Today's Veterinary Business

OCT 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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45 October/November 2018 • TODAYSVETERINARYBUSINESS.COM 6 In regard to veterinarians, the AVMA supports the following objec- tives and efforts to address the national opioid epidemic: • Continuing education (CE) on judicious use, compliance, security and prescribing of opioids and other controlled substances, with an em- phasis on identifying and preventing human misuse and diversion. • Exemption of veterinarians from accessing private health infor- mation and prescription data on a person prior to prescribing or dispensing controlled substances for an animal. » Veterinarians are not trained to evaluate the appropriate- ness of a human prescription and are not trained in the privacy practices surrounding human medical information. • Options for reporting of suspected opioid and controlled substance drug shoppers and/or diversion, with immunity from prosecution for the reporter. • Exemption of veterinarians from mandatory electronic prescribing for controlled substances due to the lack of veterinary elec- tronic medical record compatibility with electronic prescription programs. Remediation of this problem would require funding, resulting in an increased financial burden to taxpayers and clients. • Research to determine the prevalence of veterinary drug shop- pers and to clarify the degree to which veterinary prescriptions impact the human opioid epidemic. • If participation in a PDMP [prescription drug monitoring program] is mandated: » Develop software that captures accurate data from veteri- nary opioid prescriptions to benefit human health. » Until veterinarians have effective prescription software equivalent to human health care (i.e. automatic PDMP reporting), regulations should be drafted with consider- ation for the burden of compliance. Politics & Policy columnist Mark Cushing is founding partner of the Animal Policy Group and a former litigator. He serves as legislative consultant to the Veterinary Nurse Initiative and is a member of the Today's Veterinary Business editorial advisory board. Legislatures do not appear to be backing away from the opioid issue, so veterinarians should be prepared for more engagement. The AVMA issued a policy statement that might serve as a framework for future legislative discussions. Here it is in part: Three updates: • The University of Arizona, a land-grant and national research university, is seek- ing a letter of reasonable assurance in 2019 to open a veterinary college in 2020. Arizona was turned down in 2016 but has revamped its program in an attempt to move forward. Arizona would be the first land-grant institution to open a veterinary college since Mississippi State University in 1977. • Long Island University is seeking a letter of reasonable assurance in 2019 for the launch of a veterinary college. • Texas Tech University continues to argue that Texas needs a second veterinary col- lege. Texas Tech plans to seek permission this fall from the state's Higher Education Coordinating Board and in 2019 from the Legislature. I have no prediction yet on the Lone Star State skirmish. This remains an intraprofessional discussion rather than a legislative issue. The number of states considering changes to accommodate telemedicine continues to grow, and the pace of industry conferences considering the topic quickens. The most important news comes from the American Association of Veterinary State Boards' proposed policy statement, which is up for approval this fall. The language opens the door for more flexibility at the state level in veterinary usage of digital tools. The policy statement reads: Telemedicine Guidelines for the Appropriate Use of Telehealth Technologies in Veterinary Medical Practice Licensure A veterinarian or veterinary technician must be licensed by, or under the authority of, the board of veterinary medicine in the jurisdiction where the [veterinarian-client-patient relationship] is established (location of patient at time of VCPR establishment). Any veterinarian who is licensed in anoth- er jurisdiction, or any person whose expertise, in the opinion of the veterinarian with an estab- lished VCPR, would benefit an animal, and who is consulting with the veterinarian, is exempt from licensure in this jurisdiction, provided such service is limited to such consultation. Evaluation and Treatment of the Patient(s) The veterinarian must employ sound profession- al judgment to determine whether using tele- health is suitable each time veterinary services are provided and only furnish medical advice or treatment via telemedicine when it is medically appropriate. A veterinarian using telemedicine must take appropriate steps to establish the VCPR, obtain informed consent from the client and conduct all necessary patient evaluations consistent with currently acceptable stan- dards of care. Some patient presentations are appropriate for the utilization of telemedicine as a component of, or in lieu of, hands-on medical care, while others are not. The veterinarian must take appropriate precautions to safeguard the confidentiality of a client's or patient's records. Such includes ensur- ing that technology and physical settings used as part of telemedicine services are compliant with jurisdictional or federal requirements. The veterinarian must ensure that the client is aware of the veterinarian's identity, location and jurisdiction's license number and li- censure status. Evidence documenting informed consent for the use of telemedicine must be obtained and maintained in the medical record. Continuity of Care/Medical Records Veterinarians must maintain appropriate med- ical records that contain sufficient information for continued care and are compliant with jurisdictional requirements. Documentation of the telemedicine encounter should be readily available upon request by the client. Emergency Services Teletriage may be performed by a veterinarian or veterinary technician without establishing a VCPR or obtaining informed consent to provide emergency, potentially life-saving telemedi- cine services. Prescribing Medications Prescribing medications in person or via telemedicine requires a VCPR and is at the professional discretion of the veterinarian. The indication, appropriateness and safety consider- ations for each prescription issued in association with telemedicine services must be evaluated by the veterinarian in accordance with all jurisdic- tional and federal laws and standards of care. Telemedicine Service Requirements A provider of telemedicine services must ensure that the client is aware of the veterinarian's identity, location and jurisdiction's license num- ber and licensure status, and should provide to clients a clear mechanism to: • Access, supplement and amend cli- ent-provided contact information and health information about the patient. • Register complaints with the appro- priate board of veterinary medicine or other regulatory body. New Veterinary Schools 5

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