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Access to Safe, Quality Healthcare Environments: HPSA & MUA/MUP Workshop

Join the 27th Annual HPSA & MUA/MUP Workshop in Anaheim, CA to learn about shortage designations, recruitment and retention efforts, and the role of the Primary Care Office in meeting California's healthcare needs.

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Access to Safe, Quality Healthcare Environments: HPSA & MUA/MUP Workshop

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  1. “Access to Safe, Quality Healthcare Environments that Meet California’s Dynamic and Diverse Needs.” 27thAnnual HPSA & MUA/MUP workshop October 3 & 4, 2019 Anaheim, CA Presented by: California Primary Care Office Office of Statewide Health Planning and Development

  2. Workshop Objectives • Role of the Primary Care Office • Purpose of Designations • Benefits of Shortage Designation • Data Elements of Shortage Designation • Understanding the Shortage Designation Process • Methodology & Purpose of Automatic Facility Shortage Designations • Discussion on Recruitment and Retention Efforts • Technical Assistance on the Shortage Designation Process and Scoring

  3. Primary Care Office Staff Hovik Khosrovian PCO Director (916) 326-3734 hovik.khosrovian@oshpd.ca.gov Richard Creer Program Administrator (916) 326-3715 richard.creer@oshpd.ca.gov Elyssa Urias Program Administrator (916) 326-3718 elyssa.urias@oshpd.ca.gov Steffi Wong Program Analyst (916) 326-3717 steffi.wong@oshpd.ca.gov Bally Nagra Program Analyst (916) 326-3714 baljinder.nagra@oshpd.ca.gov Jalaunda Granville Program Manager (916) 326-3699 jalaunda.granville@oshpd.ca.gov

  4. Role of Primary Care Office Development: • Identify areas with underserved populations, limited access to health professionals, or health disparities. • Develop designation applications. • Conduct statewide analysis of unmet need, disparities, and health workforce issues. Technical Assistance: • Provide technical assistance. • Provide guidance regarding the National Health Service Corps (NHSC) site application process and Nurse Corps program.

  5. Role of Primary Care Office Collaboration: • Collaborate with statewide organizations, county health offices, community organizations, and other HRSA partners to expand access to primary care. • Collaborate with HRSA partner organizations to maintain and strengthen the growth, support, and role of health centers. Oversight: • Review and submit applications to HRSA. • Review NHSC site applications for compliance of federal criteria.

  6. Purpose of Designations • There are two types of shortage designations: • Health Professional Shortage Area (HPSA): designations that indicate health care provider shortages in Primary Care, Dental Health, and/or Mental Health. • Medically Underserved Area/Medically Underserved Population (MUA/MUP): designations that identify geographic areas and populations with a lack of access to primary care services. • Improve healthcare service delivery and workforce availability to meet the needs of underserved populations. • Identify geographic areas or population groups with a shortage of primary care, dental care, and/or mental healthcare services.

  7. Benefits of Shortage Designation

  8. Benefits of Shortage Designation

  9. HPSA DESIGNATIONS Components • MSSA or County • Population to Provider Ratio • Population Data: 2012-2016 5-year American Community Survey (ACS) Estimates • Provider Data: National Provider Identifier (NPI) • Contiguous Area Analysis Disciplines (Direct Outpatient Care Only) • Primary Medical Care • Family Practitioners, Gerontologists, Internal Medicine, Obstetrician/Gynecologist, and Pediatricians • Dental Health Care • Doctor of Dental Surgery (DDS) and Doctor of Medicine in Dentistry (DMD) • Registered Dental Hygienists and Dental Assistants are also counted • Mental Health Care • Psychiatrists, Clinical Psychologists, Licensed Clinical Social Workers, Psychiatric Nurse Specialists, Licensed Marriage and Family Therapists

