Shortage Designation Modernization November 1, 2016 · Shortage Designation Modernization November...
Transcript of Shortage Designation Modernization November 1, 2016 · Shortage Designation Modernization November...
Shortage Designation Modernization November 1, 2016
Melissa Ryan Acting Deputy Director, Division of Policy and Shortage Designation Bureau of Health Workforce (BHW) Health Resources and Services Administration (HRSA)
Today’s Discussion Topics
1. Refresher on Key Concepts for Shortage Designation
• Programs that Use Shortage Designations
• Types of Health Professional Shortage Area (HPSA) Designations
• HPSA Designation Criteria
• HPSA Scoring Criteria and Calculations
2. Shortage Designation Modernization Project
3. What does this mean for Primary Care Associations and Community Health Centers?
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Shortage Designations Not just the NHSC and CHC Program Anymore
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Shortage Designation Option National
Health Service
Corps (NHSC)
NURSE
Corps
Health Center
Program
CMS Medicare
Incentive
Payment
CMS Rural
Health Clinic
Program
J-1 Visa
Waiver
Primary Care
Geographic HPSA X X X X X
Population HPSA X X X X
Facility HPSA X X X
Dental Care
Geographic HPSA X
Population HPSA X
Facility HPSA X
Mental Health
Geographic HPSA X X X X
Population HPSA X X X
Facility HPSA X X X
Exceptional MUP X X
Medically Underserved Area X X X
Medically Underserved Population X X
State Governor's Certified Shortage Area X
Types of HPSAs
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Primary Care
Mental Health
Dental Health
Population Group
Facility
A shortage of:
providers in a:
Geographic Area
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Population Facility
While the general components of designation analysis are similar across designation types, the specific eligibility criteria vary depending on designation type…
Geographic Area
HPSA Designation Criteria
In order to achieve a designation, the area under consideration must:
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HPSA Designation Criteria
Be a rational area for the delivery of services;
Have a certain ratio of population to providers serving the area that has been determined to qualify as a shortage; and
Demonstrate that health professionals in contiguous areas are
excessively distant, over-utilized, or inaccessible to the population under consideration.
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Rational Service Area
Rational Service Area (RSA)
A state-identified geographic area within which most area residents could or do seek and obtain most of their
health care services
RSAs can be: 1) A whole county 2) Multiple counties 3) Sub-counties 4) Statewide Rational Service Areas (SRSA) 5) Catchment areas (for mental health only)
Rules of RSA Determination: 1) RSAs cannot overlap existing designations 2) RSAs cannot be smaller than a census tract 3) Exceed travel time between population centers 4) RSAs cannot carve out interior portions
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Ratio of Population to Providers Which Providers Count?
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Primary Care Mental Health Dental Health
Includes Doctors of Medicine (MD) and Doctors of Osteopathy (DO) who provide services in the following specialties:
Family Practice Internal Medicine Obstetrics and Gynecology Pediatrics
Includes: Psychiatrists and sometimes Clinical Psychologists Clinical Social Workers Psychiatric Nurse Specialists Marriage & Family Therapists
Includes: Dentists Dental Auxiliaries
Dental auxiliaries are defined as any non-dentist staff employed by the dentist to assist in the operation of the practice.
Note: Providers solely engaged in administration, research or training are excluded.
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Ratio of Population to Providers What are the ratios?
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Each HPSA category has a unique ratio of population to providers,
which has been identified as the point at which it can be designated as having a shortage of health professionals.
*Excludes high-needs and special population designations, which have distinct ratios
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Primary Care Mental Health Dental Health
Geographic 3,500:1 6,000:1 & 20,000:1 CMH and Psychiatrists
OR 9,000:1 30,000:1
CMH only Psy only
5,000:1
Population 3,000:1 4,500:1 & 15,000:1 CMH and Psychiatrists
OR 6,000:1 20,000:1
CMH only Psy only
4,000:1
Facility 1,000:1 2,000:1 1,500:1
Min Pop 500 Min Inmate Pop 250 Min Pop 1,000
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• Population of the area must meet at least one of several criteria demonstrating higher than normal need.
