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I'm just wondering what part it plays on the AMCAS. They have your county of residence and area zip code, even exact address of residence. Do they match this up to the county and what purpose does it serve? You could live in an affluent part of the county, but the county could still be medically underserved. The Center for Rural Health maintains a database of health care providers practicing in rural and underserved areas. Shortage area designations allow providers to participate in a variety of different state and federal programs. The designations include health professional shortage areas (HPSA), medically underserved areas (MUA), and medically.
Centroid - A centroid is the geometric center of a feature. In the UDS Mapper ZIP Codes are mapped to the ZCTA that best fits its location based on these centroids.
County Subdivisions - County Subdivisions are the primary divisions of counties and equivalent entities. They include census county divisions, census subareas, minor civil divisions, and unorganized territories and can be classified as either legal or statistical. Minor civil divisions (MCDs) are the primary governmental or administrative divisions of a county in many states (parishes in Louisiana) and the county equivalents in Puerto Rico and the Island Areas. Census county divisions (CCDs) are areas delineated by the Census Bureau in cooperation with state, tribal, and local officials for statistical purposes. CCDs have no legal function and are not governmental units. CCDs often exist where there are no legally established MCDs. Census subareas are statistical subdivisions of boroughs, city and boroughs, municipalities, and census areas, all of which are statistical equivalent entities for counties in Alaska.
Dominant Health Center - The dominant health center is the health center with the highest number of health center patients in a ZCTA. This is the health center with the highest Share of Patients.
Share of Patients - The percent of total health center patients from the specified ZCTA that were served by the specified health center.
Facility/Point HPSA - A facility HPSA designation, as defined by the Public Health Service Act, is given to FQHCs and RHCs that meet the requirement of providing access to care regardless of ability to pay. FQHC in this definition includes all types of FQHCs: Health Center Program (HCP) grantees, HCP look-alikes, and outpatient health programs/facilities operated by tribal organizations (under the Indian Self-Determination Act) or urban Indian organizations (under the Indian Health Care Improvement Act).
Point HPSAs are only applicable to Alaskan Native and Native American Tribal populations. The Federally Recognized Native American Tribes and Alaskan Natives receive automatic population HPSAs. These HPSAs are represented as a point which is placed at a provider location/ facility within the tribal area.
Federal Poverty Level (FPL) - the threshold of poverty (based on income and family size) determined annually by the U.S. Department of Health and Human Services. For more information on the FPL, please see http://aspe.hhs.gov/poverty/index.shtml. For information on how poverty is measured in the American Community Survey, please see http://www.census.gov/hhes/www/poverty/poverty-cal-in-acs.pdf.
Federally Qualified Health Center (FQHC) - A Federally Qualified Health Center (FQHC) is a public or private non-profit health care organization that meets certain criteria under the Medicare and Medicaid Programs (respectively, Sections 1861(aa)(4) and 1905(l)(2)(B) of the Social Security Act.) An organization that meets these criteria is eligible to apply for Health Center Program grant funding from the Health Resources and Services Administration's Bureau of Primary Health Care.
Health Center Program (HCP) Look-Alike - an FQHC that meets all of the eligibility requirements of an organization that receives a Health Center Program grant, but does not receive Health Center Program grant funding.
Health Professional Shortage Area (HPSA) - A HPSA is an urban or rural area, population group, or medical or other public facility which has received federal designation as having a shortage of health care providers. Each year, the Department of Health and Human Services (HHS) evaluates HPSA designations and awards them through state Primary Care Offices (PCO). All federally qualified health centers, their look-alikes and tribal facilities receive automatic HPSA designation, while Rural Health Clinics must request HPSA designation. More information can be found here: http://bhpr.hrsa.gov/shortage/hpsas/index.html.
Geographic Information Systems (GIS) - A geographic information system (GIS) integrates hardware, software, and data for capturing, managing, analyzing, and displaying all forms of geographically referenced information. GIS allows visualization, understanding, questioning, and interpretation of data in many ways that reveal relationships, patterns, and trends in the form of maps, globes, reports, and charts.1
1http://www.gis.com/content/what-gis
Health Center Program (HCP) Grantee - a public or private non-profit health care organization that meets certain criteria under the Medicare and Medicaid Programs (respectively, Sections 1861(aa)(4) and 1905(l)(2)(B) of the Social Security Act and receives funds under the Health Center Program (Section 330 of the Public Health Service Act) (i.e., Community Health Centers, Migrant Health Centers, Healthcare for the Homeless Programs, and Public Housing Primary Care Programs). For more information on Health Center Program grantees see the HRSA website. A detailed explanation of health center program terminology is also available from the HRSA website.