  10. Service Areas Medical Service Study Areas (MSSA): • Recognized by HRSA’s Shortage Designation Branch (SDB) as Rational Service Areas (RSA) • Census Tract based • Cannot cross county boundaries • Must be whole areas, no carved out portions • Defined cities, neighborhoods, or recognized communities that are socio-economically or demographically similar Uses for MSSAs: • HPSAs and MUA/MUP designations • Health workforce planning and development • Policy development • Used in OSHPD Geographic Information Systems development

  11. service areas Types of MSSAs: • Urban • Population range 75,000 to 125,000 • Reflect recognized community and neighborhood boundaries • Similar demographic and socio-economic characteristics • Rural • Population density of less than 250 persons per square mile • No population center exceed 50,000 • Frontier • Population density of less than 11 persons per square mile

  12. Example of Whole County MSSA

  13. Example of Sub-county MSSA

  14. 3rnetNational Rural recruitment and retention Network Healthcare Jobs Across the Nation

  15. 3rnet • 3RNet is a national nonprofit network of members committed to matching healthcare professionals with rural and underserved jobs. • Finding a job on 3RNet is as easy as: 1) Search Jobs 2) Register 3) Get Answers

  16. 3rnet • 3RNet Website: https://www.3rnet.org • Email the OSHPD Shortage Inbox: shortage@oshpd.ca.gov

  17. 3rnet In fiscal year 2017-18, there were: • 8,693 Views of Posted Positions in California • 17 New Facilities Registered • 98 New Positions Posted • 1271 Active Health Professionals Registered Top 5 Health Professional Types Registered: • Physicians • Nurse Practitioners • Registered Nurses • Dentists • Physician Assistants

  18. Recruitment and retention Current Efforts: • Bi-Annual Workshops • Quarterly Mini-Workshops • Technical Assistance • Collaborate with other government partners, communities, and stakeholders • 3RNet Suggestions?

  19. HPSA Designations Rules and Policies of HPSA Designations

  20. HPSA designation The applicant must demonstrate a shortage of providers within a service area including an analysis of resources surrounding the service area to determine if the population is isolated from it’s neighboring communities Step 1: Service Area • Determine your area of interest for the HPSA designation • Utilize the OSHPD website to find your MSSA, http://geo.oshpd.ca.gov/hpsa-search-by-address Step 2: Type of Designation • Determine the type of designation Primary Care, Dental Care, or Mental Health and sub category, e.g., Area, Population, or Facility

  21. HPSA Basics Step 3: Contiguous Area Analysis • Review maps of contiguous areas • Determine which areas can be ruled out to demonstrate access to care inaccessibility Step 4: Provider Survey and Analysis • Conduct provider survey • Calculate the Full Time Equivalent to determine if it meets criteria for shortage area • If necessary survey the contiguous areas that were not inaccessible to determine if they are over utilized Step 5: Nearest Source of Care (NSC) • Determine the nearest provider outside of the MSSA that is accessible • The provider distance is determined using either private transportation or public depending on the location and size of the MSSA

  22. Service Area • Must Use MSSAs. • MSSA Maps can be found on the OSHPD website, https://oshpd.ca.gov/data-and-reports/healthcare-workforce/, or by contacting the PCO. • MSSAs can be combined for designations if, • The MSSA population centers are within 30 minutes of each other for Primary Care HPSAs, or 40 minutes of each other for Dental and Mental Health • Or, there are no services available to one or more of the MSSAs, and the population must travel to a neighboring MSSA to seek care • The MSSAs whether combined or not cannot exceed the population maximum of: • 250,000 people for Primary Care • 250,000 people for Dental Care • 250,000 people for a County Mental Health HPSA or 999,999 for a MSSA based Mental Health HPSA

  23. Service Area

  24. Service Area Criteria • Population Data • 2012-2016 ACS Data, found on your Workshop flash drive • Farmworker Enumeration Profile Data and calculation worksheet can be found on your Workshop flash drive, Worksheet section • Seasonal Residents and Tourist data can be obtained by contacting the counties or tourism boards, the calculations can be found on the Workshop flash drive, Worksheet section • Homeless count is obtained by contacting the county or reaching out to the homeless shelters in the MSSAs to get an estimate • Mental Health Quartile Rankings • Substance Abuse and Mental Health Service Administration (SAMHSA) data is used • The SAMHSA quartile rankings are available on the Workshop flash drive

