Conversations about COVID-19 and the Veterinary Industry
The following articles offer an in-depth look at how COVID-19 affected veterinary practices and the supplier community supporting them.
The articles are split into three parts:
- How the COVID-19 pandemic has reinforced the need for veterinary clinics to have the right infection prevention products on hand, and a plan in place for how to use them effectively
- Examining how stakeholders – veterinarians, reps, and organizations – adapted to the new restrictions to work brought about by stay-at-home orders
- The importance of telemedicine to veterinary clinics during COVID-19 and moving forward
Table of Contents
Part 1: At the Forefront – Infection Prevention
Part 2: Shelter in Place – A Greater Appreciation
Part 2: Shelter in Place – Changing the Approach
Part 2: Shelter in Place – Remote Rhythms
Part 2: Shelter in Place – Doubling Down on Education
Part 3: Telehealth – Top of Mind
Part 3: Telehealth – Telemedicine Post COVID-19
At the Forefront – Infection Prevention
The COVID-19 pandemic has reinforced the need for veterinary clinics to have the right infection prevention products on hand and a plan in place for how to use them effectively.
In general, veterinary clinics have always been aware of the need for cleaning and disinfection and other infection prevention measures, said Nicole Kenny, HBSc., Assoc Chem, vice president, professional and technical services, Virox Technologies Inc. But, “unless there has been a break in a clinic’s infection control program, the financial impact of an outbreak was not always apparent.”
All of that has changed with the COVID-19 pandemic. Now, there is a new urgency on infection prevention efforts, and distributor reps can play an integral role helping veterinary clinics procure the products and create the plans needed to ensure the safety of employees and clients alike.
“Infections transmitted within a veterinary clinic can have devastating effects on the health of veterinary patients, as well as the emotional and financial well-being of their owners,” said Kenny. “Close contact between people and their pets allows for the transmission of infectious pathogens between humans and animals, and many
of the most important hospital-associated infections in human hospitals such as MRSA
are now emerging in veterinary hospitals.”
Every veterinary clinic, regardless of type or size, should have a formal infection prevention program, written infection prevention and biosecurity manual, and ideally, a designated infection control practitioner (ICP) to coordinate the program, said Kenny.
Jason Stull, VMD, MPVM, Ph.D., DACVPM, assistant professor at The Ohio State University College of Veterinary Medicine said veterinary clinics can start to form an infection prevention plan with the general goal in mind – to limit the introduction and spread of disease in the practice to patients, owners, veterinarians, and staff. Although veterinary clinics will share similarities with human medicine providers, the introduction of animals brings with it unique challenges. “Animals can carry their own pathogens (disease causing organisms), some of which can be transmitted to us,” said Stull, who was chair of the AAHA Infection Control Task Force that put together the 2018 AAHA Infection Control, Prevention, and Biosecurity Guidelines. “Pets can also become contaminated from the household environment. For instance, if someone in the household is sick with a certain disease, it’s possible the pet can become infected or have some of the pathogen on their fur. We need to be able to respond to protect ourselves in all the ways we do in human medicine, but also account for the animal component.”
Stull said infection control has often been out of sight, out of mind for many veterinarians until recently. “Until recently, it has not been at the forefront of what we do in veterinary medicine,” he said. “Certainly, with the experience with COVID-19, infection control has become much more present. Because of that, some clinics might not have been well-prepared, perhaps they did not have a plan or key policies in place. Those that do have existing policies, frequently don’t do as good of a job as they should at ensuring their staff are aware of what those policies are.
And then equally important, they need to actually follow through and continue to implement those policies.”
There are immediate implications of dealing with infection control as it relates to COVID-19, but there will also be long-term issues when we get to the other end of the pandemic, and businesses begin to ramp up again. “It’s equally important that we maintain many of the types of interactions and practices that are needed to protect ourselves during this crisis. As situations change in our communities, it’s important that we ensure all of our staff members and anyone stepping foot into our practice are aware of how these policies have changed and that we can keep people up to date.”
Stull recommended veterinary clinics elevate key team members to become “infection control practitioners.” It doesn’t have to be a team member with extensive training. In fact, a veterinary technician is a great person for the role, Stull said. “They know a lot of what’s going on in the practice and are well-versed around the concepts of infectious diseases.”
The most important thing to remember is that the infection control practitioner can’t do it alone, Stull said. “It’s not a job meant to be the only source of infection prevention for the practice,” he said. “The infection control practitioner serves as the quarterback or leader in the process. They help team members recognize what everyone’s job is to ensure infection control is performed in a well-managed way and that the clinic adjusts as needed based on the risks for the clinic and changes in diseases that are in the community. This person needs to be someone that’s going to be respected and listened to by everyone at the clinic, from the owner, to practice manager to colleagues.”
Indeed, the veterinary clinic will need a commitment by all members of the team to change the culture. “Sometimes doing things the right way with infection control isn’t always the easiest to do,” Stull said. “Sometimes, it takes a little bit more time and some additional dedicated resources. It means changing how we prioritize things and how we respond to different situations. It’s very similar to what we’re doing with COVID-19, trying to help each member of the veterinary team recognize their role and to get them to change the way they do their day-to-day practices.”
Steps to take and resources to use
Regardless of whether you work in a human medical clinic or veterinary clinic, infection control is a team-based effort, said Kenny. “Certainly, we need to consider the difference in how patients experience their environment; dogs sniff each other or the floor, whereas humans touch things like doorknobs. If we keep the big picture in mind regardless of if we’re in a vet or doctor’s clinic, the development and management of an infection prevention program can be distilled into seven relatively simple steps.”
- Clarify roles and responsibilities. “Everyone needs to understand the protocols and processes involved as well as who is designated as being responsible for completing what parts of the program (e.g., lobby, exam room, kennels, surgical equipment, or stethoscopes).”
- Identify and designate levels of biosecurity. “Different areas pose different levels of risk. Introducing a numbering or color-coding system clearly identifies different areas and highlights the cleaning and disinfection and biosecurity measures needed.”
