Chewy’s push toward telehealth for pets faces regulatory hurdles, and skeptical vets

chewy., the pet-goods e-commerce giant known for its convenient car-shipping services and generous return policies, wants to develop a tele-veterinary healthcare service as part of a universal healthcare push.

While telehealth is a small part of the company’s rapidly expanding health offering, it is critical to its strategy. However, they also face regulatory hurdles and skepticism from the veterinary community. Veterinarians told CNBC that the service could have some benefits in minor situations, or for people who don’t have easy access to veterinary care. But they said it could cause problems for pets, too.

Chewy’s service, Connect With a Vet, has seen significant growth, but has been limited by a specific type of regulation known as a veterinary client-patient relationship, or VCPR, according to Chewy CEO Sumit Singh.

“If you take a look at our Connect With a Vet, it’s the most unique telehealth platform on the market today, just two years later, and yet, it’s not a meaningful part of our business. Why? Because when you’re looking for pet health, You will find that there is a specific term called VCPR,” Singh said.

He also noted that the barrier is “crumbling” in the wake of the Covid pandemic and multiple countries are “already phasing out VCPR”.

Most states prohibit veterinarians from performing their primary duties—diagnosing conditions and prescribing medications—until a VCPR has been established by seeing an animal in person and performing a physical examination.

“Trying to do a video assessment without any prior relationship whatsoever, that’s the part that worries me,” said Brett Levitzky, chief medical officer and founder of Veterinary Emergency and Referral Group, an emergency animal hospital in New York City. . “There is no substitute for a physical examination. Period.”

However, there is a growing movement to change the VCPR regulations. The leader behind the push, the Virtual Veterinary Care Association, or VVCA, is an advocacy group co-founded by longtime lobbyist and political strategist Mark Cushing. It was funded by Chewy and several other pet companies that are expanding into telehealth.

When asked about the company’s position on VCPR, Chewy said it does not take a position on the issue and declined to say whether vets would diagnose and prescribe the drugs if the laws were changed. Currently, Chewy vets do not diagnose conditions or prescribe medications.

The company suggested CNBC speak with Cushing, whom the company describes as an industry expert on the matter, to learn more about VCPR. Cushing said he does not represent Chewy “in the field of telemedicine,” but that the company is a primary sponsor of VVCA.

It is not clear how much money Chewy has donated to VVCA because, as a non-profit, charitable organization, it is not required to disclose donor information to the public. Cushing is also CEO of the Animal Policy Group, a lobbying organization, which has advocated on behalf of Banfield Pet Hospital, a network of clinics offering in-clinic and tele-veterinary care, according to lobbying reports filed with the U.S. Senate. Banfield Pet Hospital is owned by Mars Veterinary Health, a subsidiary of the Mars pet food and treat group.

The goal of the VVCA is to make telemedicine legal nationwide so that vets can diagnose conditions and prescribe medications at their own discretion — even if they’ve never held the animal.

“The hardest thing, though, and the most expensive thing about telemedicine in the veterinary field, by far, is customer acquisition,” Cushing said.

Prescribing medications and diagnosing conditions without ever performing a physical examination on an animal poses “serious risks” that can ultimately be harmful, or even fatal in some rare cases, said Dr. Linda Isaacson, who has been a veterinarian since 2003 and runs three clinics in Brooklyn, told CNBC.

Sometimes, for example, a pet owner might say their animal is constipated, but a physical exam will reveal a urinary tract obstruction, Isaacson said.

“Urinary blockage is life threatening, you know, if they don’t urinate, they’re going to die and you won’t be able to tell through telemedicine,” she said. “So if you’re using telemedicine and they’re prescribing you, you know, a laxative, it’s not going to help the pet, is it? They’re going to die.”

Chewy was founded in 2011 by Ryan Cohen, an activist investor and current president of Chewy Jim Stop. He left the company in 2018 and the following year, it went public for $8.8 billion. Chewy’s market capitalization is currently around $18.5 billion.

Under Singh’s leadership as CEO, Chewy’s annual revenue rose from $3.53 billion in fiscal 2018 to $8.9 billion in fiscal 2021, but the company has faltered due to recurring annual net losses and thin margins.

During an interview with CNBC earlier this month, the former Amazon CEO said expanding pet health and wellness, two of the higher-margin categories of pet food, would be necessary to put the company on a path to profitability.

It’s Chewy’s main competitor’s strategy outside of the big box retailers, Petco, like that. Rebranded as a health and wellness company in 2020. Petco has vets on their payroll who work inside full-service hospitals and clinics built inside the stores. When asked, Petco said telehealth isn’t off the table, but for now, its focus is on “hands on pets,” which is what they say pet parents want.

