Past links with some background from the February meetings: day 1; day 2; day 3.
The Committee was created by the Affordable Care Act and must file an interim report to the Sec. of Health and Human Services in April, 2011 and wrap up our work by Summer. I will be blogging throughout the meetings, which are open to the public.
10:45 am: sub-committee work groups meeting this morning, with the full committee convening after lunch. The work group that was looking at facility HPSA designations has done much good work and has suggested draft regulations that are useful in helping to move us ahead.
The workforce sub-group is also meeting and a key issue for this full meeting will be to consider the threshold of population to primary care provider ratio for designation. A key decision made at the last meeting was to include non physician primary care providers into the supply of workforce available. This will mean the ratios used for designation will be very different from the old 3500:1 or 3:000:1 for primary care physicians only that has been used since the mid-1970s.
The barriers work group that was considering the 3 non-provider parts of the index of medical underservice (health status, accessibility, ability to pay) has focused most since the last meeting on how to represent ability to pay and on the various measures of access.
Key issues on ability to pay have been whether there is a better measure of local economic situation than unemployment, because of the issue of persons leaving the workforce. Items considered have included 1 minus the population employed which is really an employment rate, with all included in the denominator. Other issues considered were looking for an alternative measure to poverty rate that better measured purchasing power in a local community. I think in all these issues it was much easier to describe the problems of existing measures than it was to propose a workable alternative.
12:30pm: We convened as a full group around 11:30am and have discussed the roadmap for where we are going and what time frame we will need to complete our work.
Then we had a presentation on a proposed process for medically underserved population designations and how they relate to facility and population designations. Key issue is what groups may be advantaged in terms of granting a medically underserved population designation. Lunch and the reconvene at 1:15pm.
2:15pm: We have been receiving a report and voting on recommendations from the workforce subcommittee. We are working through a variety of decisions about what types of providers to count in a series of idiosyncratic (but important) groups. For example, backing out federally supported providers such as National Health Service Corps physicians to keep from 'yo yoing' designations. Meaning if you count a NHSC doc, this could de-designate an area....then the area may be underserved and later designated to get a NHSC physician. Deep in the weeds now, but important details that have to be nailed down.
3:05pm: receiving report from Facility designation subcommittee and working through many issues. Key question is what types of providers (incl FP) would be eligible for designation as HPSA facility designations. Also discussing the issue of whether there will be facility MUA/P designations. Other key issues here that some want to address is the fact that local county jails are not eligible to get HPSA facility desingations, whereas state and federal prisons can receive a designation. Apparently, a person in county jail awaiting trial loses federal benefits like Medicaid even before a trial....some counties have thousands of inmates either awaiting trial or serving short(er) sentences.
3:50: we have received all reports back from workgroups. Facilities designation and workforce group is going to meet for the next hour to try and work through some sticking points surfaced from earlier this morning. I think we are closest to having the facility designation issues wrapped up, then the workforce decisions with some hard work left for the accessibility, health status and ability to pay aspect of the MUA index.
5:00pm: back in full meeting talking through recommendations from the workforce group. Going to have to start putting the parts together soon. Reminder, the MUA measure must address four issues:
- Health Status
- Ability to pay for care
- Availability of primary care providers