One of the primary hurdles veterinarians face when adopting telemedicine in their practice is that virtual care traditionally has been free. At the inaugural Veterinary Virtual Care Summit in August, Cherice Roth, DVM, vice president of veterinary operations at ask.vet, Beth Fritzler, DVM, CVPM, managing partner at Cascade Heights Veterinary Center, and Aaron Smiley, DVM, chief of staff at 2 Indiana veterinary hospitals, talked about the economics of incorporating telemedicine into veterinary practice, and how to profit from it.

When it comes to telemedicine, the hurdles do not appear to stem from pet owners. Clients are appreciative of the service because they perceive value in virtual care and are willing to pay for it. The resistance comes from the veterinary side.

It is not easy to change the mindset of veterinarians and staff to start charging for something that typically has been offered for free. The first step is to remember that your knowledge has value and that you deserve to be compensated for sharing that knowledge, Roth told summit attendees.

It also helps to make the process more structured. Instead of informal callbacks or text-message responses, tell the client that you agree that the pet’s issue needs to be addressed, and that you can give them your full attention during a virtual appointment. Because the conversation has transitioned to a formal (albeit virtual) appointment, the owner sees greater value in it. It also provides a template for staff to explain the telehealth process and fees to owners.

Fritzler reminded attendees that human patients typically cannot talk to their physicians so easily. Instead, they typically receive a callback from a nurse, or set up a recheck appointment if they need to speak to the doctor. “We can easily expect the same in veterinary medicine,” she said.

Another hurdle facing veterinary teams is a lack of clinical and social confidence. We have spent years learning to become proficient clinicians, Roth said, and pet owners are paying for our knowledge and experience, not just a 10-minute chat. In other words, we need to believe that our words have power and value.

To practice telemedicine, veterinarians and staff must make time in an already busy schedule to learn new technological skills, and so should be compensated for this time. Further, incorporating virtual visits into the normal daytime schedule results in less nonbillable time spent after hours returning phone calls to pet owners. When these calls are incorporated into virtual visits during normal appointment hours, the practice is not losing money.

Neither Roth nor Fritzler has experienced lower average transaction rates for virtual visits compared with in-person visits. Roth did note that owner compliance and willingness to pursue additional diagnostics are often higher when the visit is virtual, a fact that she attributes to the virtual visit allowing more time for education and discussion about why certain diagnostic tests are important. When recommended during a virtual appointment, owners can bring their pet in for a technician visit for diagnostic tests. If the virtual visit requires an in-person evaluation, then the client is credited the amount of the virtual visit and the appointment is converted.

Fritzler noted that virtual visits tend to be quicker than in-person visits because there is no need to put the pet in a room or to clean the room after the appointment. The increased number of visits per hour offsets any potential decrease in revenue per transaction. For this reason, daily revenue per doctor may be better than average transaction per doctor.

Finally, because virtual visits lower the barrier for receiving care for some new pets, they may help to bring in new clients. For example, an owner who is really reluctant to bring a pet into the clinic may start with a virtual visit and establish a relationship with the veterinarian. Subsequently, when they do need in-person care, they continue the relationship.

Smiley mentioned 3 options for charging for virtual visits: subscription services, per appointment, or per unit time. All 3 veterinarians on the panel charge per appointment, and their fee is the same whether a visit is in person or virtual. That said, Roth noted that many younger clients seem to prefer subscription-based services, so that may be a pricing model to consider.

The panel agreed that triage services should remain free. It should be clearly stated that while triage can be provided at no charge, if the owner would like to talk to a doctor or if the pet requires medical expertise, a virtual appointment will be required and charged for. In addition, to offset the time spent sending text updates about patients, Fritzler adds a nominal fee for all hospitalized pets or those undergoing procedures. This allows doctors and staff to be compensated for their time without specifically billing for providing updates to owners.