At least 20% of the population at or below 100% FPL The youth ratio exceeds 0.6 The elderly ratio exceeds 0.25 A high prevalence of alcoholism A high degree of substance abuse
At least 20% population at or below 100% FPL More than 100 births/year per 1,000 women ages 15-44 More than 20 infant deaths per 1,000 live births Have insufficient capacity
At least 20% of the population has income at or below 100% FPL More than 50% of the population has no fluoridated water Have insufficient capacity
Ratio of Population to Providers What constitutes high need? 2
Review of Contiguous Area (CA) Resources
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Are the providers excessively distant?
Are the providers over-utilized?
Are the CA providers inaccessible?
Is there a demographic disparity?
Does the CA have economic barriers?
When determining whether an area’s “neighbors” are accessible for health care services, HRSA asks:
Facility HPSA Designations
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Federal and State Correctional Institutions
State and County Mental Hospitals
Public or Non-Profit Medical Facilities
Have an average daily inpatient census of at
least 100 The number of workload
units per psychiatrist
FTE exceeds 300
Be medium or maximum
security
Have at least 250 inmates
Meet internees/year to provider ratio thresholds:
Primary Care
Dental Health
Mental Health
1,000:1 1,500:1 2,000:1
Provide primary care, dental, or mental health services to a similarly
designated geographic
or population HPSA
Have insufficient capacity to meet the
needs of that area or population group
Automatically Designated HPSAs
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Using the statute and regulations, HRSA has deemed the following facility types as eligible for automatic HPSAs:
Health Centers (funded under Sec. 330) Health Center Look-Alikes Tribally-Run Clinics Urban Indian Organizations Dual-Funded Tribal Health Centers Federally-Run Indian Health Service Clinics Rural Health Clinics
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Other HPSAs Automatic Facility HPSAs
Auto HPSAs compared to other HPSAs: Similar but not the same
• Designation & scoring done online • Criteria used to first designate as
HPSA • Criteria used to determine HPSA score • Scores range from 0-25 (26 for dental) • Designations are required to be
reviewed and updated as necessary annually
• Score of “0” is rare
• Designation & scoring currently done manually
• No designation process necessary • Same criteria used to determine HPSA
score as other HPSAs • Same scoring range used • HRSA has not historically required Auto
HPSA scores to be reviewed regularly; updates are requested by facility
• Score of “0” more frequent and means low shortage or no data was available for scoring
HPSA scores are based on a variety of factors and range from 0 to 25 in the case of Primary Care and Mental Health, and 0 to 26 in the case of Dental Health.
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HPSA Scoring Criteria
Primary Care 0-25
Dental Health 0-26
Mental Health 0-25
HPSA Scoring Calculations
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Primary Care
Dental Health
Mental Health
Factor Max Pts Awarded
Multiplier Total
Points Possible
Max Pts Awarded
Multiplier Total
Points Possible
Max Pts Awarded
Population : Provider Ratio 5 x 2 = 10 5 x 2 = 10 7
% of Population below FPL 5 x 1 = 5 5 x 2 = 10 5
Travel distance/time to NSC
5 x 1 = 5 5 x 1 = 5 5
Ratio of children under 18 to adults 18-64
5 x 1 = 5 1 x 1 = 1 3
Ratio of adults 65 and older to adults 18-64
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Substance prevalence 1
Alcohol abuse prevalence 1
Max Score: = 25 = 26 = 25
How are HPSA Scores Used?
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1
2
1
Award Levels
Priority in Awards Funding Preference
3 Scholar Placement
2 Scholar Placement
Shortage Designation Modernization Project
Bridging people, processes, and data
Shortage Designation
Project
Regular Updates
Designation Updates of Scores via Standard Data
Use of Predefined
Rational Service Areas
Standard Data Sets
Auditable & Traceable
Projections Based on Standard Data
Impact Analysis & Trending
Defined Roles & Responsibilities
New Business Process & Functions
Single, Automated
System for all Processing &
Scoring
Shortage Designation Management System (SDMS) …
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DATA
CDC
CMS
Census ACS
… is an application tool used to manage
designations
… uses standard data sets to calculate
designations
… is based on regulations
• Standardized data are sourced from: • The Centers for Medicare and Medicaid Services (CMS) for provider data
• The Centers for Disease Control and Prevention (CDC) for infant health data
• The Census Bureau for population data
• The Environment Systems Research Institute (ESRI) for travel and spatial mapping data
SDMS Data Sources
Federal Data Industry Data State Data
Population Data Population Data Health DataHealth Data
Infant Mortality Rate (IMR)
Low Birth Weight(LBW)
Total Resident Civilian Population
Ethnicity Populations: Hispanic, Caucasian,
Asian, etc.