- Consider the mode of transmission of pathogens. “It’s impossible to stop infectious pathogens from coming into a veterinary practice. However, it is our job to ensure that they do not spread within our facilities. Hand hygiene, minimizing movement of animals and equipment, or dedicating equipment to specific areas can help minimizing transmission within your facility.”
- Choose the right disinfectant. “We often choose a disinfectant focusing entirely on efficacy or the number of claims on the product label. Prior to choosing a disinfectant product, take the time to outline the needs for your facility such as efficacy, contact times, safety, areas where the disinfectant needs to be used, storage, and handling capabilities within your facility, shelf life, ease of dilution and use. Also, talk with key personnel regarding their likes and dislikes of the existing product. By illuminating the importance of compliance, we force ourselves to ask why our staff are not using our existing disinfectant correctly or why we are looking for a new product in the first place.”
- Staff training. “One of the key things we need to keep in mind is that people do not like change. Introducing a new disinfectant product and educating about its proper use is not as simple as just giving the product name and telling staff what the contact time is. Setting everyone up with clear expectations will make the transition run smoothly.”
- Make sure the product is accessible and easy to use. “It’s the simple things in life such as having empty bottles, sprayers, workplace labels, and if using a concentrate, a method to dilute that takes the worry away that the wrong dilution will be used. Always use the manufacturer’s recommended accessories. It will make everyone’s life simple!”
- Set up a Quality Control program. “This includes ensuring you have clearly identified expiration dates on the disinfectant bottles and using test strips to validate the dilution is correct. Developing a checklist or cleaning log as a way to ensure cleaning and disinfection is being completed or spot checks to audit practices and processes allows an opportunity to provide positive feedback and when hiring a new member of the team is a way to help train to ensure they know what the practices and processes for your facility are.”
Distributor rep response
When it comes to selecting a disinfectant product, distributor reps can play an invaluable role as an educator for their customers. Prior to launching into the features and benefits of the disinfectant product being promoted, spend some time to better understand the priorities of your customer. Understanding what has worked in the past or challenges encountered with their previous cleaning and disinfection process or products currently being used helps focus the discussion on the key pain points, said Kenny. The following are a few examples of questions to ask:
- What challenges are you currently experiencing in your cleaning and disinfection process?
- Do you or have you had any concerns from staff with the safety of your current disinfectant for either the animals or themselves?
- In your practice, what are the pathogens you are primarily concerned with?
- Does your current cleaning and disinfecting process impact your ability to turn over an exam room? Would using a disinfectant with a faster contact time improve your process?
- Does your current product allow you to clean and disinfect in one step?
- Do you want to use one product for all disinfection? If so, a product should be selected with good efficacy against pathogens of concern.
Lastly, distributor reps can support in the successful conversion of the facility. “It is important to share not just the benefits the new product will bring to the facility but to clearly communicate the benefits to the user, such as the product being safer for them or improving or simplifying the work they do,” said Kenny. “People do not like change, so managing expectations upfront when the product is first introduced sets everyone up for success. Education provides the power to overcome any fear or anxiety we are feeling, allowing for a smooth implementation regardless of the type of product.”
Photo cutline: istockphoto.com/Paola Giannoni
COVID-19 Conversations | Shelter in Place
A Greater Appreciation for what Veterinary Practices do for Pets
Amid the COVID-19 pandemic, veterinarians were finding a dip in business but greater appreciation from clients for what they do.
Yes, the way veterinary clinics interact with clients has changed amid the COVID-19 pandemic. But Christina Restrepo, DVM, BluePearl Specialty and Emergency Pet Hospital in Florida, said there may be a silver lining. A greater appreciation for what veterinary clinics do for pets may be an unexpected benefit to come out of the current situation.
“Right now, pet owners are realizing how much they need our advice and recommendations. They realize they can’t as easily reach out to the veterinarian or go to the veterinarian,” she said. “It will hopefully strengthen that need in the client’s mind. The last decade, we’ve been struggling with clients thinking they can Google something and don’t need the veterinarian, or they buy some random product online and think they don’t need the veterinarian. This could strengthen and remind them that they actually do need proper veterinary advice and proper products.”
Veterinary Advantage received feedback from several veterinarians on how their practices and lives have been affected by the COVID-19 pandemic.
Clients ‘cooperative and understanding’
Restrepo said despite the disruption that COVID-19 has caused and the need for social distancing; clients have been extremely cooperative and understanding. Her animal hospital adjusted by implementing curbside receiving of the clients. “We’re still open and seeing our patients,” she said, “we’re just making sure we try to keep ourselves safe and follow social distancing rules.”
For the exams, clients stay in the parking lot in their car. A technician wearing PPE will go outside to pick up the patient. Then, the veterinarian will perform an exam, take any samples needed for tests, perform cytology if needed, and then call the owner who is waiting in the parking lot. “I talk to the owners just like if they were in front of me in the exam room,” Restrepo said. “I listen to their history of the problem, I explain my exam findings, and we talk about a treatment plan.” Clients have been open and receptive to the new ways of doing things, she said.
The animal hospital also offers telehealth consults. For the owners that shouldn’t be leaving their home, Restrepo asks them to email pictures of their pets. Then they will have a phone consultation. Or, Restrepo may recommend the client drives to the clinic to drop off a sample from a home-obtained gentle swab of an affected ear canal or a skin lesion. The owner can place the swab sample in a plastic bag and drop it off at the clinic. From there, Restrepo will analyze the sample, and discuss the results with the client via telephone consult.
There has been a dip in visits, but Restrepo said her animal hospital is still able to see the clients that truly feel they need to be seen or talk to the ones that would prefer telehealth. “We’re still able to offer those services,” she said.
‘This too shall pass’
Jennifer Nash, DVM, CVA, owner and medical director of Turkey Creek Animal Hospital in Plant City, Florida, said they have had to reimagine their process weekly as CDC recommendations emerge.
