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Chapter 1: Tales from the COVID-19 front lines

Veterinary practices are hard at work seeing patients in person and by remote means.

Chapter 1: Tales from the COVID-19 front lines
Deb Stone (upper right) leads a staff town hall at Brodie Animal Hospital in Austin, Texas.

Today’s Veterinary Business asked veterinary and industry professionals to talk about what they’re seeing and hearing as the United States deals with the COVID-19 pandemic.

This week: Telemedicine is getting a big thumbs-up from veterinary practices during the national coronavirus emergency. Veterinary professionals inside and outside of practice report that while it’s business as usual at many clinics, some hospitals are putting remote consultations to greater use, meeting clients in parking lots and doubling down on cleaning and sanitizing.

Read other installments in this series:
Chapter 2  Chapter 3  Chapter 4  Chapter 5  Chapter 6  Chapter 7  
Chapter 8  Chapter 9 Chapter 10  Chapter 11  Chapter 12  Chapter 13  Chapter 14  Chapter 15

Cary Consulting CEO and change agent Mia Cary, DVM

What’s happening at the practice level seems to be changing by the hour. The American Veterinary Medicine Association is advocating to ensure veterinary practices continue to be listed as essential businesses so that they can remain open as long as possible.

I’m seeing increased use of telemedicine. The practices that are further along on the virtual care continuum are having an easier time adjusting to more virtual connections with their clients. Even for practices that are just beginning to dabble with virtual care, it’s a valuable way for any veterinary practice to honor social distancing while continuing to provide top-notch care for their clients and patients.

Most veterinary practices are deferring elective procedures to preserve medical supplies for emergencies. One client I am working with was ready to launch a pilot field trial for a new product, and we have, of course, put that on hold.

[The American Association of Veterinary State Boards is urging lawmakers to classify veterinary practices as essential businesses. Read “National Veterinary Group Issues COVID-19 Guidance” at http://bit.ly/38Z4oXI.]

Getting Technical columnist, practice management consultant and Patterson Veterinary University instructor Sandy Walsh, RVT, CVPM

My practices are notifying clients of their enhanced cleaning protocols and asking clients to postpone wellness services in an effort to reduce crowding in the waiting rooms. Practices are also asking for prescription refills to be called in in advance for delivery to the car.

Options for staff are to do vaccines in the car or to take the patients from the owners in the parking lot so they don’t have to come in to the clinic.

Hospital staffing is not really impacted, but employees are asked to stay home if not feeling well.

I’m also seeing telephone or video consults for non-urgent medical progress exams and incision checks.

Creative Disruption columnist and WellHaven Pet Health chief medical officer Bob Lester, DVM

Ever the optimist, I’m reminded of past crises like 9/11, the Great Recession and the Gulf War, when Americans turned inward to home and hearth. At the center of that home are our pets, whose unconditional love and constant support is even more important in times like these.

We’re seeing a similar phenomenon in our family of WellHaven hospitals during today’s coronavirus outbreak. Clients are eager to care for their four-legged family as they spend more time at home. Pet families need veterinary professionals now more than ever. Through this weekend, we’ve helped a record numbers of pets over the first 11 weeks of the new year, with little impact to staffing and hours. We anticipate that will begin changing this week and in the weeks to come.

To date, we have only a handful of team members out on quarantine, none with confirmed COVID-19. Our first concern is the health of our doctors and teams, balanced with the necessity of fulfilling our Veterinarian’s Oath to provide for the protection of animal health and welfare.

We’ve built contingency plans to share resources between sister hospitals, arranged for telemedicine options, provided for car-side check-in, provided hospitals with flexibility in schedules, and have had kids come to work with parents — safely supervised and housed in the break room — in some instances.

We are monitoring the CDC, WHO and AVMA/COVID-19 websites throughout the day and have assembled a rapid-response team that meets daily in support of our hospital teams to answer their questions and give them the support they need to continue to help pets and families.

It’s a day-by-day, very fluid situation for now. We stand ready to support our teams, clients and the pets in our care. April may prove to be a very interesting month.

