HRSA Neg Reg Day 2

Day 1.

10am: work groups started up at 8:30am. We have hit the point where several work groups are close to having tangible recommendations for the parts of the process. The problem is that the last 10% of group discussions and deliberations often hinge on the question: it depends upon what the other groups recommends on.....

A bit stuck on process. We need to move some decisions closer to completion and look for a way to rank order what comes next.

Noon: the health status work group has brought a recommendation to the full group for how to represent the health status aspect of the new MUA index (yeah!). Now discussing this recommendation as a full committee. Would be good to nail down a draft for at least one portion of the new MUA index.

Full committee approved a recommendation to accept report from subcommittee on how to represent health status in a new MUA index. Big picture, the recommendation to be tested:

• Social determinants of health index (4 variables that we have shown to be related to outcomes). This could be thought of an index that shows areas at risk of poor health.
  
• Direct Measures of health. This would include standardized mortality ratio and three measures of morbidity (diabetes prevalence, low birth weight, disability). We will also test sensitivity of using low birth weight v. Infant Mortality Rate.

1:30pm: full committee received a report from the facility designation subcommittee. They have made progress but are still working on several issues. More work group meeting this afternoon.

1:40pm: Having initial discussion about how to put together the new MUA index. Big issues are the relative weight or importance of the 4 parts of the MUA (health status, accessibility, ability to pay, and provider availability), how the MUA relates to the HPSA, how to set the relative weights of the various parts of the index, thresholds, and how designation will be done.

General discussion of relative importance of factors, with biggest areas of disagreement seeming to be around the issue of how much to weight health status in the MUA index. In one sense, the HPSA is being viewed by some (many?) as being akin to the inverse of the MUA....meaning MUA is about health status and access and then accounts for availability of providers. HPSA is about absolute deprivation or lack of providers with some accounting of health status/barriers.

5:30pm: Access workgroup brought a proposal for testing, so we have a concrete initial test in the health status and access part of a new MUA index. Facilities group is getting closer to a recommendation, which will likely come tomorrow. An initial work group attempt to talk this afternoon about how to put all the parts together surfaced lots of disagreements....particuarly about relative importance of the various parts of a new MUA.