“We moved our ‘lobby’ to our parking lot and now do a majority of our client communication over the phone, text, email, or video streaming,” she said. “Our team has been segregated to individual exam rooms while working with patients to allow for social distancing and conserving cleaning supplies. We are allowing the patient care team to use their cell phones to avoid sharing of our office phones. Extending our appointment times has allowed for us to work through new process snags, but that, along with removing routine procedures from our surgical schedule, has resulted in lower revenue each day.”
Turkey Creek Animal Hospital staff have been working with website and Facebook updates, email campaigns, and on-hold messaging to keep clients up to date on the ever-changing processes. “We are working to add telemedicine in some form to accommodate our clients and health department recommendations to keep families at home,” she said.
The two biggest challenges Nash said clients face are first, the loss of being able to attend the exam in the building with their pet and the veterinarian. “That face-to-face time is invaluable.” The other challenge is affording emergency veterinary care when many are facing layoffs and unemployment.
In order to connect with co-workers, the animal hospital has adjusted shifts to allow for team members to have more limited interactions with each other, “which is hard for our more extroverted employees!” Nash said. “We have a group Facebook page that we post on to share funny things we see, commiserate with our struggles, and just connect. We text to check in on each other. We are all still healthy and coming into the office, so we haven’t had to address remote working at this time.”
Personally, Nash said there has not been much change to her weekly routine other than trying to balance kids being home all day with work responsibilities. “This has made home time more full with toddler care, helping my older girls with school work and a lot more house cleaning since everyone is always home,” she said. “Add that to a busier work schedule, and we are pretty tired.
“My spouse is also a veterinarian, and I have flexed our schedules to allow us to take care of the toddler most of the week,” Nash continues. “Our oldest daughter keeps him two half days a week.”
Nash admits it has been a real challenge with the additional demands from work, along with supporting online learning with the older kids and balancing the needs of a toddler. “While one might think this would create more down-time, I feel like any personal time has evaporated for me. I feel thankful that I have a practice that is busy and a family that is healthy and invested in their online learning, so my struggles I will keep! This, too, shall pass.”
In a lot of ways, relationships are being strengthened, Nash said. Neighbors check in on each other frequently, across the yard, or via social media. “My family created a group on Google Duo, and we all ‘meet’ on Sunday to catch up and see each other’s faces. Oddly, my family is far-flung all over the world and before COVID-19, and we hardly saw each other. This virus created a space where we now do … what an appreciated unintended effect!”
Essential visits only
Jennifer L. Fry, VMD, The Vet On Main in Birdsboro, Pennsylvania, said her clinic was limiting appointments to sick and urgent cases. They have reduced hours and close early every night to limit exposure. “We are continuing to do puppy/kitten boosters as I feel they are critical,” she said. “I don’t want to have to treat a parvo puppy! Also, I feel the 1-year-olds need to come in to get their second rabies boosters. Rabies doesn’t stop because of COVID-19, and with the weather getting warmer, there are more strays and wild animals out and about.”
The Vet On Main postponed visits for older adults that have had multiple vaccines. “We have a lot of clients wanting to come in because they are home. We have to keep telling clients that nail trims are not essential! We’re still taking new clients and new patients.”
The clinic asked clients to reschedule if they or anyone in their house is ill. “We are allowing only one person in the hospital with the pet,” Fry said. “I did not feel comfortable with sending the techs out to the car to stand outside to get history and bring the pets in. The pets are already stressed, and being without their owner just adds more stress, worry, and fear.” When the client comes in, the clinic staff puts them directly in the room and does not allow clients to congregate in the lobby.
The clinic staff sanitizes everything after each client. Face masks are required, and staff are washing and re-washing hands constantly. At press time, the clinic was trying as best it could to keep full-time employees working full-time. Two older part-time employees elected to stay home during this time.
The clinic was asking clients to pay over the phone and call when they arrive to do curbside delivery of meds and supplies. They cancelled surgeries for two weeks and were not doing dentals until May, “unless medically necessary,” she said. “We are really limiting surgeries for (April).”
Obviously, sales have decreased since there is less foot traffic for retail items. And revenue for wellness visits has gone down. “We’re being mindful of supplies and trying to order just the basics and not making big purchases at this time.”
Fry signed up for a telemedicine app to do virtual visits but had not done any yet. “Trying to get the camera, mic and speakers all working is challenging, as I didn’t realize our new computers didn’t come with those features,” she said. “We have some clients emailing photos and fielding more phone calls. We have done more refills of meds or tried empirical treatment with different meds to reduce the number of people coming into the hospital. We have some people wanting to stock up on Rx Diets. We are trying to promote our online pharmacy. We even had a few outside requests for medication since a local veterinarian ran out.”
Personally, Fry said her sister works at the hospital, so she gets to see her almost every day, but she has not seen her parents for weeks. “We canceled Easter dinner and have not been able to go over for homemade pheasant pot pie either, so that is very upsetting,” she said. “I text and call my parents, but they don’t have a computer or smartphones, so we can’t video chat.”
Fry said she has been on Facebook a lot. Her CE Conference in Baltimore was canceled, so she recently had a rare 4-day weekend. “I took that time to sleep in, snuggle more with my cats, and mentally recharge. With the extra hours at home, I have organized my closets and ran an online auction for my nonprofit, although we had to postpone our Bingo fundraiser.”
Fry said she misses going out to eat with friends and socializing, “but I know the importance of social distancing so we can get through this quicker and end up stronger!”
Tackling the biggest challenges for customers
Penn Vet’s Strategic Alliance Manager, Christine Merle, DVM, MBA, CVPM, provided Veterinary Advantage with insights on how the COVID-19 pandemic has affected customers and her organization.
Veterinary Advantage: What are the biggest challenges for your customers right now?
Dr. Christine Merle: Keeping up with the evolving situation while maintaining the health and well-being of the pets they care for, the pet owners that trust and rely on them and the health and safety of their teams.
Veterinary Advantage: What are some of the ways the COVID-19 pandemic has affected your organization?
