I am participating in meeting number three of this committee that is considering alterations to the Health Professional Shortage Area (HPSA) and Medically Underserved Area (MUA) designations methods/processes, as stipulated in the Affordable Care Act. We are beginning to move into the nitty gritty of discussing the many issues related to this task.
Update, 2pm: We have been looking at how measures of utilization overlay/relate to measures of self-reported health status and then outcome as measured by standardized mortality ratio. Had some presentation/discussion about the Notice of Proposed Rulemaking (NPRM-2) attempt to redo the HPSA/MUA designations in 2008 that went down in flames during the comment period of the rulemaking process. We are trying to to take account of the many issues that lead to the proposed rule not being adopted in 2008.
Big issues ahead: considering different data sources, how to deal with sub-populations and/or small geographical areas, and finding the correct balance between conceptual purity and creating something that is both understandable and which can be effectively applied by local areas and states.
Update, 3:30pm: Lots of discussion about the desire of the committee to fully consider outcome/need based approaches to designation, and not to accept proxies until we have fully investigated outcome/need based approaches. Of course, data and unit of analysis will remain limiting factors.
Update, 4:15pm: The data/technical committee will do more work on health care status/outcome based approaches and report back to the entire group. Now shifting into discussion of sub-population designations, both the types of sub-population groups now designed, and various rules related to these populations as compared to area-based designations. As always, data concerns and trade-off between burden of collection/specificity will be paramount.