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VII. MUA/MUP

VII. MUA/MUP. --------------------------------------------------. VII-1. MEDICALLY UNDERSERVED AREAS (MUA) & MEDICALLY UNDERSERVED POPULATIONS (MUP). --------------------------------------------------. Objective: Participants will understand: 1) The difference between MUAs & MUPs

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VII. MUA/MUP

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  1. VII. MUA/MUP -------------------------------------------------- VII-1

  2. MEDICALLY UNDERSERVED AREAS (MUA)& MEDICALLY UNDERSERVED POPULATIONS (MUP) -------------------------------------------------- Objective: Participants will understand: 1) The difference between MUAs & MUPs 2) The information required for a complete submission 3) How each factor is weighted and scored to determine a final Index of Medical Underservice (IMU) Score. VII-2

  3. Designation Requirements for Selected Federal Programs VII-3

  4. MUA CRITERIA -------------------------------------------------- Origin: HMO program and Community/Migrant Health Centers (C/MHC) Measures the degree of underservice of an area (MUA) or population (MUP) 1) Component: Rational Service Area (RSA) 2) Criteria and Weighted Values: a) [V1] Percent of Population at 100% Poverty b) [V2] Percent of Population > 65 c) [V3] Infant Mortality Rate (IMR) d) [V4] Primary Care Physicians per 1,000 Population 3) Index of Medical Underservice: Value must be < 62.0 VII-4

  5. MUP CRITERIA -------------------------------------------------- 1. Component: Rational Service Area (RSA) 2. Criteria and Weighted Values: a) [V1] Percent of Population at 100% Poverty b) [V2] Percent Population > 65 c) [V3] Infant Mortality Rate d) [V4] Primary Care Physician serving the low-income pop(200% poverty level) per 1,000 low-income population 3. Index of Medical Underservice: Value must be < 62.0 VII-5

  6. STEPS -------------------------------------------------- • 1) Determine the Rational Service Area (use MSSA) • 2) Assemble data • a) Percent of the population at the 100% poverty level • b) Percent of the population > 65 • c) Infant mortality rate • d) Primary care physicians per 1,000 population • 3) Determine weighted values • 4) Compute the Index of Medical Underservice Score VII-6

  7. STEP 1 -------------------------------------------------- Determine the Rational Service Area (use MSSA). VII-7

  8. Types of MSSAs -------------------------------------------------- Medical Service Study Areas (MSSAs) • Whole County MSSA • Sub-County MSSA VII-8

  9. STEP 2 -------------------------------------------------- • Assemble data on: • a) Percent of the population at the 100% poverty level • b) Percent of the population > 65 • c) Infant mortality rate (IMR) • d) Primary care physicians per 1,000 population VII-9

  10. STEP 3 • Determine weighted values of: -------------------------------------------------- • Percent of the population at the 100% • poverty level • Percent of the population > 65 • Infant mortality rate (IMR) • Primary care physicians per 1,000 • population VII-10

  11. Step 3aPercentage Population at 100% Poverty -------------------------------------------------- • Determine the percentage of the population in the area at the100% poverty level • Use latest available data (2005 Claritas Population Estimates) • Calculate 100% Poverty: Number at 100% Federal Poverty Level Resident Civilian Population • Determine the weighed value (see table)1 1 This value is the same for both MUAs and MUPs VII-11

  12. 2005 Claritas Population Estimates (Sample) -------------------------------------------------- MSSA 8 – Magalia/Paradise/Stirling City: Source: HWCDD - Access Database VII-12

  13. Step 3a (V1) Percent Population at 100% Poverty -------------------------------------------------- VII-13

  14. Step 3a (V1) Percent Population at 100% Poverty continued -------------------------------------------------- VII-14

  15. Step 3b(V2) Percentage of Population > 65 -------------------------------------------------- • Determine the percentage of the population in the area > 65 years old • Use the latest available data (2005 Claritas Population Estimates) • Calculate percent > 65 years old: Number > 65 years old Resident Civilian Population • Determine the weighted value (see table)2 2 This value is the same for both MUAs and MUPs VII-15

  16. Step 3b(V2) Percent Population > 65 continued -------------------------------------------------- VII-16

  17. Step 3b (V2) Percent Population > 65 continued -------------------------------------------------- VII-17

  18. Step 3c(V3)Infant Mortality Rate (IMR) -------------------------------------------------- • Use the SDB available data (5-year average) or SDB-approved State Department of Health data Department of Public Health’s Center for Health Statistics website: http://www.cdph.ca.gov/certlic/birthdeathmar/Pages/default.aspx Use the IMR for the service area (MSSA) or countywide • Calculate Infant Mortality Rate Number of Infant Death Number of Live Births • Determine the weighted value (see table)3 x 1,000 3 This value is the same for both MUAs and MUPs VII-18

  19. Step 3c(V3) Infant Mortality Rate (IMR) continued -------------------------------------------------- VII-19

  20. Step 3c(V3) Infant Mortality Rate continued -------------------------------------------------- VII-20

  21. Step 3d(V4) Providers per 1,000 Population -------------------------------------------------- • Determine the FTE: MUA – All primary care physicians are counted MUP – All primary care physicians servicing the population group are counted Must collect inpatient and outpatient hours • Determine the population: MUA = resident civilian population MUP = number in that population group (e.g., low-income pop = pop at or below the 200% poverty) • Calculate Providers per 1,000 population: MUA:Total FTE4MUP:Total FTE Res-civ. PopPop to be designated • Determine the weighted value (see table) X 1,000 X 1,000 4 All physician must be counted (including J-1 Visa physicians, NHSC physicians, etc.). For MUA designations, the HPSA adjustment factor for the FTE is not used. VII-21