Merle: Being able to quickly address and react to the needs of our customers in different states/ locations. Staying in regular communication internally, if not even overcommunicating, so that everyone remains involved, engaged, and customer-focused. Really becoming and acting as one team.
Veterinary Advantage: How are you working with veterinary practices on effective infection prevention?
Merle: Providing resources and tools they can refer to. Educating them on products that fit their needs and helping them consider alternatives when possible.
Veterinary Advantage: How can veterinary practices effectively leverage virtual care?
Merle: Most veterinarians have been utilizing some form of virtual care for years – phone calls, emails, texts – so “virtual” isn’t really that new. What is different is that for some, this is now the primary means to communicate and “visit” with their clients and their pets. While the current situation is bringing virtual care to the forefront, the ease, convenience, and peace of mind that it provides to pet owners will be valued long after the current pandemic. Veterinarians should see this as an opportunity to embrace virtual care both now and for the future of their practice.
Veterinary Advantage: Trying to look ahead, what lessons are we learning as an industry during this pandemic?
Merle: Resiliency and determination. I’m amazed to hear how practices are being creative, resourceful, and dedicated to supporting pets and people. Whether its providing PPE resources to human hospitals or having staff deliver chronic medications to pet owners’ homes, veterinarians and their clinics are true members of One health.
Photo cutline: istockphoto.com/bohemama
COVID-19 Conversations | Shelter in Place
Changing the Approach of Veterinary Work
Opportunities will come following the COVID-19 crisis, PSIvet President Pat McCarthy said. Will veterinary practices put themselves in a position to capitalize?
In the early days of the COVID-19 pandemic, PSIvet quickly started fielding concerns from members, many of them unprecedented.
No. 1 was HR management and redefining how practices were going to operate, said PSIvet President Patrick McCarthy. For instance, “should they be operating in A and B shifts so that they don’t have everyone exposed at the same time?”
PSIvet gathered operational best practices from its membership and shared the information via its e-newsletter.
The other challenge was getting supplies such as gowns, facemasks, and gloves, as well as cleaning supplies. “We’ve been helping our members get access to these with our vendor partners,” said McCarthy. “We have relationships with vendors who can ship directly to practices instead of our members having to go to Walmart and Costco. So our members are getting access to the supplies that they need.”
Meanwhile, practice teams working in close quarters increased concerns about spreading the virus. “There is a heightened awareness around the value of healthcare and health benefits for employees,” said McCarthy. “We anticipate seeing a big uptick in that area. Fortunately, we just launched our new healthcare plans in partnership with Vault Strategies, so our members have solutions to help keep their teams healthy.”
A new workflow
McCarthy said PSIvet members found that the drop-off and pickup of pets worked best in the new environment. “We’re seeing workflow changes within these practices that allow a client to arrive, make a phone call to the practice while they are in the parking lot, then the tech comes out fully gowned with gloves and masks and takes the pet in while the client stays in their vehicle.” While veterinary practices weren’t doing elective surgeries, pet owners could still drop off their pets for critical needs.
“There’s been a ramp up of our members gaining their skill set around doing this new way of business because it’s a big workflow change,” said McCarthy. “Many of them are now up to speed on how to do that.”
PSIvet has a lot of information on COVID-19 on its website, including services and programs available from vendor partners. PSIvet also worked closely with two telemedicine providers, Petriage and VitusVet, to show members how to treat patients when clients aren’t willing to visit the practice in person.
Adjusting their day-to-day
Like their members, PSIvet area managers are adjusting to the new work dynamics. They’re all working from home. “We’ve outfitted every single one of them with a Zoom account,” said McCarthy. “It comes down to doing homework, getting better at your job, learning a new way of doing your job and preparing better. The Zoom accounts are working really well.”
Their primary focus for each area manager is outreach to PSIvet members via emails and phone calls, “letting them know some key areas we’ve heard practices need help with, and just making sure they knew those resources are available,” said McCarthy. From there, the area managers may set up calendar invites for more in-depth conversations.
McCarthy said down the road he thinks the work that area managers are doing now will change how they approach their accounts. “I really believe they’re going to be much savvier in terms of strategically setting up meetings, and having face-to-face meetings via Zoom versus always having to drive to a practice,” he said. “I think that’s going to change the entire sales force in the veterinary community.”
He added that the veterinary community could also see a significant boost in its workforce from the service industry.
“Think about the amount of people out of work in places like the service industry – hotels, bars, and restaurants,” he said. “That is a group of available employees that maybe the veterinary community could benefit from. These are people without jobs who may decide that going back to a restaurant or a hotel or bar as a service person might not be the best job for them or safest job opportunity.”
It may open up an opportunity for the veterinary community to reach out to these workers and offer to train them for veterinary positions. “I think there are opportunities for the veterinary community to pick people up who are not working from other industries and bring them into the veterinary community,” he said. “The job market was so tight with technicians and front-end staff in veterinary practices prior to this; this shifts available resources in terms of personnel.”
McCarthy said PSIvet is fully equipped to help members attract new employees, including offering health benefits to people coming from service industry jobs where they may not have had that option. “That’s what we’re working on for the future; how do we help our veterinary community attract and keep these good employees that could benefit practices?”
PSIvet Business Symposium
PSIvet has not canceled its annual Business Symposium, scheduled for September. But the organization is keeping an eye on conditions and will decide at a later date. “We’re looking at it in [a] couple different ways,” McCarthy said. “People will want to come back together again at some point in time. This event is not only educational but also where colleagues talk to colleagues and share a lot. We’re keeping that open.”
Photo cutline: istockphoto.com/herraez
COVID-19 Conversations | Shelter in Place
Remote Rhythms for Veterinary Sales Reps
How one MWI regional accounts manager has adjusted to working remotely while still providing solutions for customers.
Even amid an unprecedented time, there has been a familiar rhythm to the work routine for Brian Van Beek, AmerisourceBergen, regional accounts manager, MWI Animal Health. For the first nine years of his career, Van Beek was an inside sales rep calling on customers for another company.
