Transcript

Krysten Bennett: Jack, thank you for joining us today to talk about the five regulatory things veterinarians must know.

Jack Advent: I know it’s not the most exciting subject matter for a lot of people, but it is important that they know it, because it will save them a lot of angst and it also could result in them winning $10,000. So I think it’s well worth your time to listen!

KB: And on that note, let’s get started with what is arguably the most exciting one of your regulatory facts. 

#1: Veterinary Loan Repayment Grants

Mia Cunningham: All right, Jack. A few months ago, the Veterinary Licensing board awarded loan repayment grants to some veterinarians under a new state program. So, first of all, can you remind us where that money came from and how many areas were eligible to receive it?

JA: Sure. So a few years ago, OVMA worked with a couple of state legislators in the licensing board to create a program where any kind of surplus funds that are collected by the veterinary licensing board—and they collect funds from license fees—that they wouldn’t use in the oversight enforcement administration of the law, that those would go into this designated fund that could be used for loan repayment grants for veterinarians. This is actually veterinarians’ money, if you will, being returned to veterinarians. So we thought it was a win on many levels. In the past, any time there was a surplus, it just went into the general revenue fund state. So this is a good targeted use of those funds.

This was a few months ago, that was the first time that the program and actually been officially put in place in terms of awards being given. So to be eligible, a veterinarian just simply needed to have completed at least 12 hours of some sort of charitable work in the preceding year. So, you know, one hour a month. We know a lot of our folks do a lot of good things in their community and help out in a lot of ways. They just need to acknowledge they’ve done that. It’s not an evaluation. It is, if you’ve done it, you apply. They do have to agree that they’re going to stay in the state of Ohio for two years if they do win one of the grants. Your name is put in a pool that would be drawn lottery style. Really, It’s that simple. It’s not a cumbersome process at all.

KB: So for the first round of the program, how many veterinarians received a loan repayment grant and in what amount?

JA: Eleven veterinarians received a grant of $10,000. The number of applicants was much lower than we anticipated. There was actually a pool of $270,000 available, but the grants cannot exceed $10,000. So really, only $110,000 of that was actually awarded. There were 16 more veterinarians that could have had $10,000 awarded to them for loan repayment.

KB: Since they didn’t use all of the money in the fund, what happens to the extra money now?

JA: An application was put by the veterinary medical licensing board to be able to continue to use that money for the loan repayment program, so they can do it again next year—assuming that the legislature does not take the money back and put it in the general revenue fund.

KB: And was that a one-time thing, or will this happen again in the future?

JA: The vet licensing board budget runs every two years. So in essence, that surplus is determined every two years. We can’t guarantee that there’s going to be a surplus in the future, but there’s certainly a good likelihood, based on at least the last 10 years, there’s been a relatively significant surplus. So we feel pretty good that this program will continue. Hopefully next year, next May. Assuming they’re allowed to use that money, but if not, in two years.

MC: Will there be the same number of grants in the same amount, or does it depend on surplus?

JA: So it depends on the surplus that’s available. So let’s let’s take the normal scenario, not think about next year because this kind of an unusual situation with surplus funds. So in two years, whatever the surplus is that the licensing board has, that will go into this pool of money. Last year, it was $270,000. It could be $220,000, $150,000—pick a number. The licensing board then will determine, based on the number of applicants, how many grants they are going to award. And the way the law is written, the grants can be anywhere between $5,000 and $10,000. So, if we have a $220,000 surplus and 22 people apply… Guess what? Twenty-two people are getting $10,000 each.

MC: And Jack, you had mentioned something earlier about how people are eligible as long as they commit to stay in state of Ohio for two years. Suppose someone has a change in circumstance and they decide to take a job outside of Ohio before that time is up. Do they face any penalties? Do they have to repay the loan? How does that work?

JA: No one’s going to stop them at the border and refuse to let them leave the state. (Laughs) If they can’t meet their obligations, they owe the money back. No one obviously knows, a lot of times, what their circumstances might be. But if if you’re thinking of leaving the state, maybe not a good idea to apply, you wouldn’t want to get a check for ten and then have to turn around and give it back. That wouldn’t be fun.

