By Aaron Smiley, DVM

Veterinarians have offered virtual care for over 100 years. We consult on the phone, answer emails, and exchange text messages with our clients about their animals every day. Through telemedicine we have been able to meet the increasing expectations of convenience, access and immediacy from our clients, but veterinarians have struggled to monetize this service.  Thankfully, clients are willing to pay for virtual care and this technology now provides a seamless platform to exchange money. Momentum behind telehealth has been growing as the American Veterinary Medical Association (AVMA) encourages veterinarians to explore the possibilities of telemedicine. Like a lot of veterinarians, I had concerns about charging clients for virtual care, including liability, client acceptance and reimbursement. I soon realized, however, that virtual visits conducted inside the right technology actually reduces liability, improves the veterinary-client-patient-relationship (VCPR) and creates a new revenue stream. Below are four persistent myths preventing widespread adoption of paid telemedicine.

Myth #1: Telemedicine increases liability

Telemedicine inside of a secure technology reduces liability in three ways. First, a picture or video is worth a thousand words.  A veterinarian who only offers virtual care via a telephone has to rely on the owner to accurately describe the problem. If, on the other hand, the veterinarian can obtain a picture or a video of the same problem, he or she can now form a more independent and accurate opinion, resulting in a better medical decision for her patient.

Second, a conversation about a patient with a client requires documentation in the medical record.  When I previously used SMS text messaging to communicate with clients, I did not always get the conversations into the medical record because it was difficult to export. At that time, I wasn’t always compliant with state requirements for veterinary medical records. Now I use a platform that will easily export the entire conversation to be preserved in the medical record.

Third, telemedicine platforms offer liability insurance in addition to your existing malpractice insurance. I use a platform that provides $1 million in malpractice insurance.  It is more than I need but I am glad to have peace of mind.

Myth #2: Veterinary telehealth will not generate revenue 

Since I began offering fee-based virtual care via Direct Health, I have generated an additional 2% in revenue per month. I believe this number will continue to grow as clients become more aware of the service. Approximately 60% of our clients that engage with fee-based telemedicine on Direct Health use the service again within 12 months. This is a strong signal that clients like the service. The only additional cost is the subscription fee because the owner is paying for my professional service. Eventually, my goal is to handle all simple cases via telemedicine, with the potential to use virtual care on up to 30% of my cases. By seeing more patients remotely, I’ll have a greater amount of time to spend on more complex cases and wellness exams that require in-office visits.

Myth #3: Clients will not pay for virtual care

This myth is deeply embedded in the veterinary profession because we have offered free telemedicine for more than 100 years, but it is not true. I have found that clients are willing to pay for telemedicine if two requirements are met: First, free telemedicine is offered with veterinary technicians and second, the cost of telemedicine is less than an in-clinic exam.  Clients appreciate the lower cost and convenience of telemedicine. Dr. Matthew Salois, AVMA chief economist, reports that pet owners do not seek veterinary care due to cost. Even 20% of clients who earn income of more than $100,000 annually are concerned about the cost of veterinary care. When we explain fee-based telemedicine to our clients as being characterized by “more convenience and less expense,” most are eager to try it.

Myth #4: Virtual care will ruin my work-life balance

Fee-based telemedicine has reduced my workload and allowed me to work from home on Saturday mornings. The time I would otherwise spend calling owners back is streamlined with texting through Direct Health. As a result, I don’t have to play phone tag and almost all my consults occur during the work week. Initially, I was worried that I would get messages all hours of the day and night but after approximately 1,700 cases, I have found that clients do not send messages in the middle of the night.

I attribute the lack of calls during the night to four factors. First, I can turn Direct Health off.  Second, people are more respectful of me when there is a value placed on the interaction. Third, if the animal is having an emergency that requires immediate in-person care, the client takes the animal to the ER clinic. Fourth, I am interacting with VCPR-compliant cases. These are people who know me and choose me to care for their pets.

After handling a telemedicine case, the most common response I get from clients when I let them know that I am going to charge them for the visit is “Thank you!”


About the author

Dr. Aaron Smiley is president of the Indiana Veterinary Medical Association and is on the University of Illinois Veterinary Alumni Board. He leads two practices and provides guidance to additional practices as Chief of Staff Advisor for VetCor.

Dr. Smiley is an early adopter of fee-based telemedicine and has completed over 1,700 cases using Direct Health. He is an expert on incorporating telemedicine into practice and has lectured on the topic at multiple national meetings. Dr. Smiley is also the co-founder of VetMed2.0, a think tank focused on discovering divergent ideas in veterinary medicine. The company organized the first annual Hackathon at the University of Illinois and is currently developing technology to match veterinary mentors and mentees.