“I guess in some ways now, I’m approaching my role as an inside sales rep,” he said. “In between stops, you’re always communicating with customers. Now our communication is basically phone calls, texts, and emails. In a couple of instances, we’ve done Zoom calls. It’s changed from so much face-to-face contact to contact in a different way.”
Calling on customers
Like most distributor reps, Van Beek is trying to make the most of the new normal. “You can do a lot more phone calls, emails, and texts during the day than when you’re on the road,” he said. “When you go from stop to stop, you could walk into a veterinary clinic and be in there for 5-10 minutes depending on who is around and what’s going on, to being in there for a couple of hours. You have a lot more time to touch base with customers in that way than what you did in the past. You can get in contact with more people during the day.”
The conversations with customers have understandably changed. Van Beek said before COVID-19, veterinary clinics were more interested in the latest programs, rebates, and new product launches. “Now, most of my customers are more worried about hearing what’s on backorder because so many products are going on allocation, and they can’t get ahold of them right away,” he said. “It’s more product/inventory concerns than what programs are going on or what new product is coming out.”
Van Beek said he is also mindful of when and how he communicates with customers. For some clinics, their only way of communicating with clients is by phone, so any time Van Beek is on the phone with them could mean missed calls from clients. On the livestock side, farmers have to call in their orders to the veterinary clinics, “they can’t just pull up, walk in and get what they need,” said Van Beek. “It has to be ready.”
Van Beek said that for the first few weeks of the COVID-19 pandemic, business was busy, and it seemed like from conversations with veterinary clinics that they were able to maintain normal operations. However, of the three states where Van Beek travels to call on accounts, two issued stay-at-home orders. And customers across all of his territory started experiencing diminished walk-in traffic. “A lot of the elective stuff is not happening,” he said. “Everybody is adapting. As with any industry, there is a lot of concern. The biggest thing is the unknown. When will life be back to normal? Or, more likely, it will be adapting to whatever the new normal looks like. I’m getting more clinics interested in doing online with clients then maybe they weren’t before.”
Van Beek’s day-to-day has undergone a transformation of its own. At lunchtime, Van Beek takes a break to catch up with his family and share a meal. Not being on the road means having more time to review emails and voice messages during the day rather than at the end of it. “Before all of this, normal days included road days where you would get up, and you go, and you didn’t come home until whatever time or until you got to the hotel. Then working through the emails of the day and other tasks you couldn’t do until then. Now you get those things done during the day. The plus side is I probably have more time with family.”
Van Beek said that when business returns to something resembling normal, he will try to make sure he dedicates more time for the office than he did pre COVID-19 for a couple of different reasons. “First, so I don’t spend so much time at night on the computer catching up on emails and projects. And second, it would lead me to be better organized.”
However, visits to customers won’t be a thing of the past. Van Beek said that when the disruption from COVID-19 settles, there will still be value for face-to-face interactions. “There is something you get from face-to-face meetings you can’t get over the phone,” he said. “I can talk to people over the phone, but when you’re in a clinic, you can see everything else that’s going on around you. That’s an element you’re losing right now. I can’t see what’s on a shelf. Sometimes you walk into a clinic, and a certain thing sparks your interest that you should talk to them about.”
Or, veterinarians may be coming and going from the practice, and Van Beek is able to have conversations with them that wouldn’t happen on a phone call. “When I am on the phone, I focus on one person. In the clinic, I get to have so many more conversations with people that are part of the practice. That’s what I miss.”
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COVID-19 Conversations | Shelter in Place
Doubling Down on Education
Training and education have come to the forefront of what veterinary practices want and need to function amid COVID-19.
For Shelley Johnson, Patterson Veterinary’s senior manager of training and education, the workspace has not changed amid the COVID-19 pandemic. But the way she and her team operate, and the conversations they are having with other Patterson team members, certainly shifted.
Johnson and her team work remote, so the physical workspace they occupy has remained the same. “That being said, the day-to-day changes with respect to understanding what others are navigating has changed,” she said. “For example, members of my team have school-age kids that they are educating, so that has been something for us to understand and be respectful of.”
Johnson and her team are also mindful of the changes happening to Patterson team members across the organization. One of her responsibilities is training for the sales force. Both Patterson Veterinary and Dental reps were working remotely amid Shelter in Place orders and not visiting customers. “That’s a big shift,” she said. “Sales professionals are used to scheduling their appointments and moving from appointment to appointment and location to location. This is a complete change for them. How to navigate that? It’s important to help equip them for strengthening relationships and being mindful of their customers – our veterinary practices – and what they are going through.”
Johnson also has a customer-facing role in creating training for veterinary practices through Patterson Veterinary University. The demand for training and education has created a “just-in-time” delivery of information, she said. “That creates a different cadence of work,” she said. “The work we’re producing has gone from place your order and receive education to one that is just in time and really determined by the environment around us.”
For example, Johnson’s team created a Patterson Veterinary University telehealth curbside course that is RACE-approved and available on its website. The course is designed for any member of the veterinary health care team. It takes the learner 40 minutes to an hour to complete. “We start broad on the topic of telehealth and then move into what veterinary practices want to know about how they would set this up in their hospital. What are the things they need to consider?”
Telehealth and telemedicine had been on Patterson Veterinary University’s radar as a topic to cover at some point this year, but COVID-19 reprioritized it. “We had to move to a just-in-time delivery and say ‘What’s needed now?’”
Along with telehealth, coursework on financial issues has been a hot topic for customers. Veterinarians want to know the steps they can take to make sure their hospital will be ok, how this situation will affect their taxes, and what it will mean for the business at the end of the year. “Veterinarians are wondering, concerned, listening and grabbing anything they can pertaining to business continuation, the Small Business Administration, and understanding how to support and maintain their business.”
Indeed, the interest in education has increased across the board. “Veterinarians are asking, ‘What do I need to know right now?’” Johnson said. “There’s a sense of FOMO (Fear Of Missing Out) on the things that will help us survive and excel beyond where we’re at right now.”
