A new law in Nevada is expanding the use of telemedicine, which relies on virtual technology to connect doctors and patients. This makes Nevada the most advanced state in the country for telehealth implementation. But as Reno Public Radio’s Esther Ciammachilli explains, there's debate over whether this will help some of Nevada’s biggest healthcare issues, like its severe doctor shortage.
Lisa Polvado suffers from migraines and she’s having an exceptionally hard day. Stresses from her job and family life are aggravating this condition and she’s decided it’s time to see a doctor. But she can’t leave work. So–from her office in Reno–she does what anyone living in the 21st century would do: She goes to the Internet.
"Is this the first time you’ve ever had a virtual visit? Yes. So a couple of things, just ground rules for you, are you able to see me and hear me well enough? Looks perfect. Good, good, and I can also see you.”
Polvado logs in to a virtual healthcare network where she’s quickly connected with the first available doctor, who at this time is Carol Meyer in Fernley. By using video-conferencing technology, Meyer is able to examine and treat Polvado even from miles away.
“You wanna talk about what a migraine is? Yeah, that would be great if you can educate me.”
Northern Nevada’s telemedicine program was launched in 2012, but the practice itself has been around for more than two decades. Until recently, telemedicine was only covered by about half of the insurers in Nevada and could only be used by people in rural areas. But one healthcare official thought the program should be available to everyone.
“There’s a lot of patients in Clark County and Washoe County that can’t get to their provider; a lot of Medicare recipients might be in long-term care facilities and they can’t get to a provider, so how do we use telemedicine to connect the provider to the patient?”
That’s Kirk Gillis. He spearheaded this campaign for Renown Health and was a critical lobbyist for the TeleHealth Parity Law. This expands telemedicine to residents in all areas of the state. It also requires Medicare, worker’s compensation and every insurer to pay for these services. Gillis says this makes Nevada the most advanced state in the nation for telehealth parity.
“And so this parity act is to make sure there’s a level playing field for patients, and consumers, and providers when you’re looking at virtual or in-person healthcare programs.”
The American Telehealth Association measures parity laws across the country. Every state receives a grade on a scale from A to F. Since the new law went into effect, Nevada has jumped from a C to an A. But the state still ranks low in several aspects of healthcare and professionals are torn about whether telehealth expansion will cure these ailments. Gerald Ackerman directs the Office of Rural Health in Elko.
“I think the challenge with the implementation in rural Nevada is provider shortage.”
Currently, there are about 73 doctors for every 100,000 people in rural Nevada. That’s a 9 percent decrease over the past decade. Ackerman says physicians are already overwhelmed and they just don’t have the means or the time to implement new technology.
“When you’re looking at a community that is struggling to provide primary care because they need more physicians, or nurse practitioners or P.A.s, it’s kind of hard to add a new level of service.”
But Dr. Evan Klass sees it differently. Klass is the director of Project ECHO, a telehealth initiative that connects specialty doctors to primary care providers in rural and underserved areas. The focus of this program is to create peer-to-peer development opportunities.
“Rather than a single specialist speaking to a single patient, it’s a specialist or a specialty team communicating with many primary care providers and helping them in managing their challenging patients.”
By seeking expertise from outside sources, Klass says telehealth can potentially help physicians in rural Nevada treat their patient population more effectively. He adds, however, that the biggest hurdle facing the telehealth industry is a doctor’s inability to treat patients across state lines, a challenge being dealt with nationwide.