Population at Federal Poverty Level
Providers Providers
Providers Address from National Provider Identifier
(NPI)
Youth & Elderly Population in Service
Area
Center for Medicare & Medicaid (CMS)
Centers for Disease Control and
Prevention(CDC)
Census Bureau(Census and ACS)
Travel DataTravel Data
Private Transportation Network
Environmental Systems Research
Institute (ESRI)
Data PointsData Points
Provider Attributes for HPSA FTE Calculation
Other Populations (Medicaid, Homeless, Migrant
Farmworker)
Fluoridation Rate
Alcohol & Substance Abuse Rate
State Primary Care Offices (PCOs)
Stakeholder Engagement
• State PCO/PCA/HRSA Steering Committee
• State PCO/HRSA Technical Working
Group • State PCO/HRSA Policy Working Group • PCO monthly conference calls
• Dedicated shortage designation email
box
• Individual State PCO interaction with HRSA Project Officers
• Individual State PCO technical assistance
• SDMS demos and hypercare sessions
• User guides, policy and procedures manuals
• Monthly National SDMS snapshots
• Monthly State-specific snapshots
• Webinars and trainings
Feedback Mechanisms for State Input:
Additional Support Resources:
Shortage Designation Project | Today & the Future
Today The Future Today * The Future
Every new or updated designation created uses the same standardized data. Application and review steps are fully automated and have eliminated manual processing. Business rules and system validations are reflective of regulation and policy and applied to every designation. Policy definition well aligned with authorizing statutes and regulations. Paper has been eliminated, excluding supporting documentation.
Every designation uses the same standardized data with the HPSA update and continue to source standardized data. Release additional functionality to streamline and automate. Continue requirements definition with State and HRSA involvement for additional functionality. Ongoing clarification of regulations in order to define policy and requirements. A fully automated, transparent shortage designation business process that leverages standardized, national data for timely and accurate designations.
*Currently, Auto-HPSAs scores are manually calculated outside of the Shortage Designation Management System and the information above does not apply. Until July 2017, scores will continue to be calculated based on non-standardized data and other individual site provided data.
Auto-HPSA Manual Process Overview
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• Initial and re-scores are initiated by sites through email on an ad hoc basis
• Withdrawals are initiated on an ad hoc basis by SDB
• Scoring requests are processed in Excel by SDB analysts
• Scores are created using a myriad of non-standardized data sets and site-provided data and averaged at the network level
• Sub-scores and data points are not currently captured
• If the site’s score does not increase, the site may terminate its request and keep it’s existing score
Auto-HPSAs: Manual vs. Automated Scoring Process
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Manual Automated
Process and data are consistent for all Auto-HPSAs*
Process and data are consistent with Geographic, Population and Facility HPSAs
Less prone to human error
Transparent
Efficient
Replicable
Auditable
*Provider data are dependent upon PCO validation.
PCAs and PCOs
• PCOs are actively validating provider data, upon which the impact analysis is dependent • Assist your PCO with data collection wherever possible
• PCOs will not have impact analysis results until January 2017
• Establish a regular dialogue with your PCO, if you have not done so already
• Help Health Centers understand the changes that will occur in July 2017
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A list of PCOs is available at: http://bhpr.hrsa.gov/shortage/hpsas/primarycareoffices.html
Shortage Designation Project Timeline
2014
•Initiated Shortage Designation Project
•Launched SDMS
•PCOs began validating provider data
2015
•PCOs began to submit new and updated Geographic, Population and Facility HPSA designations in SDMS
2016
•PCOs continue to submit new and updated Geographic, Population and Facility HPSA designations in SDMS
•PCOs continue to validate provider data
2017
•Provide impact analyses to stakeholders
•Incorporate Auto-HPSA scoring process into SDMS
•Update all* HPSA designations, including Auto-HPSAs, in SDMS
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*MUA/P Designations are not included in the July 2017 Designation Update.