Innovation and collaboration
Johnson said that one lesson we may glean from this time is that COVID-19 has given individuals and organizations the chance to innovate. “I think it’s challenged us to look at what we had been doing and questioning if we can do it differently or better,” said Johnson. “It’s challenged us to be impactful in ways that maybe we hadn’t thought of before.
“When we become somewhat established with things, we can get comfortable,” Johnson continued. “We work hard at trying to be relevant, but at the same time, when something like this happens, it causes us to think of ways we could do it a little bit differently.”
Johnson said everyone appears to be more open to collaboration. “I’ve been on calls all day long, many of them around the topic of COVID. The last call I had a colleague reflect that this is creating a collaborative mindset. People want to contribute to the profession to work together. ‘How can I help you?’ ‘How can I help a pet parent or veterinary practice?’
“People are trying to be good humans.”
Postponing and rescheduling
Like most organizations putting on events, Patterson Veterinary University canceled 8-9 events in March due to COVID-19 and ended up postponing
twenty-two events once it became clear that the situation would not stabilize in the spring.
Now comes the discussion of whether to cancel, postpone, or reschedule.
“At this time, rescheduling poses its own challenges, but that is absolutely secondary to keeping people safe,” said Johnson. “We are going to err on the side of caution and keep people safe, first and foremost.”
The question of whether the information from the event can be converted to a virtual experience is one an organization will have to answer.
“Technically, you can take information and put it into a virtual program,” she said. “We do have the capability of video, but what is the piece that is missing? Why do we have virtual offerings in the first place as well as in-person courses? It is that human nature, relationship aspect of having those in-person courses we will miss. I’m still of the mindset that in-person events are essential to general human compatibility and how we work, live, play, and create together. I think we’re still a ways off from saying it’s ok to be 100% behind a screen.”
Being too quick to reschedule could mean strained relations with attendees. “No one wants to get into a position where you reschedule something for a time that may not be viable,” she said. “If we rescheduled everything in June or July and come to find out this thing stretches into July, you’ll have to cancel again. Then you start having some credibility issues. Who is going to reschedule twice? Will I do that twice as a consumer?”
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COVID-19 Conversations | Telehealth
Telehealth: Top of Mind
Telehealth providers in the veterinary space are seeing an explosion of interest as a result of COVID-19. What does this mean for veterinary practices now and in the future?
Veterinary Advantage reached out to telehealth companies for insights into how COVID-19 was affecting customers, their business operations, and how distributor reps can approach the topic with interested veterinary practices. Participating were:
- Brandon Werber, founder, and CEO of Airvet, an app that helps veterinarians engage with clients via video and real-time chat.
- John Dillon, founder, and CEO; and Katherine Donahue, DVM, and chief medical officer, GuardianVets.
- Shlomo Freiman, DVM, co-founder and Chief Veterinary Office, Petriage, a B2B telehealth provider of state-of-the-art services to veterinary practices.
Veterinary Advantage: What are you hearing from veterinary clinics as far as what they need to continue to operate amid the COVID-19 pandemic?
Brandon Werber, Airvet: What we’re seeing is hospitals moving towards telemedicine and other types of “connected care” platforms. They’re all making unique adjustments, like curbside pickup, to continue to operate.
What’s interesting is how so many of them have found ways to pair telemedicine with curbside pickups to mimic a normal visit by having the client join the appointment from their car via live video to feel like they’re in the exam room. Everything has become contactless, from exams to payment.
John Dillon and Dr. Katherine Donahue, GuardianVets: Some clinics are absolutely slammed with the amount of emergency consultations they are receiving. Others are struggling to maintain business. Either way, it is certainly a time that is unprecedented for virtually everyone.
Dr. Shlomo Freiman, Petriage: They’re experiencing an inherently complex and fundamentally different dynamic. They want to ensure the safety of their clients and their staff, but they can’t continue business as normal. In several states, vets can only treat pet emergencies and forego routine exams. So, the only avenue for clients if something happens to their pet at home is via telehealth and teletriage services.
Telehealth offers DVMs a way to monetize their time when they no longer can deliver a personal pet exam. And they increasingly desire a holistic standard-of-care model because of the newfound need triggered by the coronavirus.
Clinics’ phone lines are incredibly tied up, and at a time when many clinics only have a skeleton crew available. Many vets and technicians must work remotely. They don’t want to miss calls or have clients wait interminably. These situations further prompt an intense interest by vets to implement a telehealth solution.
It’s usually a pain to introduce new technology, processes, and training – even though our onboarding process is as painless as possible. Also, while we didn’t design our unique software platform to be a substitute for in-person exams, client engagement is increasingly virtual these days.
Many vets tell us they believed a telehealth platform could prove beneficial, but there wasn’t the urgency this is now. The go-slow attitude was understandable before COVID-19 but is gone now.
Veterinary Advantage: How has COVID-19 affected your business?
Dillon and Dr. Donahue, GuardianVets: There is an immediate need for virtual solutions, and telemedicine and teletriage are no exception. With our Teletriage and Telemedicine platform, we are here for veterinary clinics that need these services to help continue their level of care.
Freiman: Before the coronavirus erupted, Petriage had a healthy and steadily growing business. Now, we’re seeing a drive for clinics to find a telehealth solution and put it into effect right away to best serve their clients and, quite frankly, to keep their doors open. In March, for instance,
we provided over 170 demos of our platform and services, completing one demo each business hour, and we don’t foresee that pace slackening much if at all. In fact, we’re practically doubling our onboarding team to help with the increased interest from vets and clinics.
We can get a vet up and running in a matter of hours to a few days, depending on the scope of services they want and the steps required. We can install our basic service, the free, simple-to-use mobile interface for pet owners to assess the urgency of a pet’s health symptoms and deliver trusted recommendations to the vet in a few hours. Our essential service, which offers pet parents telemonitoring capabilities with their vets, takes a bit longer.
