Veterinary clinics adapt to new normal

Veterinary medicine showed itself to be mostly resilient to the Great Recession. The question now is whether the profession is pandemic proof.

With about 400,000 cases of novel coronavirus disease confirmed in the United States as of April 7, the Trump administration had announced the creation of a Coronavirus Task Force, declared a national emergency, and closed the U.S. borders with Canada and Mexico while the State Department issued a Level 4 “do not travel” advisory, recommending that United States citizens avoid any global travel. Meanwhile, at least 42 states in addition to local governments had responded with various shelter-in-place policies to turn the tide of infection, such as ordering the closure of schools as well as malls and other businesses deemed nonessential.

Veterinary organizations are requesting federal and state lawmakers exempt veterinary practices from such measures and allow practices to remain open during the quarantine. “Veterinary teams provide essential animal care, play a critical role in protecting the health of animals that enter the food supply, and serve as trusted members of the local community in disaster situations,” the AVMA explained in a March 17 statement.

Improvise, adapt, overcome

Most jurisdictions recognize veterinary practices as essential and are allowing them to operate during the COVID-19 outbreak, but it’s far from business as usual.

Many clinics have temporarily suspended elective procedures, such as routine dental cleanings and nail trims, while still performing emergency procedures and some vaccinations. Physical distancing is observed by providing curbside pickup so clients need not enter the hospital. Clients who are feeling ill may be asked to postpone their pet’s appointment or have someone else bring the animal in; if that’s not possible, then other arrangements may be made.

Kathryn Coyne, CEO of the Animal Medical Center in New York City, said the most obvious impacts of the epidemic at the hospital are a decline in elective appointments and a 50% drop in patient visits.

“A heated, outdoor waiting area in our parking lot separates the general public seeking care from our medical and clinical staff in order to reduce the risk of virus transmission,” Coyne said. “There is no public access to the building with few exceptions, and all discussions with clients … take place by phone as the animal is admitted for care.

“We have established separate hotline numbers, one for clients and another for referring veterinarians, to call with questions and to help determine if they should send an animal to our ER (emergency room),” she added.

This is a time when a small business can really build relationships with their clients by making sure that they communicate clearly.

John Volk, senior consultant, Brakke Consulting

Coyne said the Usdan Institute for Animal Health Education at AMC hosted a live presentation on Facebook on March 18 to answer client questions on COVID-19 that is available at facebook.com/theanimalmedicalcenter.

The AVMA, in addition to communicating with public officials about the importance of veterinary services, is helping veterinary practices keep their teams safe as they continue to provide medical care for patients. The AVMA resources include recommendations for mobile practitioners and brick-and-mortar clinics to keep staff and clients safe and veterinary patients well cared for. Veterinary practices that remain open may need to provide documentation for staff traveling to and from work. While not required in every jurisdiction, the AVMA has created a customizable template practices can use to issue essential employee authorization letters if needed. Moreover, the AVMA Board of Directors approved delaying the termination of membership to June 1 for all members in default of payment of dues as of April 1.

The American College of Veterinary Surgeon’s Board of Regents sent out a notice March 24 encouraging veterinary surgeons to consider the following decision-making framework when determining the necessity of surgery:

• Work collaboratively with local, state, and national public health officials to fulfill the obligation to protect animal health and welfare, prevent and relieve animal suffering, and promote public health.
• Make medical and surgical decisions in the spirit of one health, and consider the impact of resource use on human and animal health locally, nationally, and globally.
• Surgery should be considered necessary, urgent, or an emergency if not performing surgery will cause irreversible harm. Criteria to determine irreversible harm include the following: threat to the patient’s life, threat of irreversible damage to the patient’s physical health, threat of permanent dysfunction of an extremity or organ system, risk of metastasis or progression of staging, and risk of rapid worsening of severe symptoms.

Easing restrictions on telemedicine

Many veterinarians are looking to adopt telemedicine as a way to continue providing care for their patients when having them come into the clinic may not be possible or ideal because of the risk of coronavirus spread, according to Dr. Lori Teller, clinical associate professor of telehealth at the Texas A&M University College of Veterinary Medicine & Biomedical Sciences.

“Utilizing telemedicine can help veterinarians and clients determine if a pet does need to come in or if the problem can be handled, at least temporarily, at home,” said Dr. Teller, who is also a member of the AVMA Board of Directors. She noted that federal and many state agencies are easing rules in several areas, including requirements regarding the veterinarian-client-patient relationship, and allowing veterinarians to use their best judgment in helping patients and clients.

“It is important for veterinarians to know what their state boards are stating about telemedicine and to continue to use common sense when working with clients and patients through virtual visits,” Dr. Teller said. “Telemedicine is a tool of practice and has many useful indications to help with patient care. Use it wisely.”

On March 24, the Food and Drug Administration issued guidance for immediate implementation that temporarily suspends enforcement of certain aspects of the federal requirements regarding the veterinarian-client-patient relationship. Those temporary changes relate to requirements for veterinarians to conduct in-person examinations or premise visits for extralabel drug use and the issuing of veterinary feed directives.

The FDA guidance acknowledges individual state VCPR requirements may be more stringent in some cases and emphasizes the suspension of federal requirements is a temporary measure during the COVID-19 outbreak.

Communicate, communicate, communicate

One of the unavoidable outcomes of the COVID-19 pandemic is that veterinary practices, like most businesses, will see revenues fall, regardless of how well they adapt to the new reality. “It’s unquestionably going to hurt business over the short term,” said John Volk, a senior consultant with Brakke Consulting.

Seeing fewer patients for safety concerns is one reason. Recession is the other.

“The coronavirus is grinding the global economy to a halt and is likely to trigger a recession,” Volk said. “As we saw in the Great Recession, veterinary practices weren’t as vulnerable as some other businesses, but it still hurt them financially.”

Volk said the three most important things a veterinary practice can do during this time of crisis, apart from protecting staff and clients from infection, are “communicate, communicate, communicate.”

“This is a time when a small business can really build relationships with their clients by making sure that they communicate clearly,” he said, “by telling them whether they’re open or not. If they’re closing, tell people where they can take their pets in an emergency. If they’re only taking emergencies, then make sure their clients are aware of that.”

If the practice offers home delivery for medications or prescription diets, now is the time to tell clients.

“Of all times when practices should be informing their clients that they have home delivery for pet medications and pet food, this is the time,” Volk explained. “That can go a long way toward building stronger relationships with your clients and letting them know that they don’t actually have to come into the practice to get their flea control or whatever. They can have it delivered right to their home.

“That’s a really important service, particularly right now.”

It is important to keep in mind that the recession resulting from the COVID-19 pandemic will be unlike any other in our recent economic history, according to Matthew Salois, PhD, AVMA’s chief economic officer.

“This downturn isn’t about the economic fundamentals—like the housing bubble in 2007-08 and dot-com bust in 2000-01. This downturn is connected to a global natural disaster,” Dr. Salois explained.

He noted that more than 3 million Americans requested unemployment benefits during the week of March 23, a number sure to rise as 40 million jobs are at high risk. “This is an unprecedented number and something hardly seen outside of wartime,” Dr. Salois observed.

“Right now, the veterinary profession is coming to grips with the reality of providing veterinary services in an environment where people are not coming to the practice, but they are still spending on veterinary care,” he continued. “We could soon be facing a situation in which many pet owners are forced to prioritize food and mortgage payments over veterinary care. The AVMA has developed resources to help veterinarians prepare and respond to such an environment.”