Medically Underserved Area/Population (MUA/P) - A medically underserved area (MUA) may be a whole county or a group of contiguous counties, a group of county or civil divisions or a group of urban census tracts that the Department of Health and Human Services (HHS) has designated as having a shortage of health services for residents. Designations are based on the qualifications outlined in the Index of Medical Underservice (IMU), published in the Federal Register on October 15, 1976.
A medically underserved population (MUP) may include groups of persons who face economic, cultural or linguistic barriers to health care. Designations are also based on the qualifications outlined in the Index of Medical Underservice (IMU), and exceptional MUP designations are based on the provisions of Public Law 99-280, enacted in 1986.
For more information, see the HRSA website: http://bhpr.hrsa.gov/shortage/muaps/index.html.
National Health Service Corps (NHSC) - The NHSC program aids HPSAs in attracting the necessary medical, dental and mental health providers to meet the health care needs of the underserved area. The scholarship and loan repayment programs are awarded to physicians who fulfill an obligation to serve a HPSA with a sufficiently high score for underservice. The Bureau of Clinician Recruitment Services (BCRS) oversees the program for the Health Resources and Services Administration (HRSA). For more information see: http://nhsc.hrsa.gov/about/.
Penetration rate - is a ratio of all patients (from health centers with 11 or more patients in that ZCTA) to a sub-population (such as the total population or low-income population). In other words, for each ZCTA the number of reported health center patients is divided by the number of low-income or total residents.
Note: Because the UDS does not distinguish the income of health center patients at the ZIP Code level, this measure is not perfect, particularly when dividing the number of health center patients by the number of low-income (as not all health center patients are low income/below 200% FPL). But because it is known that approximately 92.2% of health center patients nationally are low income, the basic utility of the calculation in assessing the role of health centers in serving the community is not changed. Such penetration rate measures should be considered the starting point for exploring potential unmet need, not the final answer.
Primary Care Association (PCA) - A PCA is a regional, state, or local organization which works in close concert with, and represents the interests of, nonprofit community clinics and health centers and advocates for the health needs of their distinctive populations and geographic areas, most importantly those who face barriers to care due to poverty, language, or geographic isolation.
Primary Care Office (PCO) - A PCO is a state government entity, often under the purview of the state Department of Health, which works to improve access to care for underserved populations. PCOs work with the various bureaus of the Health Resources and Services Administration (HRSA) to promote the community health center program, establish HPSA designations and find suitable locations for placement of NHSC scholar and loan repayors.
Rural Health Clinic (RHC) - The RHC program strives to be the major provider for primary care services for Medicaid and Medicare patients in rural communities which tend to have health disparities due to geographic isolation and low physician density. RHCs can be public, private, or non-profit entities. All RHCs are eligible for facility HPSA designation and the federal funding that comes from that designation, but due to their patient population, RHCs' main funding sources are enhanced reimbursement rates for providing Medicaid and Medicare services to rural populations. As such, RHCs must be located in underserved rural areas, as designated by HRSA, and must employ midlevel practitioners (i.e. physician assistants or nurse practitioners) alongside physicians as part of a team-based approach to patient care. For more information, see: http://www.raconline.org/info_guides/clinics/rhc.php.
Uniform Data System (UDS) - The UDS is the specific data collection and reporting requirements for Health Center Program grantees developed by the Health Resources and Services Administration (HRSA) to track the patient population and effectiveness of the health care services of the Health Center Program. The organizations that receiving funding through one or more of the Health Center Program's four funding mechanisms are: Community Health Centers, Migrant Health Centers, Health Care for the Homeless, and Public Housing Primary Care.1 According to HRSA, 'the [UDS] data helps to identify trends over time, enabling HRSA to establish or expand service to targeted populations, and identify effective methods and interventions to improve the health of underserved communities and vulnerable populations.2' Thus, UDS data are a vital component of the community health center program, enabling HRSA to inform the expansion of service to low-income medically underserved areas and populations.
1http://www.hrsa.gov/data-statistics/health-center-data/index.html
2http://bphc.hrsa.gov/healthcenterdatastatistics/
ZIP Code Tabulation Areas (ZCTAs) - ZIP Code Tabulation Areas (ZCTAs) are generalized representations of US Postal Service ZIP Codes. Currently, each ZCTA is built by aggregating Census 2010 blocks, whose addresses use a given ZIP Code, into a ZCTA which gets that ZIP Code assigned as its ZCTA code. While in most instances the ZCTA code equals the ZIP Code for an area, not all ZIP Codes have their own ZCTA. For more information, see: http://www.census.gov/geo/reference/zctas.html
Healthcare shortage areas are two types of designation within the United States determined by the Health Resources and Services Administration (HRSA). Health professional shortage areas (HPSAs) designate geographic areas or subgroups of the populations or specific facilities within them as lacking professionals in primary care, mental health, or dental care. Medically Underserved Areas and Populations (MUAs and MUPs) only designate geographic areas or populations, and only for their lack of access to primary care services. Geographic areas can designate single or multiple counties, parts of cities, or other civil divisions depending on the state. Populations typically designate those subgroups which face barriers to healthcare access in an otherwise well-served population, such as homeless or low-income groups. Facilities designate specific healthcare locations such as clinics, mental hospitals, or prisons.