  25. Types of DESIGNATIONS A shortage of: Primary Care Mental Health Dental Health providers in a: Population Group Geographic Area Facility

  26. Types of DESIGNATIONS • Geographic Area • Geographic Area based on MSSA and the Resident Civilian Population. • Can add Homeless Populations, Migrant Farmworkers, Seasonal Residents, Tourists for Primary Care and Dental Health • Geographic Area with High Needs • Primary Care: • More than 20% of population must be at or below 100% Federal Poverty Level (FPL); or • More than 100 births per year per 1,000 women ages 15-44; or • More than 20 infant deaths per 1,000 live births; or • Meets insufficient capacity criteria • Dental Health: • More than 20% of the population must be at or below 100% FPL; or • More than 50% of the population has no fluoridated water; or • Mental Health: • More than 20% of the population must be at or below 100 % FPL; or • The youth ratio (# of persons < 18 to the # of adults ages 18 - 64) is greater than 0.6; or • The elderly ratio (# of persons > 65 to the # of adults ages 18 - 64) is greater than 0.25; or • Alcohol or substance abuse prevalence data showing the area to be in the worst quartile nationally, state, region.

  27. Types of Designations • Population Group • Low-Income Population: 30% of the population must be at or below the 200% FPL • Medicaid Eligible Count • Medicaid Visits (5,000 visits = 1 Full Time Equivalent (FTE)) • Can add Homeless and Migrant Farmworker counts to all three disciplines • Facility • A facility that is either designated as a HPSA based on a request to the PCO using specific facility data or by statute or through regulation without having to apply for a designation. • Other Facility (OFAC) • Correctional Facility • State Mental Hospitals • Automatic Facility HPSAs (Auto HPSAs)

  28. Population to provider criteriaprimary care • Area (Geographic) Primary Care HPSA Population to Provider Ratio Requirements: • ≥3,500:1 • Area (Geographic with High Needs) Primary Care HPSA Population to Provider Ratio Requirements: • ≥3,000:1 • Population (Low-Income) Primary Care HPSA Population to Provider Ratio Requirements: • ≥3,000:1 • Population (Medicaid Eligible) Primary Care HPSA Population to Provider Ratio Requirements: • ≥3,000:1

  29. Population to provider criteriadental care • Area (Geographic) Dental Care HPSA Population to Provider Ratio Requirements: • ≥5,000:1 • Area (Geographic with High Needs) Dental Care HPSA Population to Provider Ratio Requirements: • ≥4,000:1 • Population (Low-Income) Dental Care HPSA Population to Provider Ratio Requirements: • ≥4,000:1 • Population (Medicaid Eligible) Dental Care HPSA Population to Provider Ratio Requirements: • ≥4,000:1

  30. Population to provider criteriamental health • Area (Geographic) Mental Health HPSA Population to Provider Ratio Requirements: • ≥30,000:1 • Area (Geographic with High Needs) Mental Health HPSA Population to Provider Ratio Requirements: • ≥20,000:1 • Population (Low-Income) Mental Health HPSA Population to Provider Ratio Requirements: • ≥20,000:1 • Population (Medicaid Eligible) Mental Health HPSA Population to Provider Ratio Requirements: • ≥20,000:1

  31. Contiguous area analysis

  32. Contiguous Area Analysis Contiguous Area Determination: • A polygon is created based on the population center of a MSSA • The polygon is based on public or private transportation rules for 30 minutes of travel • Public Transit: • MSSA must be an Inner City/Metro area • Public Transportation can be used if the 100% FPL is ≥20%; or • Ridership Rate is greater than 30% in the MSSA or region • Private Transportation: • Primary Care HPSA is a 30 minute travel polygon: • Mental Health and Dental Care HPSA is a 40 minute travel polygon: • Any MSSA the polygon is touching is considered a contiguous area

  33. Contiguous Area Analysis Determination of Access to Care Contiguous Areas must meet one of the following to be ruled out as inaccessible: • The Contiguous Area is currently a HPSA. • There are significant socio-economic/demographic disparities or physical barriers. • The Contiguous Area’s providers are excessively distant from the population center. • >30 minutes travel time for Primary Care • >40 minutes travel time for Dental and Mental Health • The resources in the Contiguous Area exceed the population-to-provider ratio and are therefore over utilized.