KB: Speaking of applying, how does a veterinarian apply to receive a grant?

JA: So they would go to the veterinary medical licensing board website. They have a tab there for applying for the grant. You just want to make sure that you’re applying for the correct program. There’s another grant that exists for those who are willing to engage in large animal medicine in underserved areas. Just make sure you’re applying for the right one. When you apply, you’re just certifying that you have completed the requirements, which is the 12 hours of charitable work. And you can read there the definition of charitable work; it’s pretty broad in terms of what you can do. It just has to be for either a government entity or a nonprofit.

KB: Are applications being accepted now on a rolling basis, or is there an application period when people should apply?

JA: I don’t know if they’ve kept that open. I would tell people to wait and apply a little closer to when the awards will be given. So in other words, more like towards the end of the year, just because you’re certifying you’ve done the 12 hours of charitable work.

KB: What if those same veterinarians who won this year apply again next year? Are they eligible to win another one?

JA: They have to wait another cycle. So in another two years, they could apply and potentially win again.

#2: DEA Renewal

KB: So we understand that the DEA has issued renewal emails to prescribers that contains something that may cause confusion for veterinarians. What is that issue?

JA: Earlier this year, Congress passed legislation that requires all prescribers to take 8 hours of opioid abuse education. Obviously we have some overprescribing some problems, with the abuse of opioids. They just want to make sure that all prescribers are aware of how they need to manage that, to make sure it’s being used in the right circumstances, in the right quantities, etc. The requirement shows up when you go to do your registration. But the key thing for veterinarians is, veterinarians were exempted from that requirement. So you do not, as a veterinarian, need to have taken 8 hours of opioid training education. But when you get the renewal notice, it’s not abundantly clear when you see it. The exemption is definitely there. You just have to dig a little bit. So I think what will happen is, when veterinarians see that, they’ll be like, “Oh, what is this requirement? I didn’t know I had to do this.” Just know that you don’t as a veterinarian; you can simply check the box that you understand, and you don’t actually have to do it.

#3: Continuing Education Hours

MC: So we’re going to move on to a new CE rule change. The Ohio Veterinary Medical Licensing Board is in the process of reviewing its regulations. Where do things stand with respect to the continuing education rule?

JA: First of all, the rules of any regulatory entity have to be reviewed at least every five years. So some of the rules that they’re doing, they’re going through because the five-year time has come up. That’s not the case with continuing education.

So the pandemic changed, obviously, a lot of things in our lives. And one of the things that did change is how we look at continuing education in terms of the requirement and what forms and how it’s achieved. Obviously, during the pandemic, people couldn’t gather, so everything was online driven. After the pandemic, the question became, do we revert back completely to the old system, should it be some sort of a mix, or do you continue to allow all online? That kind of a conversation took place in a variety of regulatory boards, including the veterinary licensing board. So what the licensing board previously did in the spring was to say, basically: “For a veterinarian,you need 30 hours every two years. We’re going to allow half of that to be in an online form.”

There was also some confusion in terms of the different types of online education. The licensing board had been asked: “If I view a live streamed online program, does that count as being in-person?” They made a determination that they thought it did, even though that seems to conflict directly with the rule that they had written. So we asked the question, Are you sure? Is that what you intended? Because we believe that the definition, certainly as Webster’s defines it, is that “online” refers to education that would come, basically, online. That doesn’t distinguish between something that’s recorded and offered whenever you want to watch it, and something that is live streamed. As part of this, we asked them to clarify.

So now, the licensing board has reviewed that rule, and they’re putting forth a new version for consideration. And that new version will, first of all, it will say online is online. So you you get to count it exactly the same, whether you watch it as a live stream, like a webinar, or you watch it prerecorded whenever it is convenient for you. They’re also going to modify and expand a little bit the number of online hours that you can take. So for veterinarians, that would be 18 hours that can be achieved in an online format, and then the remaining 12 would need to be in-person. The concept is that, 12 is essentially two days in the two-year period, you need to be in-person to achieve that component. The rest can be in an online format.