Take Charge columnist and Charleston, South Carolina, practice manager Abby Suiter, MBA, CVPM

We haven’t changed hours or services yet. We are discussing various methods of social distancing while continuing to provide patient care.

To date, child care obstacles are the only effect. No one has called out yet, but we are working on ways to accommodate for it, including paid time off, when it inevitably occurs. We set aside a portion of our H.R. budget for bonuses, which also allows us to keep employees paid in unique situations such as this. We are routinely faced with closures for evacuations during hurricane season and lean on this budget line to ensure our team receives a full paycheck and business profit is protected.

Today [March 16] was our first day of heightened local awareness, and the schedule for the next few days is full, per usual. While some clients may avoid our office to social distance, others will more readily make an appointment because they are more free from work and school obligations than usual.

Beyond Indigo Pets president and Today’s Veterinary Business editorial adviser Kelly Baltzell, MA

Everyone we talk to is in scramble mode. We are working with hospitals every day to keep up with the changing environment. Tomorrow [March 17], we are putting on a web conference with Dr. Jess Trimble to discuss the options of telemedicine. [View the webinar at http://bit.ly/2U0r8lU.]

What we are working on right now with all hospitals is how do we keep them accessible to pets during this time, being it electronically or changing procedures at the hospital? Our hospitals as a whole have been very fluid about making changes quickly, like having people stay in their cars and the staff comes and gets the pet.

Our advice to clients is stick to a few messages like:

  • “We are open.”
  • “Don’t abandon your pet; they can’t make you sick.”
  • “Look at how to reach your clients in a shutdown through telemedicine, FaceTime and Zoom.”
  • “Look at delivery options for meds.”
  • “Update your Google My Business area to reflect if you are open and how to reach you.”
[For more information, see the Beyond Indigo Pets blog post “Using Technology to Support Client Communications During COVID-19” at http://bit.ly/2TSybga.]

HR Huddle columnist and Veterinary Business Advisors human resources consultant Kellie G. Olah, SPHR, SHRM-CP

We have some practices that are going on like nothing is happening and others that have no clients. Most of the differences are geographical. Our clients in North Carolina are thriving and those in New Jersey are struggling right now.

Some practices are going emergency only, others are starting a concierge service where clients wait in their cars until appointment times, others are practicing telemedicine, and others have made no changes.

With school closings, a lot of staff has to be home to take care of children and help them with online schooling, so a lot of hospitals are running on skeleton crews already.

My advice is to communicate, communicate, communicate. With the situation seemingly changing by the hour, be sure you are continually in communication with your staff and clients.

I also suggest that practices follow CDC recommendations for cleaning and keeping good hygiene.

Today’s Veterinary Business contributor, practice consultant and Southern California Veterinary Medical Association executive director Peter Weinstein, DVM, MBA

I’m not hearing from members about any overt business slowdowns — in other words, they haven’t felt it quite yet. I am seeing tremendous numbers of emails from members to clients that provide peace of mind for them to come to the practice and to know that it is as safe as possible from the spread of infectious disease.

One practice is decreasing the number of patients or clients they are seeing so that no more than one or two people are in the waiting room. Some practices are telling clients to text when they arrive and to stay in the car until an exam room is open. They’re taking payments either in the car, in the exam room or over the phone so that they’re minimizing exposure to other people. They’re also educating their staff members on preventive care as far as hand-washing, distancing, etc.

I spoke with a telemedicine company on Friday [March 13], and apparently they signed up more people in 24 hours than they had in the prior three months.

It’s a perfect time to integrate telemedicine into your practice, however there are still laws and regulations under which we have to practice veterinary medicine. The use of telemedicine for follow-up care is pretty straightforward. The use of telemedicine with clients with whom you have an existing veterinarian-client-patient relationship is a little bit easier because you’re just giving them a convenience that they might not have necessarily had.

