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The winds of change

As 2019 approaches, several critical matters — from the Fairness to Pet Owners Act to opioid abuse to telemedicine — remain unresolved.

The winds of changeIt’s October, schools are back in session and politics are in full campaign mode with the off-year elections. Here are notes and updates on most of the items we’ve been following all year.

1. Fairness to Pet Owners Act

This bill has hung around Congress since September 2010 and still hasn’t gained a hearing in the Senate or House. You will recall that “Fairness” is the legislation that attempts to drive the pet medications business from veterinary practices to big-box retailers and online pharmacies. The bill would give the Federal Trade Commission legal authority over all U.S. veterinary practices, establish the right of Congress to intervene in veterinary-client-patient relationships and mandate that no prescription be provided to a client without the veterinarian first giving a written prescription, whether requested or not. Despite widespread fears in 2010 that Walmart and other big-box retailers would roll over the veterinary industry in Congress, we won. How? By explaining to members of Congress what the bill would do to veterinary practices and how pets would be harmed if the link between veterinarians and pets was weakened. Here is the latest news: First, the act’s lead Republican sponsor in the House, New York Rep. Chris Collins, was indicted in August on insider-trading charges and removed from the Energy and Commerce Committee. He is not seeking re-election. Second, the Senate battle for party control remains too close to call. Reminder that if Democrats take control, then New York Sen. Chuck Schumer becomes majority leader. He is a Fairness sponsor in the Senate, so that means the Fairness bill would get a hearing. The president’s party almost always loses seats in his first off-year election, and Donald Trump’s standing is shaky by any measure. Nevertheless, Democrats are defending 24 seats and Republicans only nine. For this last reason, I give an oh-so-slight edge to Republicans, which means no Fairness committee hearing.

2. Hospital Unionization

You will recall from past Today’s Veterinary Business stories that the National Veterinary Professionals Union (NVPU) was formed and is attempting to organize clinics across the country at the staff level below veterinarians. While this is news, the headline is that the NVPU has teamed up with the International Longshore and Warehouse Union for financial, management, political and organizing support. This changes everything, as the prize of a share of NVPU dues from members is sure to motivate the longshoremen, a strong union with a long history. Two union votes, in San Francisco and Seattle specialty practices, were won by the longshoremen/NVPU, and one Northwest vote is under review. Stay tuned.

3. Veterinary Nurse Initiative

The National Association of Veterinary Technicians in America is driving the initiative to create a uniform title for credentialed vet techs who graduated from an American Veterinary Medical Association-accredited program and passed the national board examination administered by the American Association of Veterinary State Boards. The new title would be registered veterinary nurse. The first state considering passage is Ohio, where the House and Senate have the legislation under review. The results are expected in late November or December. NAVTA hopes to move forward in four or five other states in 2019.

4. Opioids and Veterinarians

National and state interest in the opioid crisis continues to grow as new data appears almost weekly about the scale of abuse and deaths. A recent survey of 189 veterinarians, conducted by researchers at the Colorado School of Public Health, found that 13 percent reported “they had seen a client who they believed had intentionally injured a pet, made them ill or made them appear unwell to obtain drugs.” Pressure is building in many states to change the manner in which any medical provider handles opioids. Veterinarians have been successful in most states in remaining outside of Prescription Monitoring Program (PMP) systems run by state departments of health for human doctors or dispensers. Thirty-one states have PMP laws or regulations on the books, but veterinarians are exempt. Seventeen states in some measure include all providers, including veterinarians. The states with legislation under consideration are Alabama, California, Illinois, Indiana, Kansas, Louisiana, Maine, Michigan, Minnesota, Mississippi, New Jersey, North Carolina, Oklahoma, Pennsylvania, South Carolina, Tennessee, Virginia, Washington and Wyoming. 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: In regard to veterinarians, the AVMA supports the following objectives 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 emphasis on identifying and preventing human misuse and diversion.
  • Exemption of veterinarians from accessing private health information and prescription data on a person prior to prescribing or dispensing controlled substances for an animal.

» Veterinarians are not trained to evaluate the appropriateness 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 electronic 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 shoppers 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 veterinary 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 consideration for the burden of compliance.

5. New Veterinary Schools

Three updates:
  • The University of Arizona, a land-grant and national research university, is seeking 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 college. 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.

6. Telemedicine

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: 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 another jurisdiction, or any person whose expertise, in the opinion of the veterinarian with an established 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 professional judgment to determine whether using telehealth 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 standards 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 ensuring 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 licensure 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 medical 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 telemedicine 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 considerations for each prescription issued in association with telemedicine services must be evaluated by the veterinarian in accordance with all jurisdictional 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 number and licensure status, and should provide to clients a clear mechanism to:
  • Access, supplement and amend client-provided contact information and health information about the patient.
  • Register complaints with the appropriate board of veterinary medicine or other regulatory body.
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.