KB: Do you have any sense of when these changes are going to go into effect?

JA: Everything I just discussed was in a draft, and then at their August meeting, they determined they would move forward with the formal rule-making process, that comment period, publication, etc. Probably it will have been adopted around the end of the year, assuming there’s no further revisions and it has to be refiled. And then they would set an effective date. That effective date is usually around when the rule is formally passed. So we’re thinking probably sometime in January, would be my best guess is when that would take effect, if everything moves as we anticipate.

#4: Ohio livestock care standards

MC: So we are going to move on to the livestock care standards rules. So the Livestock Care Standards Board at the Ohio Department of Agriculture has been looking at some of the care standard rules for various species. How often does the board review its care standards?

JA: First of all, it’s always good that they periodically look at it because sometimes there’s differences and changes in how we view things in medicine. They need to do that every five years. Obviously, if something comes up before then, they can review earlier.

KB: How does this review process work?

JA: So, you know, most entities, will engage what they call stakeholders—those that actually are affected by the rule—and say, “Here’s what we’re thinking. What do you think?” and kind of get feedback on that process. Ideally, that produces the best outcomes, because everybody has a chance to weigh in and kind of help craft it in a way that makes sense. Obviously, the regulators, they have to do what they think ultimately is right, but they should be asking for the opinions of those that actually deal with this every day.

So in this particular case, and to their credit, they knew that they wanted to to visit the area of pain management, and they wanted to make sure they did it in the right way. So they actually created a subcommittee, a variety of people like veterinarians and producers that would be affected, and asked for them to talk through the current rules and what changes potentially they should be making. And this is where that that came out. Again, they’re trying to do what they believe the science says and what’s appropriate animal care.

KB: What rules is the board looking at during this review period?

JA: In the livestock care standards, as written, there’s a general care rule and a couple of general parameters, and then they’re written by species. At this time, they’re going through most of those species rules and one of the general rules. The biggest thing that they’re looking at, is pain management and in particular the dehorning and disbudding process. The proposed rule will require that you must use pain management in dehorning and disbudding. This applies to dairy cattle, beef cattle, goats and sheep. Currently, the rule is written that you have to use it if it had already erupted; this will require prior to eruption as well. That’s based on what science tells us, and really, all the major veterinary groups and ag groups that deal with those species, everybody agrees that there’s going to be some discomfort, and you should be using some sort of local pain management before you do that procedure.

MC: So, Jack, if these changes are agreed to, when might they take place?

JA: We’re probably talking around the first of the year by the time it works its way through everything. That would be my best guess.

Number 5: Medical Records

MC: Record-keeping regulations governing the release of medical records have been on the books for quite a while, but there seems to be still a lot of misunderstanding. Can you tell our listeners when a veterinarian has to provide a copy of the medical record to a client?

JA: Absolutely. This isn’t new, but it keeps coming up. If you sit in on any of the licensing board meetings, you’ll hear, just about every single meeting, where somebody either didn’t understand or misapplied the rule.

So, as an animal owner, you can request a copy of the medical records the veterinarian keeps for your animal, at any point in time. Usually that’s done when you’re you’re going to leave a clinic and go somewhere else, for whatever reason. The actual original of that record belongs to the veterinary facility, in case there’s ever any question down the road. But you are entitled, as an animal owner, to a copy of your record. That’s in Ohio Administrative Code.

KB: Can a veterinary practice charge a fee to release those records?

JA: The veterinarian does have the right to do what’s known as a reasonable charge. That’s usually going to be very minimal—what does it cost to duplicate 10 pages of paper kind of thing? And most of the time, it’s just just provided free of charge, unless you wanted copies of, say, radiographs. That would be something that might cause some expense to reproduce.

KB: Are there any cases where a veterinarian could withhold those records?