  22. FTEs - Geographic Designation -------------------------------------------------- 6 Dr. Liver is an NHSC loan repayment recipient , counted as 1.0 FTE 7 Dr. Spleen spends 10 hours/week doing research 8 Dr. Lung spends 15 hours/ week in administration VII-22

  23. FTEs – Low-Income Population Designation -------------------------------------------------- VII-23

  24. Step 3d(V4) Providers per 1,000 Population -------------------------------------------------- Left Column – find the range which includes the ratio of primary care physicians per 1,000 population for the area being examined. VII-24

  25. Step 3d(V4)Providers per 1,000 Population continued -------------------------------------------------- VII-25

  26. STEP 4 -------------------------------------------------- Compute the Index of Medical Underservice Score (IMU). VII-26

  27. Compute the Index of Medical Underservice Score -------------------------------------------------- The Index of Medical Underservice (IMU) Score is determined by adding the values of each of the four factors. V1 + V2 + V3 + V4 =IMU Score IMU < 62.0 Qualifies for designation as an MUA/P IMU > 62.0 Does notqualify for designation as an MUA/P VII-27

  28. Time Saving Tips -------------------------------------------------- • Before surveying providers, check the IMU score of the first 3 variables • If V1 + V2 + V3 are > 62.0, the area will not designate as an MUA or MUP • If the IMU > 62, then review rational service area to determine if other boundaries would be appropriate • If not an MUA, check if area would designate as an MUP VII-28

  29. What to Include in the MUA/MUP Application -------------------------------------------------- VII-29

  30. What to Include in the MUA/MUP Applicationcontinued -------------------------------------------------- List of Primary Care Physicians: • Name • Location Non-Metro areas – name of town Metro area – address with zip code, CT is available • Degree (MD or DO) • Specialty • Average # hours/week of patient care in area • % of practice Medicaid (for low-income, Medicaid-eligible, and poverty population designations) • % of practice Sliding Fee Scale (for low-income, poverty pop designation) • Inpatient care hours • FTE total for each provider rounded to the nearest tenth of a percent • Description of how information obtained (source, method) VII-30

  31. What to Include in the MUA/MUP Applicationcontinued -------------------------------------------------- • Primary Care Physician per 1,000 Population • Total FTE • Primary Care Physician per 1,000 Population • Calculation • Other Variables • Percent at 100% Poverty • Infant Mortality Rate • Percent > 65 • Source of Data • IMU Score • Show weighted values for 4 variables • Show IMU Score • Do not submit applications forIMU > 62.0 VII-31

  32. Process Model for MUA Designation Follow arrows: Numbers are reference citations only. Refer to correspondingly numbered pages following for additional information on steps in numbered boxes Define Rational Service Area 1 Determine Service Area Population 2 Calculate Percentage of Population with Income below the Poverty Level 3 Calculate the Percentage of Population Age 65 or Over 4 Calculate the Infant Mortality Rate 5 Determine Physician FTE 6 Calculate the Ratio of Population to Primary Care Physician 7 APPLY FOR DESIGNATION STOP: Area Will Not Qualify Calculate the IMU Score 9 62.1 or Above 62.0 or Below 8 10 VII-32

  33. Process Model for MUP Designation Follow arrows: Numbers are reference citations only. Refer to correspondingly numbered pages following for additional information on steps in numbered boxes Define Rational Service Area 1 Determine Service Area Population 2 Calculate Percentage of Population with Income below the Poverty Level 3 Calculate the Percentage of Population Age 65 or Over 4 Calculate the Infant Mortality Rate 5 Determine Physician FTE 6 Calculate the Ratio of Low Income Population to Primary Care Physician Serving that Population 7 STOP: Area Will Not Qualify Calculate the IMU Score APPLY FOR DESIGNATION 62.1 or Above 62.0 or Below 9 8 10 VII-33

  34. MUA/MUP Exercise -------------------------------------------------- (Example) VII-34

  35. VII-35

  36. 2005 Claritas Population Estimates (Sample) -------------------------------------------------- MSSA 8 – Magalia/Paradise/Stirling City: Source: HWCDD - Access Database VII-36

  37. Primary Care Physician Survey -------------------------------------------------- VII-37

  38. MUA Designation Worksheet -------------------------------------------------- Type of Designation: MUA __X___ MUP _____ County: ___Any County _______________________ Service Area: _____Whole County___________________ Population: (Choose one depending on type of designation) Resident Civilian Population: 40,646 Population @ 200% Poverty Level: 14,284 (Information in this section remains the same for MUAs and MUPs) VII-38

  39. MUA Designation Worksheetcontinued -------------------------------------------------- If “Subtotal A” is > 62.0, STOP (cannot be designated)If “Subtotal A” is < 62.0, then: (Information in this section will be different for MUAs and MUPs) VII-39

  40. MUP Designation Worksheetcontinued -------------------------------------------------- If “Subtotal A” is > 62.0, STOP (cannot be designated)If “Subtotal A” is < 62.0, then: (Information in this section will be different for MUAs and MUPs) VII-40

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