Project Timeline—Upcoming Key Milestones*
October 2016
•PCOs finished validating** current providers
•HRSA begins impact analysis
January 2017
•Initial impact analysis, including Auto-HPSAs, provided to stakeholders
•Re-run impact analysis periodically
May 2017
•PCOs finish validating new providers
•Pull data for July 1 Federal Register Notice (FRN)
June 2017
•Second impact analysis, including Auto-HPSAs, provided to stakeholders
July 2017
•Publish FRN prior to Designation Update
•Update of all designations, including Auto-HPSAs
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*PCOs can submit, review, revise, or withdraw designations at any time. **Validate is defined as reviewing each eligible provider record to determine if the provider is providing service and, if not, omitting the provider; confirming that the NPPES/NPI address is correct and, if not, correcting the location (i.e., re-geocode or create a new location); adding practice locations, as necessary; and confirming that the defaults are correct or entering data for all the provider attributes for each eligible provider location.
Key Take-Aways
• The Shortage Designation Project is based on the principles of transparency, accountability, and parity.
• The current, manual process will continue to be used until July 2017.
• The scoring criteria are not changing. However, in July 2017:
• Standardized data sets will used to score Auto-HPSAs.
• Scores will be at the site level and no longer averaged across sites.
• All HPSA types, including Auto-HPSAs, will be updated based on standardized data and PCO-validated provider data.
• MUA/Ps will not be updated.
• At least two impact analyses will be provided to stakeholders to help sites, communities and states prepare for any changes that may occur.
• The first impact analysis will be available in January 2017.
• PCO-validated provider data are essential for meaningful impact analysis results.
• HRSA will consider program policies to mitigate and address concerns.
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Connect With Us
Melissa Ryan
Acting Deputy Director, Policy and Shortage Designation
Bureau of Health Workforce
Health Resources and Services Administration
Phone: 301-443-1648
Web: bhw.hrsa.gov
Workforce Connections newsletter: www.hrsa.gov/subscribe
LinkedIn: www.linkedin.com/company/national-health-service-corps
www.linkedin.com/company/nurse-corps
Twitter: twitter.com/HRSAgov
twitter.com/NHSCorps
Facebook: facebook.com/HHS.HRSA
facebook.com/nationalhealthservicecorps
facebook.com/HRSANURSECorps
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CHCANYS 2016 Statewide Conference & Clinical Forum
November 1, 2016
Robert Martiniano, DrPH, MPA
Senior Program Manager
Center for Health Workforce Studies
School of Public Health | University at Albany, SUNY
(518) 402-0250
New York State
Shortage Area Designations
The Center for Health Workforce Studies
at the University at Albany, SUNY
• Established in 1996
• Based at the University at Albany School of Public Health
• Committed to collecting and analyzing data to understand workforce
dynamics and trends
• Goal to inform public policies, the health and education sectors and
the public
• Broad array of funders in support of health workforce research
• Under contract with NYSDOH to develop shortage area applications
and provide technical assistance
2 http://chws.albany.edu
Past/Current Work
• Developed Medicaid-based Primary Care Service Areas
• Updated Provider Data
o Reviewed NPI data
– Addresses
– Medicaid data
– NHSC Placements/J-1 Visa Waivers
• Updating/creating shortage area applications
• Providing technical assistance on
o NHSC Site
o NHSC Placements
o Shortage area applications
• Representing NYS on National Impact Workgroup
Continued/Future Work
• Providing technical assistance on
o NHSC Site
o NHSC Placements
o Shortage area applications
• Reviewing re-scoring
• Working with NYSDOH to develop priority list
• Updating/creating shortage area applications
• Developing Dental RSAs based on Medicaid patient commuting patterns
AGENDA
1 LOAN REPAYMENT PROGRAM
2 SCHOLARSHIP PROGRAM
3 STUDENTS TO SERVICE
PROGRAM
4 STATE LOAN REPAYMENT
PROGRAM
5 NHSC IN NEW YORK
LOAN REPAYMENT AWARD
The NHSC Loan Repayment Program offers priority funding to applicants who work at NHSC-approved sites in high-need areas, as defined by a Health Professional Shortage Area (HPSA) score.