JA: The only thing that you have to be leery of—and sometimes veterinarians don’t realize that—but say the client wants a copy of their animal’s medical record, but they haven’t fully paid for all the services. Maybe there’s a disagreement about that. And so they say, “Give me a copy of the record. I’m leaving.” Even though they haven’t paid all their bill. And the veterinarian now and says, “No, I’ll get you a copy of your record when you pay your bill.” Well, as veterinarian, you actually can’t do that. You have to give them a copy of the record. Doesn’t mean that the client no longer owes you money, but you have to pursue that through other traditional debt recovery means; you can’t use the medical record as leverage in that situation. And that’s misunderstood a lot of times.

MC: So what about when a subsequent treating veterinarian asks for the record?

JA: The rule that we’re talking about also applies to any subsequent treating veterinarian; you have to provide a copy to that person as well. Maybe there’s a scenario where the client is going to see a specialist. Obviously, they need to know everything that you, as the original treating veterinarian, have done in terms of diagnostics, etc.

The other scenarios, when you know you’ve chosen to go to another veterinarian, maybe you’ve moved away or you just wanted you want someone else, that original veterinarian gets to hold on to the original, but they do have to provide a copy to the subsequent treating veterinarian.

KB: Are there any other instances when a veterinarian would need to release a record, either with or without a client’s permission?

JA: There are some circumstances. Let’s say, in the case of an animal bite, where maybe a local department of health needs to verify a rabies vaccination. There could potentially be a disease outbreak, and let’s say, the Department of Agriculture needs access of records, principally vaccination and within a given geographic area. That’s generally infrequent. The other common thing where a vaccination record is requested, maybe a kennel would call that veterinarian’s office and say, “Krysten has brought her dog in for boarding. Can you send me a copy of the vaccination record?” And the answer to the question is, Yes, as long as Krysten’s okay with you doing that, you absolutely can. But you need to ask Krysten that and make sure she’s comfortable with it.

MC: What happens to the records if a clinic closes?

JA: Most of the time when a clinic is bought by someone else but by another veterinarian or some some sort of an entity, it will continue to maintain those records. There are occasions where a veterinarian just chooses to retire and there’s no one that wants to buy it, or in those unfortunate situations where a veterinarian passes away unexpectedly and there’s no other veterinarian there to continue the clinic. This is not in a rule per se, but it is in a recommendation of the veterinary licensing board that they should notify all clients that the clinic is closing, that they will provide a copy of the record to you by whatever means. That could be electronic, or that could be, come by the clinic sometime in the next two weeks and pick up the hard copy. Just walking through and making people aware of that process and what they need to do to get their pets’ records. Sometimes you’re not going to be able to reach everybody. Maybe you don’t have good emails, good postal addresses, whatever. But they are supposed to make a good faith effort to let everyone know this is what’s going on, and here’s where you can get a copy of your record.

And then the other thing that they do ask is that you let the licensing board know how you’re handling that, so that if anybody ever calls them and says, “I can’t find my veterinarian,” and they can say, “Well, that clinic closed, here’s where they transferred the record to.” It could be another veterinarian. They’re not required to, but maybe there’s another veterinary facility in the area that they go to and they say, “Hey, I’m going to be closing shop. Can I send all my clients records over to you? And then maybe they’ll come to you as their new veterinarian.”

KB: Another question I think that comes up a lot in regards to medical records is, how long do you have to keep those records on file at your clinic?

JA: Yeah, it is a common question. The record has to be kept for three years from the time you last saw the animal. You may need to keep it longer—if, say, the record included some financial data that you would need to keep for tax purposes. Not saying you should or you would. But just generally, if you just think about it in the true medical sense, three years.

Some people misunderstand that, because that time period used to be longer in some previous rules. Maybe that’s where some of the confusion lies. From a veterinary standpoint, the statute of limitations, if someone had a complaint, that’s a two years. So you’re well covered in that regard. 

MC: Thank you for being here with us today.

JA: You bet. Any time.