Mark Cushing: Telemedicine does not violate Federal law

Summary

A column by Mark Cushing in The Fountain Report of 11-12-2021, an animal health industry newsletter, headed as a pending legislative and regulatory update and arguing that telemedicine does not violate federal law and that the veterinarian-client-patient relationship (VCPR) can be established electronically. The column says that in a state legislative hearing trade association representatives told legislators that federal law does not allow a VCPR by electronic means only, and calls that claim untrue. It cites the 1994 Animal Medicinal Drug Use Clarification Act (AMDUCA) and FDA rules requiring an in-person VCPR for extra-label drug prescriptions and, under a 2015 rule, for a veterinary feed directive. The newsletter pages also include a column on workplace culture, Vet Watch revenue figures and the staff list.

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than ever to work in a positive,
meaningful environment. Without
giving them a good culture, it will be
impossible to keep them, no matter
how much you pay.

Next month I'll Focus on the
qualities that Form a good culture
and how to develop those.

Dr, Karen Felsted

isa CPA as wellasa
veterinarian and has spent
the last 20 years working
as a financial and operational consultant
to veterinary practices and the animal
health industry. She is active in multiple
veterinary organizations, has written

an extensive number of articles fora
wide range of veterinary publications
and speaks regularly at national and
international veterinary meetings. In
2011 and 2017, she was awarded the
Western Veterinary Conference Practice
Management Continuing Educator of
the Year, and, in 2014, the VetPartners
Distinguished Life Member Award.

COLUMN

Pending legislative and regulatory update

Telemedicine does not
violate Federal law

The veterinarian-client-patient relationship can be

established electronically.
By Mark Cushing

The veterinary profession and
animal heatth industry are divided
about the value of telemedicine,
and—with too much ferver—about
the merits of a telemedicine VCPR,
or veterinarian-client-patient
relationship. (It would be a good
idea for all of us to catch a breath
and explore solutions that could
unite a significant majority of
interested stakeholders, But more
on that in a Future Fountain Report.)

Here I'd like to clear up one topic
of apparent confusion. Just this
week in a state legislative hearing,
trade association representatives
declared—or warned—legislators
that Federal law “does not allow
an establishment of a VCPR by
electronic means only.”

That's a bold statement and, if
true, sure to grab the attention of
an elected official.

But it's not true, and the debate
about telemedicine would be more

productive if this False claim isn’t
repeated. Here's the law:

In 1994, Congress passed
AMDUCA—the Animal Medicinal Drug
Use Clarification Act—and delegated
enforcement authority and rulemaking to
the FDA. The FDA passed administrative
rules implementing AMDUCA, one
of which required that practicing
veterinarians may only prescribe extra-
label drugs if they have an in-person
VCPR in place with the client and patient.

Another rule in 2015 required
the same VCPR for a veterinary
feed directive For food animals.

This made sense and, of course, at
the time there was no discussion
of a telemedicine VCPR, It’s not as
though the FDA made a choice.

But the agency never proclaimed
or even hinted that the practice
of telemedicine or the use of a
telemedicine VCPR (now legal in six
states) was illegal. Neither Congress
nor the FDA appointed the FDA as the

THE FOUNTAIN REPORT + 11-12-2021

governor of VCPR laws in all 50 states.
The FDA simply passed a rule saying

a prescription of an extratabel drug
or veterinary animal feed directive
requires an in-person VCPR. That's all.

It doesn’t help legislators or
veterinarians understand an issue by
declaring that certain conduct “violates
federal aw” when it’s plainly not the case.
Aveterinarian may practice telemedicine
to their heart’s delight, in compliance with
the state veterinary practice act and
state veterinary medical board rules,
without violating Federal law.

The trade association witnesses
should know better. And the
veterinary profession and animal
health industry deserve better.

Mark Cushing is the founder
and managing partner of the
Animal Policy Group LLC, based
in Scottsdale, Arizona; Portland,
Oregon; and Los Angeles.
He's a frequent speaker at
veterinary medicine and other animal policy
conferences, Mark isa Former partner of major
regional and national law Firms and served

as an adjunct professor of law at the Lincoln
Memorial University Duncan School of Law in
Knoxville, Lewis & Clark Law Schoolin Portland
and the University of Oregon School of
Law. Most recently, he’s the author of “Pet
Nation,” a book released by Penguin Random
House that illustrates an inside look at the
forces behind how our pets transformed
American society and culture, Mark can be
reached at mark@animalpoticygroup.com.