The use of telemedicine with non-clients might be a risk issue. I spoke with an attorney about [exceptions during public emergencies]. It’s going to be on a state-by-state basis, number one. And number two, it will depend on the outcome of the case — in other words, if veterinarians make assessments through telemedicine that lead to deleterious outcomes for the pets, they may not have a leg to stand on when it comes to a state board.

The other thing to consider is if you establish a telemedicine relationship with a non-client, how do you attach the client information so that you have a medical record with which to document the conversation?

I think telemedicine has a perfect opportunity to increase access to a practice for existing clientele, but I would be very careful utilizing it for non-clients.

[For more on telemedicine, see Dr. Ernie Ward’s blog post, “The Coronavirus Catalyst tor Telemedicine” at http://bit.ly/2QmnYXp. Dr. Ward is a Today’s Veterinary Business contributor and editorial adviser.]

Austin, Texas, practice manager and VetPartners President Deb Stone, MBA, Ph.D., CVPM

We’ve been watching the progression of COVID-19 since we first heard about it. Although Austin hasn’t yet been considered a hotspot, we wanted to keep our team up to date and be as transparent as possible in order to keep them, as well as our clients and patients, safe. The owners and I had early conversations about what the future could look like and how our practice could be impacted.

Steps we took:

  • We first wanted the team to learn the best self-care practices possible, so we had a human health care professional educate our team on how and why: hand-washing, no face touching, elbow bumps and more.
  • Next, I met with the associates and leads to discuss concerns and best medical practices while avoiding possible exposure.
  • Then, we had a town hall where I opened the floor to questions and I answered as many questions as possible.
  • I drafted a client letter that, after it was circulated and approved by associates and leadership, went out to all of our active clients. We will provide updates as they occur.
  • We eliminated social distancing for “physical distancing” as everyone needs to engage on some level.

We have not experienced team schedule changes. The recent announcement of school closures has caused us to develop creative scheduling for associates and all team members.

Appointment schedules have not been impacted so far. However, some clients have disclosed that they are fearful of coming in to the practice.

We all need to be open to doing things differently, and as a result, this may provide better pathways to deliver veterinary medicine and client service in the future. This also reinforces the value of telemedicine.

[Check out the VetPartners “Coronavirus-19 Resources” page at http://bit.ly/33mGXGx and the North American Veterinary Community’s “Coronavirus and Pets” page at http://bit.ly/2IOf4hb.]

Today’s Veterinary Business contributor and Cara Veterinary co-founder and President Peter Brown, DVM

We haven’t had any change in hours or access. We have launched car visits, home visits and teleconsulting when indicated. Our cleaning protocols have been increased. Clients spend less time in the lobby and more time in the exam room.

There’s been no change in staffing. We have an increased number of sick callouts based on us enforcing a strict “You feel sick, you stay home” policy.

We are flat in the number of visits compared with last year — a few cancelled appointments, mostly from senior clients who are self-quarantining.

Fearless columnist and Chicago practice co-owner Natalie Marks, DVM

As of March 16, there was very little change in the number of appointments that clients wanted. In fact, it almost seemed as busy, but with many more client calls requesting food and medication refills proactively.

We have postponed elective surgeries and dental procedures to help conserve masks and gloves for human health care.

We eliminated in-person technician appointments and are doing every appointment by drop-off. That means clients wait in the car, call when they arrive, pick up the pet at the front door of the practice and pay over the phone from the car.

We aren’t allowing any visitors, company reps or other non-essential employees inside the building. Clients are encouraged to order online for home delivery, or they call when they arrive and we will bring meds and pet food outside for curbside pickup.

Our hours haven’t changed. We are trying to be very cognizant of our clients’ concerns and worry. We are updating our social media as often as we can with updates from the veterinary world and those that affect clients.

I have tried to personally check on my known high-risk clients — those who are ill or senior — to see if they need anything.

What an unprecedented time.