INITIAL
AWARD
AMOUNTS
UP TO
$50,000 FOR 2 YEARS
Full-time
UP TO
$25,000 FOR 2 YEARS
Half-time
In FY15, awards were given to applicants working at sites with HPSA scores of 14 and above.
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ELIGIBILITY
U.S. citizen or
national
Currently work, or
applying to work, at
an NHSC-approved
site
Have unpaid
government or
commercial loans for
school tuition,
reasonable educational
expenses, and
reasonable living
expenses, segregated
from all other debts
Licensed to practice
in state where
employer site is
located
Must be licensed in one of the following eligible disciplines:
• Physician (MD or DO)
• Nurse practitioner (primary care)
• Certified nurse-midwife
• Physician assistant
• Dentist (general or pediatric)
• Dental hygienist
• Psychiatrist
• Psychologist (health service)
• Licensed clinical social worker
• Psychiatric nurse specialist
• Marriage and family therapist
• Licensed professional counselor
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STUDENTS PURSUING CAREERS IN PRIMARY CARE CAN RECEIVE
A SCHOLARSHIP NOW AND
SERVE LATER
THE SCHOLARSHIP* INCLUDES:
Payment of tuition and
required fees (tax-free)
Some other tax-free educational costs (books, etc.)
A monthly living stipend
(taxable)
*Available for up to 4 years 7
ELIGIBILITY
U.S. citizen or national
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Full-time student at an accredited school, pursuing a degree in:
• Medicine (DO or MD)
• Dentistry (DMD or DDS)
• Nurse practitioner
• Certified nurse-midwife
• Physician assistant (primary
care)
STUDENTS TO SERVICE AWARD
UP TO
$120,000 FOR 3 YEARS
Full-time Service
UP TO
$120,000 FOR 6 YEARS
Part-time Service
The NHSC offers up to $120,000 in tax-free loan repayment for 3 years of full-time
service or 6 years of half-time service. Loan repayment begins during residency.
With continued service, eligible providers may be able to pay off all their student loans.
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ELIGIBILITY
U.S. citizen or national Full-time student in the
final year at an
accredited school,
pursuing a degree
in Medicine (MD
or DO)
Planning to complete
an accredited primary
medical care residency
in an NHSC-approved
specialty (Internal
Medicine, Family
Practice, Pediatrics,
OB/GYN, Psychiatry
and Geriatrics)
Have unpaid
government or
commercial loans
for school tuition,
reasonable educational
expenses, and
reasonable living
expenses, segregated
from all other debts
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STATE LOAN REPAYMENT PROGRAM
37 STATES ARE GRANTEES
Provides cost-sharing grants to states to
operate their own loan repayment
programs for primary care providers in
underserved areas.
Eligible disciplines vary but may include
physicians, nurse practitioners, physician
assistants, dental professionals,
registered nurses, mental health
professionals, and pharmacists.
2016 NY NHSC Field Strength Report:
Where are NHSC clinicians serving?
SITE TYPE # of NY NHSC Clinicians
% of NY NHSC Field Strength
FQHCs 371 54.4%
Outpatient – Hospital Affiliated*** *153* *22.4%*
Community Outpatient – Non-Hospital 90 13.2%
Private Practice 39 5.7%
State/local Health Department 15 2.2%
Tribal/IHS Health Centers 7 1.0%
Correctional Facility/ICE 1 1.0%
TOTAL 682 100%
CONTACT INFORMATION
HRSA BWH Region 2 Team - We are here to help!
New York State Analysts
Steve Auerbach, MD, MPH, FAAP – [email protected]
Toni Williams-Sims, MS – [email protected]
Apeksha Deshpande, MS, RD – [email protected]
Wesley Tahsir-Rodgriguez, MPH - [email protected]
Regional Supervisor
Anne Venner, MA – [email protected]