- 1Designation process and criteria
- 1.1Primary Care HPSAs
- 4HPSA designations
Designation process and criteria[edit]
The primary factor used to determine an HPSA designation (as stipulated by federal regulations) is the ratio of health professionals to population (with consideration of high need). For example, to qualify as an HPSA for primary medical care, the population to provider ratio must be at least 3,500 to 1 (3,000 to 1 if there are unusually high needs in the community).[1]
Most HPSAs are designated after state Primary Care Offices submit applications for them to HRSA, although some facilities are automatically designated (and federal correctional facilities apply separately). The HRSA reviews these applications to determine if they meet the criteria for designation, and then scores them for primary care and mental health (on a scale of 0–25) and dental health (0–26), higher scores indicating greater need.
State Primary Care Offices (PCOs) submit applications to HRSA for most shortage designations in their state. PCOs are the primary state contact for Shortage Designation Branch (SDB). And they have access to the online Shortage Designation Management System (SDMS) application and review system. PCOs use SDMS to manage health workforce data for their states and apply for HPSAs and Medically Underserved Areas/populations (MUAs/Ps). HRSA uses SDMS to review shortage designation applications, communicate with the PCOs on specific applications, and make final shortage designation determinations. HRSA bases SDMS business rules on shortage designation's governing statutes and regulations, as well as the policies and procedures of the Division of Policy and Shortage Designation (DPSD).
The SDMS Determine Eligibility and Scoring by using standard national data sets, including: National Provider Identifier (NPI) for provider data, environmental System Research Institute (ESRI) for mapping data, census for demographic data, Centers for Disease Control and Prevention (CDC) National Vital Statistics for health related data.
HRSA relies on state PCOs to verify and supplement the NPI data by adding provider-level data points required for shortage designation purposes. These data points include whether or not the provider is actively engaged in clinical practice, additional provider practice locations, hours worked at each location, populations served, and the amount of time a provider spends serving specific populations
Depending on the type of designation requested, PCOs may also need to provide additional health and demographic data for which standard national data sets with the sensitivity and specificity required for shortage designation do not currently exist.[2]
Primary Care HPSAs[edit]
As of September 8, 2016 there are 6,450 Primary Care HPSAs. The percent of need met is computed by dividing the number of physicians available to serve the population of the area, group, or facility by the number of physicians that would be necessary to eliminate the primary care HPSA (based on a ratio of 3,500 to 1 (3,000 to 1 where high needs are indicated)). The number of additional primary care physicians needed to achieve a population-to-primary care physician ratio of 3,500 to 1 (3,000 to 1 where high needs are indicated) in all designated primary care HPSAs, resulting in their removal from designation. Applying this formula, it would take approximately 8,200 additional primary care physicians to eliminate the current primary care HPSA designations. While the 1:3,500 ratio has been a long-standing ratio used to identify high need areas, it is important to note that there is no generally accepted ratio of physician to population ratio. Furthermore, primary care needs of an individual community will vary by a number of factors such as the age of the community's population. Additionally, the formula used to designate primary care HPSAs does not take into account the availability of additional primary care services provided by Nurse Practitioners and Physician Assistants in an area. Other sources describing primary care supply use other ratios; for example, a ratio of 1 physician to 2,000 population. To meet this ratio, approximately 16,000 more primary care physicians would need to be added to the current supply in HPSAs.The formula used to designate primary care HPSAs does not take into account the availability of additional primary care services provided by nurse practitioners and Dental HPSA Assistants in an area.[1][3]
Mental Health HPSAs[edit]
There are currently approximately 4,000 Mental Health HPSAs. Mental Health HPSAs are based on a psychiatrist to population ratio of 1:30,000. In other words, when there are 30,000 or more people per psychiatrist, an area is eligible to be designated as a mental health HPSA. Applying this formula, it would take approximately 2,800 additional psychiatrists to eliminate the current mental health HPSA designations. Additionally while the regulations allow mental health HPSA designations to be based either on psychiatrist to population ratio or core mental health provider to population ratio, most mental health HPSA designations are currently based on the psychiatrists only to population ratio. Core mental health providers include psychiatrists, clinical psychologists, clinical social workers, psychiatric nurse specialists, and marriage and family therapists.[1]