  34. Contiguous Area Analysis Determine if the Contiguous Areas are Over Utilized: • Conduct survey of providers for the discipline you are designating • Follow methods to survey as shown in the following survey methodology presentation • For Population HPSA designations, the survey for Over Utilization must collect the percentages of Medicaid and Sliding Fee Scale as well as the provider’s outpatient hours • The population to provider ratio must meet the federal criteria to be considered over utilized for the contiguous area: • Primary Care - ≥2,000:1 • Dental Care - ≥3,000:1 • Mental Health - ≥20,000:1

  35. Provider Survey Process

  36. Primary Care Provider Survey • Use NPI list provided by PCO • Family Practitioner • General Internal Medicine • Pediatrician • Obstetrician/Gynecologist • Contact providers listed in the MSSA proposed for HPSA designation • If necessary, survey providers in the Contiguous Area to determine overutilization • Do not count providers that are: • Engaged solely in admin, research, or teaching • Hospitalists/In-patient Care/Urgent Care • Locum Tenens less than one year on contract • Suspended on Medicaid/Medicare Fraud or Abuse • Serving in NHSC, J-1, or H-1B waiver • Federal Providers (e.g., Commissioned Officers or Bureau of Prisons) • Are planning on retiring within six months

  37. Primary Care Provider Survey What Information is Needed? • Geographic and Geographic with High Needs HPSA: • # of Hours Worked in direct patient care in an Outpatient Setting • 40 hours = 1.0 Full Time Equivalent (FTE) • Provider cannot exceed 1.0 FTE • Interns and Residents are counted as 0.1 FTE • Verify Address • Population (Low-Income) HPSA: • # of Hours Worked in direct patient care in an Outpatient Setting • Percentage of Patients seen that are Medicaid or Sliding Fee Scale • 40 hours = 1 Full Time Equivalent • Provider cannot exceed 1.0 FTE • Interns and Residents are counted as 0.1 FTE • Verify Address • Medicaid Eligible HPSA: • Medicaid Eligible Designations require the Medicaid eligible population count and annual Medicaid claims visits

  38. Primary Care Provider SurveyGeographic/Geographic w/Hi Needs/Population (low-Income)

  39. Dental Care Provider Survey • Use NPI list provided by PCO • DDS and/or DMD • Contact providers listed in the MSSA proposed for HPSA designation • If necessary, survey providers in the Contiguous Area to determine overutilization • Do not count providers that are: • Engaged solely in admin, research, or teaching • Locum Tenens less than one year on contract • Serving in NHSC • Suspended on Medicaid/Medicare Fraud or Abuse • Federal Providers (e.g., Commissioned Officers or Bureau of Prisons) • Are planning on retiring within six months

  40. Dental Care Provider Survey What Information is Needed? • Geographic and Geographic with High Needs HPSA: • # of Hours Worked in direct patient care in general dentistry or pediatric dentistry • 40 hours = 1.0 Full Time Equivalent (FTE) • Provider can exceed 1.0 FTE by utilizing auxiliaries • Verify Address • Population (Low-Income) HPSA: • # of Hours Worked in direct patient care in general dentistry or pediatric dentistry • Percentage of Patients seen that are Medicaid or Sliding Fee Scale • 40 hours = 1 Full Time Equivalent • Provider can exceed 1.0 FTE by utilizing auxiliaries • Verify Address