Charging for virtual visits appears to be straightforward, but what happens when a virtual visit needs to be converted to an in-person visit? Smiley learned this lesson the hard way. Initially, when he recommended that a virtual visit convert to an in-person visit, he would waive the fee for the virtual appointment and instead charge the in-person visit fee. However, when a subset of patients recovered and no longer needed an in-person visit, that revenue was lost. Instead, he now charges for all virtual visits, but if an in-person visit is also required with a doctor (versus a technician appointment for diagnostic tests), he credits the cost of the virtual visit during the in-person visit. Costs are the same for virtual and in-person visits, but the timing of the charge is different. 

Roth noted that one of the biggest hurdles for adopting and charging for telemedicine remains state-specific veterinary practice acts, and whether a veterinarian-client-patient relationship can be established solely by virtual means. The other hurdle, as Smiley reiterated, is for veterinarians to believe in our sense of worth and remember that clients are willing to pay for our expertise. We must remember that we have value.

Rebecca A. Packer, MS, DVM, DACVIM (Neurology/Neurosurgery), is an associate professor at Colorado State University College of Veterinary Medicine and Biomedical Sciences in Fort Collins. She is active in clinical and didactic training of veterinary students and residents and has developed a comparative neuro-oncology research program at Colorado State University.

Articles

A look at the economics of incorporating virtual care in your hospital, and how to make it worth your while financially.

How to turn a profit with veterinary telemedicine 

Today marks the 14th World Rabies Day, “A global health observance started in 2007 to raise awareness about rabies and bring together partners to enhance prevention and control efforts worldwide,” according to the 

Centers for Disease Control and Prevention (CDC)

Rabies is 100% preventable, yet it claims 59,000 human lives a year. That’s why the CDC, along with the 

, the World Organization for Animal Health (OIE), and the 

Food and Agriculture Organization of the United Nations (FAO)

 have pledged to eliminate human deaths from dog-transmitted rabies deaths by 2030, which makes this year’s theme, 

“End Rabies: Collaborate, Vaccinate” 

Here are 5 rabies articles that offer vaccination updates and obstacles, plus some educational resources for your clients. Take a look:

Rabies: Making a dent in a deadly global problem

Rabies is the deadliest zoonotic disease, yet somehow it’s also neglected. Find out how 2 organizations are giving the virus the attention it deserves.

: Here’s everything you need to know about the varying laws surrounding rabies vaccination and exposure across the United States.

Veterinarian, clients clash over rabies vaccine

: In this veterinary dilemma, Dr. Marc Rosenberg shares weight in on rabies state vaccination laws and client concerns.

Put rabies on your veterinary clients’ radar

: Here are 5 rabies facts that you should share with your clients.

Client handout: Rabies 101: What you need to know

: Need help discussing rabies with your clients? No worries. We got you covered! Check out this useful handout.

In honor of this special day, here are 5 articles that detail some of the latest information about this deadly zoonotic disease, plus recent efforts to stop it in its tracks.

Celebrating World Rabies Day with 5 must-read rabies articles

This week on dvm360, we will post a wide array of engaging clinical and news content including:

 In honor of this special day, we share 5 must-read rabies articles.

: On Episode 17 of The Vet Blast Podcast, Dr. Adam Christman interviews 

 co-founder Emily M. Stein, PhD, who discusses the microbiome and dental treatment modalities. On Episode 18, Dr. Adam Christman talks with second-year veterinary student Maria Camila Garcia Estrella about the Latinx veterinary community

An article about a recent dvm360 diversity panel discussion.

Stay tuned for more news and views, and follow us on social media for updates!

Here's a sneak peek at this week's coverage of the veterinary industry.

This week on dvm360

Merck Animal Health, in concert with the American Association of Bovine Practitioners (AABP), announced today that it has awarded scholarships to 18 second- and third-year bovine veterinary students. During the 2020 AABP annual conference in Louisville, Kentucky last week, each recipient was presented with an AABP Bovine Veterinary Student Recognition Award plus $5,000, with the total monies awarded amounting to $90,000, according to 

“Merck Animal Health is proud to honor these students who represent the future of cattle care,” says Justin Welsh, DVM, executive director of livestock technical services at Merck Animal Health. “These exemplary students embody Merck Animal Health’s mission to advance the science of healthier animals. I am confident they will support this mission and make an impact on the field of veterinary medicine as they continue their careers.”

