterinarians consider implementing virtual care? EC Veterinary Science 4 (4): 259–261.
2 Ackerman, L. (ed.) (2020). Telehealth. In: Five‐Minute Veterinary Practice Management Consult, 3e, 310–311.
