Negotiated Rulemaking Committlee, Day 2

of meeting 2 is well underway. We have had some productive conservations this morning reacting to the presentation of a preliminary analysis on use/need/demand that conceived of underservice as the difference between primary care use for folks without known barriers to care as compared to those with them. The main outcome being considered here is use of care. Several lines of discussion:

• needing to look at health outcome and not just use.
  
• some concerns that this part of the analysis was too similar to parts of what was proposed the last time there was consideration of changing HPSA and MUA.
• specific suggestions about variables that need to be considered
• worries about certain aspects of the data, notably coming up with the actual supply of primary care providers on the ground (are non-physician providers counted, who is a specialist v. who is a primary care provider, etc.).

This morning it seems as though we have shifted into the meat of the discussion.

Update: 11:45am: discussion of whether there needs to be two designation processes/approaches in the future like we currently have (Health Professional Shortage Area and Medically Underserved Area) or whether there might be one unifying method. I was agnostic coming in. Most members seem to favor keeping two distinct processes, though some folks are unsure. We will probably need to move ahead with this question (one designation process v. two) still uncertain.

Update: 3pm: We are moving ahead assuming that we will have two designation approaches, but have not finalized this. We have appointed a data subcommittee to do a bit of data testing for different approaches to designation-subcommittee will report back @ November meeting. The subcommittee will be trying to give the committee a sense of the different possibilities before we lock in on one approach. In particular, we will think through and begin considering health outcome as a measure of underservice and/or a way to triangulate on measures that foucs on need/demand.

We will discuss different approaches to assessing need/demand/use at the next meeting and also take up special populations, including giving special attention to data limits/difficulties of special populations.