> RETURN TO CONTENTS
BY THE NUMBERS

Vet Watch

The Vet Watch Weekly Insight Report offers weekly insights on revenue growth, vaccine purchases and other metrics
reported across the more than 32,000 practices and shelters in the Animalytix Marketplace.

Metrics are compiled by Tim Witt, commercial director at Animalytix/DVMetrics.

Full commentary for the week is available at vetwatch.com.,

Key findings For the week YEAR TO DATE HOSPITAL REVENUE GROWTH
ending November 6, 2021
>» Revenue growth was steady 11.1%
at 9.6% year-to-date net
growth versus revenue for the 11.0% 11.5% 8.2%
comparable period last year at the
roughly 4,000 reporting practices. 9.1% 17.4%
Reported growth was notable in 9.8%
the East North Central division at 8.9%
11.5% year-to-date, up 0.4% From 7.6%
the prior week's position.

> Purchases of surgical suite

bles, which
consumables, which serve as a ROLLING 3-WEEK AVERAGE

proxy for incidence of surgical HOSPITAL REVENUE GROWTH
procedures, were up 0.1% From 0.8%
the prior week at 12.5% growth
year-to-date. 4.7% 4.8% 2.4%
> Core and lifestyle canine and
feline vaccine practice purchasing -3.7% 3.4%
improved 0.4% from the prior week
at 14.7% growth year-to-date. 2.9% 4.8%
Annual core and lifestyle vaccine
1.8%
purchases were selected as the
principal metric given 50% or more
of annual visits to a veterinary
practice are associated with
administration of these products.
robust at 13.2% growth week. The Mountain division was
> Growth in kennel cough vaccine year-to-date, notable at 6% growth, up 2.6%
purchases, which provides a From the prior week. This metric
measure of pet mobility, moved > Rolling three-week average is designed to provide a view of
up For the week to 14.1%, revenue growth across all relative robustness of growth
reflecting a 0.3% increase versus divisions moved up for the week trends (e.g., market velocity) For
the prior week, and into the positive at 2.6%. each reporting zone. A positive
Seven divisions ended positive, value indicates rolling revenue
>» Parasiticide purchases were up with Five divisions showing growth versus the prior year
0.1% From the prior week and positive movement over the prior reported three-week period,

THE FOUNTAIN REPORT + 11-12-2021 > RETURN TO CONTENTS
MARKET INTELLIGENCE FOR LEADERS IN-ANIMAL HEALTH puters errr
Barings NOVEMBER 12, 2021

The is a weekly
subscription service provided by
Antelligence. Its comprehensive
in-depth news and quantitative
data have been guiding decision
making for executives in the
business of animal health

since 2002.
CONTENTS

QUICK LINKS
> Company Activity

> General Industry,Public Policy
and Politics

> Companion Animal Market
> Food Animal Market

THE INNOVATION SPOTLIGHT
TALKATOO

NATIONAL PET OWNERS SURVEY

COLUMN
BE A PLACE PEOPLE
WANT TO WORK

COLUMN
TELEMEDICINE DOES NOT
VIOLATE FEDERAL LAW

BY THE NUMBERS
VET WATCH UPDATE

WHERE DO PET OWNERS COMPANY PERFORMANCE
GO FOR CARE ADVICE? AND ACTIVITIES
FINANCE
» Deal Tracker
> Stock Tracker
NEWS
SECTION 1.0 SECTION 3.0
COMPANY ACTIVITY COMPANION
ANIMAL MARKET
SECTION 2.0
GENERAL INDUSTRY, SECTION 4.0
PUBLIC POLICY & POLITICS FOOD ANIMAL MARKET

THE FOUNTAIN REPORT + 11-12-2021

FFOUNTAINREPORT

rw oon I Antelligence

STAFF

David Thill

Editor & Technology

Project Management
david.thill@antelligence.com

Duane Thurman
Co-Founder, Finance & News
dentrexinc@aol.com

Shannon Kelly
Subscription Sales
& Educational Coordinator

shannon.kelly@antelligence.com

Brent Cashman
Art Director
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Terry Sheehan
Commentary & Insights

tsheehan@axxiomconsulting.com

Chris Kelly

Managing Partner & Publisher
(770) 335-5445
chris.keliy@antelligence.com

COLUMNISTS

Mark Cushing, Animal Policy Group

David Sprinkle, Packaged Facts
Ali Mcintyre, VVCA

Stacy Pursell, The VET Recruiter,
Therio Partners

DATA PROVIDERS

American Pet Products Association

Animalytix
Guggenheim Partners
Packaged Facts
VetWatch

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