April brings green celebrations, contests, rebates

April is always a busy month for anyone with a bit of green in them and this is the week for premier events.

Celebration

The fourth-annual GreenFest and the 17th annual Festival of Communities are being combined from 11 a.m. to 6 p.m. Saturday on the University of Nevada, Las Vegas campus. This is a major event that you won’t want to miss, honoring national Earth Day while also celebrating the rich cultural diversity of UNLV and the Las Vegas Valley. Admission and parking are free.

The combined festivals invite community partners, nonprofits, organizations, schools, students and families to explore and be inspired. The event will include green vendors, live entertainment, performances, activities, food and drink, recycling and conservation exhibits, campus tours, fashion shows and art. To learn more, visit www.unlv.edu/festivals and www.greenfestlv.com.

Competition

I’m sure the UNLV’s Solar Decathlon team will be on hand, too. It has been working hard on DesertSol, its entry for this year’s national competition to be held in Southern California this fall. This is a huge undertaking and the team needs your help. Check out its newly updated website at solardecathlon.unlv.edu to learn more about the project and how you can support the team.

DesertSol will have a lasting impact on our community since Team Las Vegas has announced that it will have a permanent residence at the Springs Preserve in Las Vegas after the competition in October.

Heads Up on Clean Energy

As if on cue for Earth Day, NV Energy’s SolarGenerations program will accept applications for the next round of solar energy projects beginning Monday through 5 p.m. May 17. Successful applicants will be eligible for rebates to help offset the installation costs for photovoltaic panels that convert sunlight into electricity. At the close of the application period, if any category is oversubscribed, participants will be chosen by a lottery conducted by a third party.

Residential customers, small businesses, schools and public buildings are eligible to participate in the program, which was established by the Nevada State Legislature in 2003 to encourage Nevadans to invest directly in renewable energy. Participants must be NV Energy customers.

Rebates for the next round of projects range from $1.25 to $1.35 for residential customers and small businesses, and from $2.80 to $3.10 for schools and public buildings. You can visit the SolarGenerations Web page at www.solargenerations.com for a detailed description of how the incentives will be allocated.

NV Energy customers interested in applying for SolarGenerations are encouraged to get more information by reviewing the program handbook located on the website. Anyone with questions about applying can call toll-free at 866-786-3823 or contact the program by email at renewable generations@nvenergy.com.

SolarGenerations is one of several renewable-energy programs offered through NV Energy’s RenewableGenerations initiative. Since the start of the program, customers have installed more than 35 megawatts of solar power in Nevada.

When weighing your options for solar power, be sure to consider the renewable-energy credits that your system will produce. If you accept a rebate from NV Energy, your RECs will be permanently assigned to them. If you forgo the rebate and keep your RECs, you can still claim a 30 percent federal tax credit on the total cost of the system and you will have the opportunity to sell your RECs directly. I suppose it is appropriate for Nevada that it is a bit of a gamble since the market for RECs is still maturing. Sales and prices are not guaranteed now.

If your primary interest is the lowest first cost, going for the rebate might make the most sense. The low cost of photovoltaic panels along with the tax credit make an attractive deal that works for many, even without the rebate. That is the path I would take if I were doing it over again.

Enjoy the spring weather and have a great Earth Day.

Steve Rypka is a green living consultant and president of GreenDream Enterprises, a company committed to helping people live lighter on the planet. For more information and links to additional resources relating to this column, or to reach Rypka, visit www.greendream.biz.

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State doctor shortage diagnosis: critical but stabilizing

The patient is still in critical care, but his condition is stabilizing.

That’s the diagnosis on Nevada’s doctor shortage, a chronic problem that’s getting some first aid from state lawmakers, but that needs longer-term remedies to heal completely.

“I do think we’re making a dent in it, but I’m a little concerned that legislators might think just tweaking scope-of-practice laws or dealing with reciprocity (out-of-state licensing) will take care of the issue. It won’t,” said John Packham, a health policy researcher at the University of Nevada School of Medicine.

The legislative focus comes on the heels of Packham’s February health work force report, which revealed big, statewide doctor shortages. Those shortages are especially important because health experts say they’ll only worsen after January, once the Affordable Care Act — or Obamacare — puts hundreds of thousands more Nevadans on insurance rolls. Lawmakers do have solutions, and though some of them seem set to become law, observers agree the proposals aren’t enough.

To understand why, consider the numbers. Packham’s analysis showed the Silver State ranks 46th or worse in primary care docs, family practitioners, pediatricians, psychiatrists and general surgeons per 100,000 residents. That low ratio could become a major issue as the number of insured rises, because people with coverage are likelier to see the doctor. Packham’s research found that primary-care visits in Nevada could surge by as many as 280,000 appointments a year post-Obamacare.

To handle the patient influx, legislators said in January that they’d work hard to boost provider counts. They’ve kept to that, introducing bills in a variety of areas. Senate Bill 324 would streamline Nevada medical licensing for doctors already licensed with unblemished records in other states. Dr. Mitchell Forman, dean and professor of medicine at Touro University Nevada College of Osteopathic Medicine in Henderson, said the bill would help quickly recruit doctors to the state by slashing license-approval times for relocating doctors from several months to a few weeks.

Other bills might not help as rapidly.

Forman said doctors are working with legislators to expand medical residencies in Nevada. Doctors typically practice within 70 miles of where they complete their residency, so it’s important to expand graduate medical education here, Forman said. Markets that could see the biggest gains are mostly underserved areas in rural parts of the state, and in urban cores. Residencies would also be outside the traditional hospital setting, happening in outpatient and community clinics, for example.

Finally, Assembly Bill 170 and Senate Bill 69 would expand scope of practice for advanced practice registered nurses, relaxing requirements on physician oversight and letting nurses handle more routine primary care independently.

But the problem with boosting medical residencies is that it’ll take more than one legislative session to find the money and rewrite the rules to fund them, Forman said. And the bills to let nurses practice primary care on their own face stiff opposition from doctors’ groups.

“It’s a very messy issue, and one of paternalism and control,” Forman said. “It’s being looked at as a turf war, or war of financial interests, and it’s really not. For most primary care issues, I think advanced practice nurses and physician assistants are very capable of performing, but I think it should be in the context of having a formal supervisory relationship with someone who has more training and experience. Ultimately, it’s about patient care and safety. You can’t get me to believe that an advanced practice nurse who’s had limited education in terms of time and experience is more competent than a physician who’s had considerably more education and residency experience.”

Still, Packham said he senses little legislative opposition to lifting some limits on advanced practice nurses. Nevada is one of the few remaining states with its level of restriction, and increasing the number of doctors alone won’t be enough to solve primary care shortages here.

“The training and pipeline issues are much smaller for nurses and physician assistants, and I think everybody knows that,” Packham said.

Yet, even if every health-related bill passed in the session, which ends in June, it wouldn’t be enough to fix shortages, observers agree.

Sen. Joe Hardy, R-Boulder City, said the state must find funding for more medical residencies. Packham also cited the need for “substantial investments” in both undergraduate and graduate medical education, but that won’t be an easy task in a state where revenue is still reeling from half a decade of economic downturn. If Nevada can’t work its way through its residency shortages, today’s bills will mean little.

Said Forman: “The answer is developing innovative and creative ways of training our medical graduates in the state and keeping them here. Unless that dramatically changes, we’ll be having the same conversation about shortages 10 years from now.”

Contact reporter Jennifer Robison at jrobison@reviewjournal.com or 702-380-4512. Follow @J_Robison1 on Twitter.

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