Chewy’s expansion into health — including insurance, food, and prescriptions — came as the pet boom fueled the pandemic, seeing 23 million American families welcome a new animal into their home, transforming the overall pet industry into a $123.6 billion market in 2021, according to data from the ASPCA and the American Pet Products Association.

Chewy aims to make healthcare about 30% of its total business in the coming years, according to Singh. The company wouldn’t say how much pet healthcare accounts for in its current revenue stream, but less than 5% of Chewy’s customer base buys their health products from the company.

“If you notice, there has been little or no innovation in pet health over the past decade, however, in the last three years there has been more innovation in pet health than in the last decade,” Singh said. or the past twenty years.

The sudden surge of new animal owners during the pandemic has made it difficult to book their appointments, and has strained an already understaffed and overwhelmed veterinary community. Rules about creating a VCPR virtually without a physical exam have been relaxed in some states due to an emergency need.

Outside of an emergency like a global pandemic, the American Veterinary Medical Association, the nation’s leading advocacy group for veterinarians, maintains that a VCPR can only be established after in-person testing. The group’s ethical standards allow veterinarians to diagnose, prescribe medications, or treat animals virtually—but only after creating a VCPR in person.

“Without VCPR, any advice given through electronic means should be general and not specific to the patient, diagnosis, or treatment,” the AVMA advises in its guidelines on telemedicine.

Despite the AMVA’s stance, at least five states — Michigan, Oklahoma, Indiana, Virginia and New Jersey — have made the lighter rules permanent, according to the VVCA.

Chewy said he considers Connect With a Vet a remote triage platform, not a replacement for in-clinic care, where clients can call a licensed doctor or technician and ask about their health concerns, diet, behavior, and products that can increase “lifelong well-being.”

Chewy said the program was created to make self-care affordable and accessible to everyone. The service is designed to help clients access some form of care when they can’t book an immediate appointment, can’t afford it, or don’t live near an in-person clinic, the company said.

Connect With a Vet also aims to help pet parents know if the problem their pet is facing is an emergency that requires immediate care or something they can handle during an in-person vet appointment. The company warns customers to go to the nearest veterinary clinic if their animals have a life-threatening condition. Other companies provide similar services.

Chewy has also started a B2B offering called Practice Hub, which creates a marketplace for veterinary clinics to sell their products to clients within Chewy.com. The service is currently free for vets, and they receive a portion of the revenue when their customers place orders on Chewy for products offered by the clinic. In exchange, Chewy gets access to his customers. Al-Shuwai said that the platform will include 1,500 clinics this month.

Isaacson, a Brooklyn vet, used telehealth during the height of the pandemic. She said about 50% of clients need to bring their pets to the clinic after the virtual sessions.

“It’s very difficult to keep the pet still. I can’t even see anything usually on video. I think it works better with human medicine, but for animals, you know, it’s not ideal,” Isaacson said. “It’s not like someone can tell you how they feel or sit still or show you something.”

Isaacson no longer offers the virtual service. She worries that new pet parents might consider Chewy’s service and others like her as an alternative to traditional, industry-standard veterinary care.

“You think if it’s allowed, it’s safe, right?” Isaacson said. “It’s not, it’s substandard care.”

On the webpage for Chewy’s Connect With Vet Service, the company advertises a sample conversation between a rubber doctor and a customer whose animal has begun to limp. It’s a potentially serious condition that can only be managed after a physical exam if there has been no previous relationship with the pet, according to Levitzke, of the Veterinary Emergency and Referral Group.

“Are they limping because they have a general sense of weakness? Are they limping because their knee hurts? Are they limping because they can’t feel their leg at all? Those are all completely different scenarios and they’re all possible,” Levitzky said. .

Chewy offered to make one of the vets who use the Practice Hub available to CNBC for an interview. The company was suggested by Audrey Westrach, co-CEO of Petfolk and co-founder of VVCA, nonprofit Chewy Funds.

Wystrach has been a veterinarian for 28 years and practices telehealth. She also practices full telemedicine, where she can prescribe and diagnose virtually, but only with clients she has an existing relationship with.

She believes vets should have more discretion to practice their licensed medicine and should be able to create a VCPR virtually, if they decide it’s safe.

“You know, it’s not a good idea to work on a pet who can’t breathe in a virtual space, that’s too big a no-brainer,” Wystrach said. “But is it okay for me to, you know, be able to look into a pet’s mouth and see if they have broken teeth or talk to someone about behavior or feeding? Or even skin?”

She said demand for vets outstrips supply, and tele-veterinary care and medicine is critical to ensuring pet parents have access to care.

“I’ve always had a mantra that virtual care is better than no care,” she said. “I think we’re getting to where we have a realistic view of how to manage the sheer volume of pets in people’s care in today’s day and age.”

Clarification: This story has been updated to clarify the functionality of Chewy’s Practice Hub.