Thursday, November 18, 2010

HRSA Negotiated Rulemaking Committee Day 2

I think we made some progress yesterday toward developing new proposals for Health Professional Shortage Area (HPSA) and Medically Underserved Areas (MUA) designation. Some colleagues on the committee don't agree!...but hey, as the Eagles said, "you got to go through Hell before you get to Heaven"....

In all seriousness, we have begun to grapple with the hard issues of data sets, units of analysis and the like. This morning we will continue our discussion of special populations and designation methods for such designations. Examples of current special-designation populations are homeless, low income, migrant populations, and HIV-positive individuals. An issue that is inherent with special-population designation is the lack of data that describe such groups.

Update, 11am: Good and interesting discussion of special population designation issues. I have learned a lot in the last 90 minutes, especially from Patrick Rock, Exec Dir. of the Minneapolis Indian Health Board, who gave the clearest explanation I have heard of how the various initiatives of the Indian Health Service and its constituent components work together, and how HPSA designation currently overlays with these providers.

Update, 12:45pm: moving into discussion of counting supply of primary care providers. Issues include what type of docs count as primary care, how to count medical residents (in terms of FTE), how to consider federal resources such as National Health Service Corps providers, etc., whether/how to count non-physician primary care providers (NP, PA, CNM), and what data sources are used to count providers.

Update, 2:15pm: continuing with presentation on data sources and estimation approaches for primary care providers.

Update, 3:00pm: wrapping up the data/supply discussion and moving to the public comment section. We have added a sub-committee to consider designation issues related to special populations, and will continue with our data/technical subcommittee that will try and push ahead with testing some various data options for consideration by the full committee at the January meeting. Public comment period is next.

All in all, a productive meeting. We are making progress.


  1. Kevin MD deleted a comment I left on his blog today - pertaining to your musings on malpractice reform.

    You're at the high and mighty Duke University. Perhaps in grapling with the big issues (like malpractice and MD shortages and public service), you and others like you should start advocating for doctors in North Carolina on the front lines - who have been through Hell (for the sake of patients) and have not found Heaven . . . because our systems of medical and legal oversight in this state do not work.

    If you have not already, I would suggest that you take a gander at Dr. J's Housecalls.

    Please share it with your VIP colleagues.

    Brought home with state and Federal money, I was fired and unsuccessfully SLAPP-sued, and then swindled by perjury, contempt and fraud by two "non-profit" executives (one of whom now pulls down over $700,000/year in his position as the CEO of a small-town hospital) . . . who did all of this to cover up medical badness . . . to shut me up after I defied their AMORAL/UNETHICAL threats and intervened to STOP MALPRACTICE - saving a newborn baby's life - and then reported it to the appropriate authorities.

    My life in my own hometown went to Hell. Where were all of the hot-shot policy-makers back in the days of Clinton?

    Where are they now?

    This could still be fixed.

  2. I think the current medmal system does almost nothing well, as stated in the Aug. 7 column on the topic that is connected on the sidebar, which was reprinted this morning on and which generated this comment. I don't have any info on the situation you NC anyway, I think the ball is now squarely in the Republican camp; I am not sure what they might have in mind regarding medmal. I suspect medmal gets wrapped up with the doc fix at the federal level.