It’s our premium service that takes a few days because of its range of sophisticated services. They include the ability of a client to chat live with the vet and share photos and videos for full engagement about a pet’s health. And it remotely integrates a pet’s medical data into a clinic’s practice management system, allowing a vet to access the records easily. This is possible because Petriage is a cloud-based platform, whereas a clinic’s traditional server-based system can’t do that.
Werber: Unsurprisingly, we’ve seen an absolute explosion in new hospitals and corporate partners signing up for Airvet, along with a surge in engagement from existing hospitals. We have hospitals doing 30-40 cases a day on Airvet, after going fully contactless. That’s really just the short and medium-term, but I think long term the entire industry will look somewhat different post-COVID.
Now that clients are finally experiencing the same levels of connected care they’re used to getting with their medical doctors; it’s kind of tough to go back. I don’t think it stays fully contactless like it is now, of course, but long term I think it lands somewhere in the middle. Veterinarians and the entire hospital staff are also seeing how beneficial and easy it is to leverage new tools for a more comprehensive client experience. It’s really exciting to see.
Veterinary Advantage: How can veterinary practices effectively leverage virtual care?
Werber: Well, there are, of course, the standard ways, like conducting virtual exams, re-checks, etc. to save time during the day and keep exam rooms open for higher transaction clients. There will undoubtedly be big opportunities integrating telemedicine into the day-to-day.
But in the more immediate term, pairing curbside check-ins with virtual care is a great and effective option. Right now, there are clients and doctors that can’t leave the house. Veterinarians can conduct virtual exams while they’re working from home to continue to see patients.
Freiman: We find that a 90-minute-long orientation is effective in explaining telehealth – the overarching term for delivering information, education, and care remotely. We can then talk about its various categories, whether it’s telemedicine that employs a mobile app or another tool to exchange medical information electronically; telemonitoring for remote checking on patients, not at the clinic; or teletriage that enables a vet to assess and determine the need and urgency for a pet’s care electronically with its owner.
We explain the process and help them identify the best telehealth approach and service model features for their practice alongside the technology. Vets decide if they favor a fee-based consultation or if our live video makes more sense. Whether a vet chooses Petriage or not, they find the orientation helpful.
Dillon and Dr. Donahue, GuardianVets: It is all about using virtual care to extend the reach of your practice. Telehealth should not replace the physical exam; just scale it and make physical visits more efficient. Our platform acts as a supplement to the practice. Keep doing what you’re doing; just integrate technology to make it easier.
Veterinary Advantage: Our audience is made up mostly of distributor reps and inside sales reps calling on veterinary practices. What questions should they be asking their customers as it relates to telehealth capabilities?
Werber: I think it all starts with understanding HOW the hospital plans to leverage telemedicine, as different hospitals have different goals. Some are more short term as a quick tool during COVID, and others see a longer-term appeal. Once they know the how, the rest becomes clear. We see that often times, considering telemedicine platforms are so new for many, the hospitals don’t actually know yet exactly how they plan to leverage telemedicine. That’s where it becomes important to ask the right questions and share the right anecdotes.
Freiman: Based on our experience, we encourage sales reps to make these important points with their customers:
- COVID-19 has created a strong sense of urgency for vets to understand how telehealth can help them and their clinics meet unique challenges. For the most part, it can help DVMs provide the type of care remotely that clients and their pets receive in-clinic. It can also help DVMs to monetize their time in a newfound way when they can’t conduct an in-person personal pet exam.
- Increasingly, pet owners expect clinics to offer telehealth services because they are comfortable with online technologies, such as Zoom teleconferencing, FaceTime, email, text messages, and the like. And
as they’ve become familiar with telemedicine for themselves, it’s only natural that they favor the same level of service for their pets. COVID-19 has simply accelerated that expectation.
- Telehealth helps clinics compete against animal emergency rooms, where they have been losing out for after-hours revenue. Pet owners not only obtain high-quality, reliable information and service via telehealth, they avoid the AER, which can prove a big headache. It’s often more expensive, they must wait in the lobby while their pet is examined, and they still usually must inform their own vet of the pet’s situation. Also, Petriage data suggests less than 5% of triage situations are emergencies that can’t wait until normal clinic hours for a pet examination.
- Premium telehealth services, such as the ability of a client and vet to chat live and share photos and video, will grow in importance as pet owners get such access to their own medical team. Also, the remote integration of a pet’s medical data into a clinic’s practice management system can prove invaluable to a vet who wants to access the records easily whether in the office or remotely.
- Easy avenues exist for recouping the telehealth cost, whether it’s a low fee added to a pet’s annual checkup or some other fee arrangement that clinics tell telehealth providers work best for them.
One other point is essential: Distributor reps and inside sales reps should know what the specific state regulations are that apply to the use of telehealth and teletriage services by their customers. On March 24, the FDA said it was temporarily lifting some restrictions on veterinary telemedicine during the pandemic. But it’s unclear what post-pandemic telehealth will look like.
Dillon and Dr. Donahue, GuardianVets: The questions should focus on what the veterinary practice is going through because while we are all in this, it affects everyone a little differently. Ask about how their business is changing, whether they are doing curbside visits?
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COVID-19 Conversations | Telehealth
The pandemic may make virtual visits a common practice.
By Mark Thill
Veterinarians have been doing telehealth since the phone was invented, said Bruce Truman, vice president business development for BabelBark. “The sad reality is, they were doing it for free.”
COVID-19 may change that.
The physical and social distancing that accompanied COVID-19 increased interest in telemedicine, said a spokesman for Boehringer Ingelheim Animal Health, which markets PetPro Connect. “And we expect that veterinarians and pet owners will use telemedicine more often after the pandemic subsides than they did before it occurred.”
Some veterinary practices agree.
‘Never got paid’
Traditionally, Georgia Veterinary Associates in Lawrenceville, Georgia, has used telemedicine as many others have, said Angel Martin, RVT, patient care, and clinical operations manager. “We used the actual telephone and never got paid for it.”