North American Veterinary Community chief veterinary officer Dana Varble, DVM

Many clinics have canceled or postponed elective procedures to ensure they have enough personal protective equipment and supplies for emergency patients. Many clinics are asking clients to either wait in the car completely or wait in the car until they can be escorted directly into an exam room. Many are doing transactions in the room to avoid crowds in the lobby. Some are instituting telemedicine practices if they have a valid VCPR. Most have also increased sanitation frequency and are asking clients to wash their hands or use hand sanitizer upon arrival.

My overall message is be prepared. Think about the worst-case scenario — large numbers of staff ill, having to close for a time — but also plan for a middle-of-the-road scenario. Be ready to change plans as needed; be flexible and creative. Consider that now might be the time to implement telemedicine practices for the benefit of yourself, clients, staff and patients.

Talk to your neighboring clinics and emergency and specialty clinics to consider collaboration. Veterinary medicine is essential and as a community, I know that we will not only survive this but thrive.

I know it is extremely stressful to take any reductions in your business at this time, such as the loss of elective procedures, but think long term. Your best clients, best patients and best staff will arise from your support and guidance.

Socially Acceptable columnist and IT and digital strategist Eric D. Garcia

On my end, practices are still operating normal schedules. They have more than anything increased sanitation and offered multiple employees the ability to use their vacation and sick time. Normally, they’d only allow one or two employees to use paid time off at the same time.

Now is the time to start engaging clients with telemedicine. I have many practices that are doing it, with some clients taking advantage of it at a much higher pace than previously.

I recommend communicating to clients what you’re doing from a sanitary standpoint. Encourage the owners of sick pets to not come in and to take advantage of telemedicine instead. Encourage clients to wait in their cars until the patients are ready to be seen. My practices use texting platforms to text clients about when it’s OK to come in and go straight to the exam room. Be proactive at communicating these steps via social, email, push notification and text campaigns.

Many conferences, of course, have been canceling. Now is a good time to take advantage of remote CE like VetFolio. Some of my engagements have been moved to a Zoom meeting to continue some level of normalcy. There is no reason for some smaller meetings to not take advantage of remote meeting programs to keep the CE moving forward.

Veterinary industry consultant and Today’s Veterinary Business editorial adviser Fritz Wood

The feedback I have so far is that business is only marginally slower. Since people are spending more time at home and their pet is important — even more particularly in times of tumult and confusion — I wouldn’t be surprised if the profession escaped relatively unharmed.

The dinner CE circuit is dead, and since that’s a large part of what I do, my schedule suddenly opened, indefinitely. It’s a great opportunity to finally work through that oft-ignored to-do list.

For the veterinary practice, I would emphasize telemedicine consults and home delivery through an online pharmacy. On the personal financial planning side of the business, the advice is to hold steady, or add to equities as appropriate.

Money Matters columnist and veterinary industry consultant Leslie A. Mamalis, MBA, MSIT, CVA

Half of Summit Veterinary Advisors’ staff work from home already, and those of us in the Denver office have been working from home a few days a week. The goal is to be prepared to move to virtual officing before the end of the year. This is just pushing us to start earlier.

I was scheduled to leave for Vietnam, Laos and Cambodia today [March 17]. Instead, I’m trying to track down fresh produce and milk. Not what I was hoping for, but my disappointment is nothing compared to what some people are enduring. It’s scary now, especially with the constant news cycle. I hope to get outside and get some healing energy from Mother Nature.

I’m pleased to say that both my family and my Summit family are healthy. My mom is in independent living and has been confined to her apartment for a few days now. She’s not sick, but some of the other residents have coughs and the facility is being cautious.

We have had a number of calls from our clients wanting help with what to tell their employees and clients. A few have needed reassurance that we will all get to the other side of this. No one has answers, but I do my best to listen.

Summit consults almost entirely on numbers and profit, but so much of a hospital’s success is based on steady leadership. We often have close relationships with our clients, and I’m honored that they reach out. I do my best to instill some calm, give advice about what to say to reassure their employees and help them look beyond the virus to the better days that are sure to follow.

We want to hear from you: How has the COVID-19 emergency affected you, your practice or your veterinary business? Email editor Ken Niedziela at [email protected].

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