Dental HPSAs[edit]
There are currently approximately 4,900 Dental HPSAs. Dental HPSAs are based on a dentist to population ratio of 1:5,000. In other words, when there are 5,000 or more people per dentist, an area is eligible to be designated as a dental HPSA. 7,300 additional dentists would be eliminated by the current dental HPSA using this formula.[1]
Automatic HPSAs[edit]
All Federally Qualified Health Centers and rural health clinics (i.e., facilities which receive federal grants to provide healthcare to underserved populations) are automatically considered HPSAs.[4][5] 'Look-a-like' community-based providers which satisfy HRSA regulations for health centers but not the statutory requirements for grants are also automatically designated.[6] Facilities serving Federally-recognizedNative American Tribes and Alaskan Natives (including all Indian Health Service as well as tribally run or dual-funded facilities) are also automatically designated.[2]
MUAs/MUPs[edit]
Medically Underserved Areas (MUAs) may be a whole county or a group of contiguous counties, a group of county or civil divisions or a group of urban census tracts in which residents have a shortage of personal health services. Medically Underserved Populations (MUPs) may include groups of persons who face economic, cultural or linguistic barriers to health care.[1]
HPSA designations[edit]
Medicare Modernization Act (MMA) Section 413(b) required CMS to revise some of the policies that address HPSA bonus payments. Section 1833(m) of the Social Security Act provides bonus payments for physicians who furnish medical care services in geographic areas that are designated by the HRSA as primary medical care HPSAs under section 332 (a)(1)(A) of the Public Health Service (PHS) Act. In addition, for claims with dates of service on or after July 1, 2004, psychiatrists (provider specialty 26) furnishing services in mental health HPSAs are also eligible to receive bonus payments. If a zip code falls within both a primary care and mental health HPSA, only one bonus will be paid on the service.
Effective January 1, 2005, a modifier no longer has to be included on claims to receive the HPSA bonus payment, which will be paid automatically, if services are provided in ZIP code areas that either fall entirely in a county designated as a full-county HPSA or fall entirely within the county, through a USPS determination of dominance, fall entirely within a partial county HPSA. However, if services are provided in ZIP code areas that do not fall entirely within a full county HPSA or partial county HPSA, the AQ modifier must be entered on the claim to receive the bonus.
Some other important points for physician bonuses include:[7]
- Medicare Administrative Contractors (MACs) will base the bonus on the amount actually paid (not the Medicare approved payment amount for each service) and the ten-percent bonus will be paid on a quarterly basis.
- The HPSA bonus pertains only to physician's professional services. Should a service be billed that has both a professional and technical component, only the professional component will receive the bonus payment.
- The key to eligibility is not that the beneficiary lives in a HPSA nor that the physician's office or primary location is in a HPSA, but rather that the services are actually rendered in a HPSA.
- To be considered for the bonus payment, the name, address, and ZIP code of the location where the service was rendered must be included on all electronic and paper claim submissions.
- Physicians should verify the eligibility of their area for a bonus before submitting services with a HPSA modifier for areas they think may still require the submission of a modifier to receive the bonus payment.
- Services submitted with the AQ modifier will be subject to validation by Medicare.
Affordable Care Act of 2010 Changes (New for January 2011 for the HSIP Bonus)[edit]
The Affordable Care Act of 2010, Section 5501 (b)(4) expanded bonus payments for general surgeons in HPSAs. Effective January 1, 2011 through December 31, 2015, physicians serving in designated HPSAs will receive an additional 10% bonus for major surgical procedures with a 10 or 90 day global period. This additional payment, referred to as the HPSA Surgical Incentive Payment (HSIP) will be combined with the original HPSA payment and will be paid on a quarterly basis.[7]
References[edit]
![Underserved Underserved](/uploads/1/2/5/8/125874641/447484389.jpg)
- ^ abcde'Primary Care Health Professional Shortage Areas (HPSAs)'. Retrieved 2016-11-23.
- ^ ab'Health Professional Shortage Areas (HPSAs) | Bureau of Health Workforce'. Health Resources and Services Administration. 2016-08-01. Retrieved 2017-07-13.
- ^'Shortage Designation: Health Professional Shortage Areas & Medically Underserved Areas/Populations'. www.hrsa.gov. Retrieved 2016-11-23.
- ^42 U.S.C.§ 254e
- ^42 U.S.C.§ 254b
- ^'Health Center Program Requirements'. Health Resources and Services Administration. 2016-08-01. Retrieved 2017-07-13.
- ^ ab'Overview'. www.cms.gov. 2016-11-07. Retrieved 2016-11-23.
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