By Charles Hightower
SEPT. 19, 2013 – Are you looking for a good primary care physician (PCP) in Nevada?
It can be hard to find a primary care physician in Nevada due to the shortage of such doctors, which is most likely to get worse when the Affordable Care Act (ACA, or “Obamacare”) kicks in in 2014. The ACA will increase the number of insured Nevadans, however there are not enough providers to take care of these folks. If you live in Nevada, and already have a PCP that you like, it is very possible that your physician is either “full” and not accepting new patients (especially Medicare beneficiaries). It is also possible that your doctor may be considering moving into a concierge, or direct pay, model of care whereby one pays a retainer fee for either all-inclusive primary care services (usually the provider “opt-out” of Medicare and insurance contracts entirely), or limit their practice size, provide improved access and additional wellness services.
How much do you value your primary care physician? For some, paying an additional $50-$120/month to retain their PCP is an easy decision. The extra convenience of being able to get in sooner and spend more time face-to-face with their doctor is worth it to these folks. Most patients who sign up for concierge practices are very happy with their decision, and certainly the doctors are happier…so it is a win-win situation for both doctor and patient. Several primary care physicians in Las Vegas, Henderson, Reno, and even Carson City have transitioned into concierge practices. The latest take on this new model of care is offering online concierge primary care services for a monthly membership fee.
Nevada has some very sparsely populated regions, where the nearest primary care doctor may be hundreds of miles away. The clinics in Hawthorne, Eureka, Ely, Elko, Wendover may have minimal access or limited provider options. Nevada recently legislated that nurse practitioners(NP’s) no longer needed physician oversight. It is possible now for NP’s to run solo practices in these rural area.
All-inclusive (within the scope of telemedicine) primary care online via secure email, video-conferencing, chat is relatively a new concept. It has been adopted by the mental health community with many northern Nevadans receiving their psychiatric care via Skype (or similar video chat service) from southern Nevada providers. Insurance companies have been slow to adopt payment for such services, which is one impetus behind the cash-pay model. There are several websites that offer “per visit” consultations with a physician, including MDLive , Teladoc, and Ameridoc. Cirrus Medical Network, take it one step farther by combining telemedicine services along with concierge primary care. Offering online concierge doctors for a nominal monthly fee, along with a VIP option for those who would like to call or text their doctor directly. No setting up appointments or waiting on hold with a busy receptionist. No waiting rooms full of sick people. No need to Google or search WebMD. With readily available home blood pressure monitors, thermometers, and a pulse oximeters, vital signs can easily be performed at home. Newer web cams with high-definition video-conferencing allow for 1:1 visits not unlike what happens in the doctor’s exam room. There are several emerging telehealth products and apps that interface with one’s mobile devices, which make the virtual house call even more appealing in the future.
Certainly, not all medical conditions can be treated online. Some cases will undoubtedly need to be seen in person (chest pain, lacerations). However, the days of putting on the gown and bending over for a routine physical are numbered. Most primary care conditions can be addressed with a good history and review of objective data (vital signs, labs, imaging). Whether Nevadans will adopt this new model of health care delivery will remain to be seen. Nonetheless, it is step forward toward improving access to healthcare for Nevadans.