The American Board of Family Medicine (ABFM) has joined forces with five other organizations representing more than 1,000 physicians in the United States and Canada to take a stand and advocate for the introduction of the Physician Quality Reporting System (PQRS) in Nevada. The program uses a list of doctors from recognized medical schools, hospitals and other healthcare providers, as it is the most comprehensive list available. It is part of a Medicare program that encourages health care professionals and groups to report on the quality of care they provide.
M Merit Health Medical Group, led by Michelle Anne Bholat, is a group of specialty physicians that includes Elko Medical Center in Las Vegas, Nevada, and a number of other hospitals and clinics throughout the state. With more than 1000 patients, the clinic is currently one of the largest medical clinics in the country.
Then there is the Elko Family Medical and Dental Center, which, as a federally qualified health center, receives funding from the federal government to treat patients regardless of whether they are privately insured, Medicare or Medicaid. HMOs that sign contracts with Medicaid and provide eligible children with benefits covered by the Children's Health Insurance Program (CHIP), the nation's largest children's health insurance program.
At some point, residents must have completed their last two years at Elko Family Medical and Dental Center, and they do their best to do so in the best possible way.
They typically see older patients who have multiple chronic illnesses and take dozens of medications, Islas said. Hogle said that once primary care providers turn patients away, they become extremely common in Elko, and most doctors will not normally see more than 20 percent of Medicare patients. Residents go to and from the hospital every two weeks, with the waiting list currently six weeks, she said, but residents estimate that 80 to 90 percent or more of their patients are Medicare patients. That, along with the high number of physicians graduating from the University of Nevada School of Medicine, Las Vegas School of Medicine, makes it difficult to recruit primary care physicians in rural Nevada.
Dr. David Hogle, who runs the Elko Clinic and has been practicing in the city for 38 years, said Medicare patients are more complex - they have multiple problems and take longer to deal with. Dr. Fred Spogen, a gastroenterologist in Elkos and a member of the Medicare task force, believes there may be a point in the future when Nevada produces too many doctors. Dr. Spogens said primary care doctors are vital because they are the first to see patients and decide what kind of treatment they need, and they would welcome the state's continued funding of a rural health program.
Spogen told the state of Nevada that Elko's 70-bed hospital typically has fewer than 20 patients, and they could still be taxed in the event of an outbreak. He's not sure what he'll do in the meantime, but he's already planning to find a primary care doctor and figure out how to qualify for Medicare. Finley said he has a lot to do to stay up to date, and that's why he's already considering starting a primary care doctor in Elkhart. But he is not enthusiastic about the idea of buying insurance through the state exchange.
The medical school is also in the process of hiring two full-time doctors to care for the residents of Elko. Hospital staff said they have seen a growing number of Medicare patients, and anecdotally, they are retired miners who have decided to continue living in the city. Currently, the emergency room has two doctors on its team, one of whom is currently behaving and a medical assistant is filling in for the other two.
O-opinions among Nevada residents vary, but the majority seem to support the status quo on prostitution and oppose the legalization of prostitution in Las Vegas. The law allows licensed brothels in rural areas, and lawmakers oppose it because legal brothel prostitution does not bring the county any significant revenue.
County control of local affairs is a hot potato because nearly three-quarters of Nevada's population live in Clark County, where prostitution is illegal. Federal law allows licenses for brothels in the rest of Nevada, but only seven counties currently have an active brothel. The problem is particularly acute in all 50 states except Nevada, and it is most acute in our state's rural border counties. After 1971, there were more than 1,000 prostitutes per square mile of land in 10 rural counties, and many of them were financially unsuccessful or violated state health regulations.
Nevada politicians have played both sides of the prostitution dispute, saying they are personally opposed to prostitution but believe it should be up to the counties to decide. Brothels in rural Nevada counties have been criticized for their lack of local control over local affairs. Nevada has no state income tax, so the brothel is exempt from the entertainment tax and pays no other state taxes. But brothel prostitutes are subject to federal income tax and pay local fees.