  41. Dental Care Provider Survey (cont.) • Calculations: • Dental Auxiliaries and Age are factored into the FTE Equation Auxiliaries are non-dentists assisting in dental care such as dental assistants, hygienists, etc. Auxiliaries<5555-5960-6465+ 0 0.8 0.7 0.6 0.5 1 1.0 0.9 0.8 0.7 2 1.2 1.0 1.0 0.8 3 1.4 1.2 1.0 1.0 > 4 1.5 1.5 1.3 1.2 If an auxiliary is less than full-time, round to nearest whole number (0.4 = 0, 0.5 = 1). If more than one auxiliary works less than full time, add total hours, divide by 40, and round if not a whole number [(16 +20 + 32/40) = 1.7 = 2]. If number of auxiliaries is not available, use these weights: <55 = 1.2 55 - 59 = 0.9 60 - 64 = 0.8 > 65 = 0.6 If dentist’s age and the number of auxiliaries are not available: Use weight of 1.2

  42. dental Care Provider SurveyGeographic/Geographic w/Hi Needs/Population (low-income)

  43. Mental health Provider Survey • Use NPI list provided by PCO • Psychiatrists only • Contact providers listed in the MSSA proposed for HPSA designation and • If necessary survey providers in the Contiguous Area to determine overutilization • Do not count providers that are: • Engaged solely in admin, research, or teaching • Hospitalists • Locum Tenens less than one year on contract • Serving in NHSC, J-1, or H-1B waiver • Suspended on Medicaid/Medicare Fraud or Abuse • Federal Providers (e.g., Commissioned Officers or Bureau of Prisons) • Are planning on retiring within six months

  44. Mental health Provider Survey What Information is Needed? • Geographic and Geographic with High Needs HPSA: • # of Hours Worked in direct patient care in an Outpatient Setting • 40 hours = 1.0 Full Time Equivalent (FTE) • Provider cannot exceed 1.0 FTE • Interns and Residents are counted as 0.5 FTE • Verify Address • Population (Low-Income) HPSA: • # of Hours Worked in direct patient care in an Outpatient Setting • Percentage of Patients seen that are Medicaid or Sliding Fee Scale • 40 hours = 1 Full Time Equivalent • Provider cannot exceed 1.0 FTE • Interns and Residents are counted as 0.5 FTE • Verify Address

  45. Mental health Provider Surveygeographic/geographic w/ hi needs/Population (low income)

  46. Nearest Source of Care

  47. Nearest Source of Care Requirements • Nearest Source of Care (NSC) is the final step to a designation: • The NSC is the provider closest to the population in the proposed HPSA that is accessible. • Needed to determine the HPSA score. • Shows the distance the population in the proposed HPSA would have to travel outside of their MSSA to seek care. • NSC has the following requirements for all HPSA designations: • The NSC cannot be in a HPSA of any type; • The NSC cannot be in an area that is overutilized; • The NSC can be excessively distant to the proposed HPSA; • The NSC can be in an area with significant socio-economic or demographic disparities; • For a proposed Population HPSA, the NSC must accept both Medicaid and have a Sliding Fee Scale; • For a proposed Geographic with High Needs HPSA, the NSC must accept Medicaid; • To determine travel time: • Use private transportation to measure NSC if your polygon is based on car travel; or • If your polygon is based on public transit, use the public transportation feature on Google Maps to determine travel time to NSC.

  48. Facility Designations Rules and Policies of Facility HPSA Designations

  49. Facility HPSA Designations Facility HPSAs are special designations for facilities that fall outside the regulations of standard HPSA designations, but have workforce issues. There are three types of Facility HPSA designations • Federal and State Correctional Institutions and Youth Detention Facilities • Public or Non-Profit Private Facilities • State and County Mental Hospitals This presentation will address the requirements of the Public or Non-Profit Facilities, as Correctional Facilities and State Hospitals are only requested by the departments that govern those facilities.

  50. Facility HPSA Designations Automatic Facility HPSAs and standard HPSAs are similar, but not the same. Other HPSAs Automatic Facility HPSAs • 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 application 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 frequentand means low shortage or no data was available for scoring

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