Today's Veterinary Business

AUG 2018

Today’s Veterinary Business provides information and resources designed to help veterinarians and office management improve the financial performance of their practices, allowing them to increase the level of patient care and client service.

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42 Today's Veterinary Business Community animal owner, and state veterinary medical boards do not have inves- tigators whose job it is to monitor whether veterinarians properly initiate a VCPR. For decades, the topic of a VCPR rarely was mentioned in state veterinary medical board or state and national VMA meetings. Frankly, the VCPR was something of an academic topic, although it was a baseline determination in state board actions against a veterinar- ian for negligence or some level of misconduct. There has been no evidence that Alaska, Connecticut, Delaware or the District of Colum- bia have lower standards of care or more disciplinary issues because they do not define the VCPR in laws or regulations. What's New That all changed in 2016 with the debate about veterinary telemedi- cine. Why did telemedicine prompt these discussions? One reason: human medicine migrated from 50 states opposing the concept of a doctor-client relationship being es- tablished through digital (telemed- icine) means to 48 states approving this development. Only Alabama and Arkansas still object. Once veterinarians began look- ing at telemedicine, it was inevita- ble that conversations turned to les- sons learned from human medicine. While human medicine continues to work through a host of issues related to the use of digital tools to deliver care, no telemedicine topic provoked more discussion among veterinarians than whether doctors may start a professional relationship with a client through digital communication without an in-person visit. Forty-eight states now permit it to happen in human medicine and 47 states forbid it for veterinarians, so veterinarians natu- rally are addressing the question. How does the VCPR work in different states? We must start with the definitions used by state legislatures across the country, so bear with us as we lay out differ- ent versions in use. In the case of states grouped together, their lan- guage is nearly identical to what is summarized below. Alabama A relationship when the veteri- narian has assumed responsibility for making medical judgments re- garding the health of the animal or animals and the need for medical treatment and is created by actual examination by the veterinarian of the animal or a representative seg- ment of a consignment or herd. Arizona, Arkansas, California, Georgia, Idaho, Indiana, Illinois, Iowa, Kansas, Kentucky, Louisi- ana, Maine, Maryland, Massa- chusetts, Minnesota, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Rhode Is- land, South Carolina, South Da- kota, Tennessee, Vermont, West Virginia, Wisconsin, Wyoming The veterinarian has sufficient knowledge of the animal to initiate at least a general or preliminary diagnosis of the medical condi- tion of the animal. This means the veterinarian has recently seen and is personally acquainted with the keeping and care of the animal by virtue of an examination of the animal or by medically appropriate and timely visits to the premises where the animal is kept. Colorado T he veterinarian should have suf- ficient knowledge of the animal to understand its current health and render at least a preliminary diag- nosis. This would require that the veterinarian is personally acquaint- ed with the animal (herd, flock, litter or large group) either through office or home visits. Florida The documented veterinarian-cli- ent-patient relationship is defined as a veterinarian's record of a cli- ent's animal which documents that the veterinarian has seen the animal in a professional capacity within a period of 12 months or less. Hawaii The veterinarian has performed a face-to-face history and physical examination of the patient that is appropriate to the specialty train- ing and experience of the physician or the designated member of the physician's health care team, made a diagnosis and formulated a thera- peutic plan, or personally treated a specific injury or condition. Mississippi, Texas, Utah, Washington The veterinarian has sufficient knowledge of the animal to initiate at least a general or preliminary diagnosis of the medical condition. This means the veterinarian has recently seen and is personally acquainted with the keeping and care of the animal by virtue of an examination of the animal or by medically appropriate and timely visits to the premises where the animal is kept. A veterinarian- client-patient relationship cannot be established solely by telephonic or other electronic means. Pennsylvania Under the veterinarian's care means the veterinarian or one of the veterinarian's licensed associ- ates has examined the animal or has made medically appropriate and timely visits to the premises where the animal is kept. Virginia A bona fide practitioner-patient relationship means that the practitioner shall (i) ensure that Community POLITICS & POLICY

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