Added Brad E. Miller, DVM, medical director, and owner, “We were not confident that a video telemedicine consult would be desired by our clients, or that we would be able to treat the pets and monetize the visit.”
Prior to pilot-testing PetPro Connect, clients might keep the doctor on the phone for as long as 30 minutes, said Martin. “We are training our staff not to allow this to happen, but rather to acknowledge the client’s concerns and let them know the vet would be happy to see them for a telemed appointment. Then we schedule it for them. We have the ability to make this a ‘free’ appointment, or we actually charge for our time.”
At the height of the pandemic, GVA remained open seven days a week. But it wasn’t business as usual.
“We made the decision to lock our doors to the outside world on March 20 – probably a little later than most,” she said. “We do not allow clients, friends, family members, or delivery personnel into the building. We are calling our model ‘Curbside Care’ and ‘Virtual Visits.’”
Curbside Care applies to pet owners who are picking up food, medicine, or other supplies. Clients call in after arriving in the parking lot, the practice invoices them, then runs items out to their cars.
For virtual visits, a GVA staffer, dressed in full PPE, picks up the pet from the client’s car and brings it into the building, she explains. “We dial up the client on the PetPro Connect app and allow them to be present for the exam and treatment, just as before COVID-19.
“We feel this is HUGELY important for our customer experience,” she said. “They appreciate the value of the veterinarian’s time and knowledge. They are able to ask questions or bring things up during the exam.” After the exam is completed, the client is invoiced, and instructions are emailed or texted to them.
“In our opinion, for concerns such as vomiting, diarrhea, swelling, coughing, sneezing, not eating, core vaccines, limping or abnormal urination, telemedicine can only be used to triage or to let the client know their concern is real and they need to bring their pet in,” she said. For less serious ailments, “we can ease their minds [via telemed] and let them know it’s ok to wait for a visit.”
GVA charges $40 for a 20-minute telemed/video consultation – a discount of 20%. If the pet needs to be seen in person, the consult is credited back to them, and they pay the regular exam fee.
“I hope we can continue to incorporate virtual visits into our common practice for ‘drop-off’ visits or appointments,” said Martin. “I think, too, our clients have been forced to become aware of the possibility and maybe, in the future, will request it more often.”
Implementing telehealth isn’t without its challenges – for the pet owner as well as the practice staff.
“The only reservations we have noticed are those familiar to any of us when we start using a new app or digital service,” said the spokesman for Boehringer Ingelheim. “We have to learn to use the app or digital service in order to enjoy its benefits.”
Amber Thompson, marketing manager for Tiger Tails Animal Hospital, would concur. The practice, located in Duluth, Georgia, began piloting PetPro Connect in March 2019.
“A lot of it is getting used to the technology,” she said. “In the beginning, there is some hesitation and almost fear. Will we be able to hear them? Will the connection be good enough? Can the owner hold their pet so we can do an exam remotely? It’s a different concept.”
“We had some hesitation as to what kinds of appointments the doctors would be comfortable with,” she continued. “That was part of the initial trial and error we worked through. We found that things like skin allergies, re-checking sutures, and even behavioral issues can be handled by telemedicine.”
“We have had a great response from all of our clients with telemed,” said Thompson. In fact, more than 1,100 clients have the PetPro Connect app. Most calls do not exceed 10 minutes, for which the practice charges $20. (Wellness plan clients access the service at no additional cost.)
It helps if one or two telemed “champions” – including the practice owner – are available to teach others about the process and to instill confidence in them, she adds.
Remote patient monitoring
COVID-19 has significantly changed the perspectives of technology-forward practices, said Truman.
“They had or are now adopting telehealth solutions to keep their practices operational, and they are tasking employees to work from home doing consults,” he said. “This allows practices to maintain continuity of care and maintain revenue from wellness visits, chronic disease cases, and medical progress exams.
“Unfortunately, those practices that have not been willing to embrace the digital transformation will see a significant decline in their business now and in the future. Those without an online pharmacy and without a telehealth solution are suffering.”
Remote patient monitoring will play an important role in the future, he said. BabelBark relies on remote devices to help its client practices monitor weight, diet, medication compliance, and activity. “It adds so much greater insight for the doctor,” said Truman.
“Veterinarians can see, for the first time, all products the pet is using – both those purchased from the veterinary practice and those purchased from OTC outlets like Chewy, Petco, and others. It also allows them to see information from visits to other practices. It shows the vaccines given at the weekend clinic and the flea and tick product purchased from a pet retailer. Great knowledge equals better medical outcomes.”
Remote patient monitoring may still be in its infancy in veterinary medicine, he said. “I think that will change because we are forcing telehealth into the workflow.” Improvements in the interoperability of veterinary software systems and remote monitoring devices will only speed up implementation.
Post-COVID-19, the profession will see the broad adoption of telehealth, Truman predicted. Already, some states have relaxed their stance on issues that have inhibited its growth, such as the veterinarian-client-patient relationship, or VCPR.
“All pets deserve care, even those that have not seen a veterinarian within the past 12 months. The impact on these state-level decisions will be long term. As practices see the value, we are hopeful that states will not roll back to the old way of doing things, but instead embrace telehealth as a needed and valuable solution.”
Telehealth may also open up new positions within veterinary practices, such as the VVN, or virtual veterinary nurse, said Truman. “Also, after COVID-19, practices will use telehealth to create new membership programs that will drive new revenue and better medical outcomes. Practices will learn how to create programs for remote chronic disease management, medical progress exams, and wellness visits. Practices post-COVID-19 will see the value of placing patients on remote care programs for chronic disease. We will see remote weight management programs, diabetes management programs, and concierge care programs for top clients.
“This will result in the optimization of the entire veterinary care team,” he continued. “We will see better use of the credentialed veterinary nurse as the frontline of care, with only those cases that need to see the veterinarian referred to the practice’s veterinarians. This will help to address the industry issues of a shortage of veterinarians and the issue of the under-utilization of the veterinary team.”
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