According to the company, scholarship recipients are selected based on academic achievement, career goals, work experience, and interest in veterinary medicine.

“This outstanding group of students demonstrates that the future of cattle veterinary medicine is in good hands,” said AABP executive director Fred Gingrich II, DVM. “The AABP is sincerely thankful for the partnership and support of Merck Animal Health so that we can recognize these promising future colleagues. Supporting the next generation of veterinarians is a mission made possible through these partnerships.”

To learn more about this scholarship, go 

All recipients received an AABP Veterinary Student Recognition Award and shared $90,000 in scholarship funds.

Merck Animal Health awards 18 bovine veterinary student scholarships

Now that fall is upon us, we will continue to keep you updated with the latest news about the pandemic and our latest coverage of the veterinary industry.

View the video below for this week's top veterinary headlines:

 across the nation are demanding less talk and more action when it comes to addressing these issues in the veterinary profession.

Pawsibilties, formed to tackle diversity and inclusion issues in veterinary medicine

our second Fetch dvm360 virtual conference

. The event, which will be held November 12-14, 2020, combines 3 of our 6 annual live events—Fetch Indianapolis, Fetch San Diego, and the Atlantic Coast Veterinary Conference (ACVC).

Videos

News wrap-up: This week's headlines, plus creating change within the profession

Dachshunds are the human equivalent to dwarfism, says neurologist and neurosurgeon Fred Wininger, VMD, MS, DACVIM (Neurology). “When we artificially bred dachshunds to have short little legs and a long back, we essentially artificially created a condition known as chondrodystrophy, which is Greek for ‘faulty cartilage.’” Where a Labrador retriever may have disk degeneration at age 8, 9, or 10, he explains, dachshunds have complete degeneration of their disks by the time they are 3 years old.

“It’s like they need another pair of legs in the middle of T12 and T13,” Christman joked. “Right,” Wininger agreed, “or more ribs.”

In this episode of the podcast, Dr. Wininger, who practices at Charlotte Animal Referral & Emergency Care in Charlotte, North Carolina, shares his knowledge about IVDD, including the differences between type 1 (degeneration of the inside of this disk predominantly) and type 2 (more of a slow protrusion or disk shifting that causes compression of the spinal cord). “Most dogs are probably somewhere on the spectrum of having a little bit of both,” he says.

Wininger also talks about type 3 herniation, also known as a missile disk or torpedo disk, which is now being seen due to the use of magnetic resonance imaging (MRI). In these dogs, he says, rather than a primary herniation or protrusion, a normal disk that is not that desiccated will rupture through, and actually not only bang the spinal cord but penetrate the spinal cord or hit it and then dissipate away. The new term is acute noncompressive disk herniation. “Those are dogs that get spinal cord injury in the absence of needing surgery.”

Regarding diagnostics, “The gold standard is always going to be an MRI,” Wininger says. “MRI is going to enable you to see not only the disk herniation and the rest of the spinal column, but it’s going to let you see the degree of the spinal cord compression.” Although computed tomography (CT) is not the first option, Wininger says there are some benefits to using this modality. CT is cost-effective, quick, and does not require the patient to be anesthetized like MRIs do.

They also discuss what types of herniation are considered a surgical emergency versus what can be treated with medical management, how the use of advanced imaging techniques has altered the typical treatment course, newer prevention options, and factors affecting patient recovery time. 

To learn more about managing IVDD in your patients, listen below.

Podcasts

In this episode of The Vet Blast Podcast, Dr. Christman is joined by Fred Wininger, VMD, MS, DACVIM (Neurology), who shares his extensive knowledge about intervertebral disk disease in dachshunds.