- New Jersey’s new telemedicine regulations are being held up as state officials try to determine whether they pertain to veterinarians.
Gov. Chris Christie met this week with healthcare and veterinary officials to discuss the ramifications of S.291, which awaits his signature after unanimous passage last month by state legislators.
The bill would, among other things, enable healthcare providers to use telehealth to establish a doctor-patient relationship, ensure the same standards of care as an in-person visit, and ensure coverage and payment parity for private payers, state Medicaid and some other health plans.
While those guidelines are important for healthcare providers, they pose problems for veterinarians. And the issue could crop up in other states where telemedicine legislation doesn’t clearly define a difference between those practicing healthcare on humans and those treating animals.
"They never thought of veterinarians when they wrote this bill," Rick Alampi, executive director of the New Jersey Veterinary Medical Association, told the Veterinary Information Network after the Wednesday meeting.
“The bill, which authorizes ‘the provision of health care services through telemedicine and telehealth’ governs such services provided by veterinarians, as ‘[h]ealth care providers,’ fails to acknowledge or provide for issues specific to veterinary medicine,” Nancy Halpern, an attorney with Fox Rothschild, LLP, recently wrote in JD Supra. “For example, several provisions require the ‘patient’s request’ before providing health care services through telemedicine. Clearly animal patients cannot request treatment or provide consent. The bill fails to distinguish a ‘patient’ from a ‘client’ or ‘animal owner’ or to permit such services at the request of a client/owner for the patient which is the fundamental way in which services are provided in a veterinary practice.”
Alampi said veterinarians are governed by state agencies that haven’t fully realized how telemedicine should or shouldn’t be used.
"Clearly, telemedicine is practiced by veterinarians," he told VIN. "It's just not well regulated."
The conflict comes as the American Veterinary Medical Association’s House of Delegates holds its annual convention this week in Indianapolis. On the agenda is consideration of a new policy for telemedicine which would, among other things, require veterinarians to establish a veterinarian-client-patient-relationship (VCPR) in person before moving to telemedicine.
"Given the current state of technological capabilities, available research and the current state and federal regulatory landscape, the AVMA believes that veterinary telemedicine should only be conducted within an existing [VCPR], with the exception for advice given in an emergency until that patient can be seen by a veterinarian," a 46 page position paper, drafted by the AVMA Practice Advisory Panel in January, states.
"Under the VCPR, a veterinarian assumes responsibility for making medical judgments and ensures that he or she has sufficient knowledge of the patient to initiate at least a general or preliminary diagnosis of the medical condition of the patient," it adds.
While not wading into the New Jersey debate, the American Telemedicine Association has kept an eye on how states distinguish between healthcare providers for humans and animals.
“ATA supports state efforts to remove artificial barriers, and allow all licensed and certified health professionals to use telehealth to practice at the top of their scope,” said Latoya Thomas, director of the ATA’s State Policy resource Center. “This includes licensed veterinary health professionals. Whether using telehealth to engage in research, direct clinical care, peer-to-peer collaboration, or direct supervision, clinical practice standards should be upheld.”
Thomas noted that Florida legislators shot down two bills this year that sought to establish a physical exam in face-to-face meeting between veterinarian and patient before using telemedicine.
And in Texas, veterinarian Ron Hines was fined and reprimanded and had his license suspended by state officials in 2013 for giving medical advice online – a practice in which he’d engaged with animal owners around the world for more than a decade. Hines filed suit, and the case went all the way to the Supreme Court, which refused to hear it.
Some within the veterinarian industry are calling on the AVMA to seek advice from the ATA and agencies like the Federation of State Medical Boards to draft responsible telemedicine legislation for veterinarians.
“Supplemented by FSMB and ATA resources, the states have learned from each other and, subsequently, all 50 have developed some level of telemedicine laws and regulations,” Mark Cushing, JD, a founding partner of the Animal Policy Group, said in a January keynote commentary to the North American Veterinary Community (NAVC). “Most important, human healthcare treats telemedicine as a staple of healthcare delivery. All we need to do is follow the lead already set in place by human telemedicine and learn from their lessons.”
In New Jersey, Christie is reportedly considering a “conditional veto.” In that case, he would call for specific changes to the bill – exempting veterinarians from the law – and send it back to legislators, who would vote to accept the amended bill, override the veto or do nothing, letting the bill die.
“This bill doesn't take into account the uniqueness of veterinary medicine, so we're going to ask for a conditional veto," Alampi told VIN. "I think we have a strong argument."