Nebraska Loan Repayment Programs are Successful and A Good Investment Helping People Live better Lives.

Health Professions Tracking Service HPTS: History Organized in 1995 Collaborative effort between University of Nebraska Medical Center Nebraska DHHS Office of Rural Health Goal Document the current practice location and retention of physicians in the State of Nebraska

Health Professions Tracking Services Designed to provide information not available through: Nebraska licensure State and federal agencies Associations Information databases

HPTS data Enables decision makers, researchers, healthcare providers & businesses to focus on their mission We utilize this information for designation of state and federal shortage areas

HPTS Survey Surveys are tailored to the profession and facility type Keep to the basics Information requested includes, but is not limited to: Professionals Demographic information Educational background Professional status (FT, PT, retired, etc.) Practice locations – primary & satellite FTE - practice location hours Primary specialty Practice specialties Preferred contact address (facility or residential) National Practitioner Identification (NPI) Facilities Location address (mapping & mailing) Telephone number Fax number Professionals (primary & satellite)

HPTS Professionals - 2019 Physicians (MDs, DOs and TEPs) Advanced Practice Registered Nurses (NPs, CRNAs, CNSs, CNMs) Physician Assistants Dentists Pharmacists Behavioral Health Professionals (Psychologists, LIMHPs, LMHPs, LADCs, CMSWs) Physical Therapists and Occupational Therapists

Diligent Persistence… Dedicated Staff… Work closely with NE DHHS, Office of Rural Health Surveys - professionals & facilities Licensure comparisons (continuous) Returned mail notifications Articles/advertisements Telephone verifications “Good Will” notifications Internet research

Physicians (MD/DO/TEP) Licensed in NE August 2018

It is the result of dedicated Quality data does not just happen… It is the result of dedicated resources & staff and we all contribute

Nebraska State Shortage Area Process Every 3 years - State Office of Rural Health gets latest information from HPTS FTEs are stripped of ER time and other specialty work and normalized to a 40 hour week High needs indicators included Maps are created and made available for public comment

Example of Information shared with Critical Access Hospital Administrators

Nebraska State Shortage Areas All incentive programs require practice in a shortage area, but shortage areas are different for each specialty (and for state and federal programs) Rural Health Advisory Commission designates state shortage areas in Nebraska and selects state Loan Repayment recipients Available Online: http://dhhs.ne.gov/Pages/Rural-Health-Eligible-Disciplines-and-Shortage-Areas.aspx

STATE of NEBRASKA Loan Repayment Programs Helping People Live better Lives.

Loan Repayment Programs For eligible licensed health professionals (do not have to be a Nebraska resident or graduate of a Nebraska college) Moving funding from Student Loan to Loan Repayment due to default rates – soon to be published study shows LR has more financial benefit than SL and leads to more satisfied practitioners. Federal programs have been moving this way for years.

Student Loan Debt by Profession Average Range Dentists $270,395.00 $103,730-$464,822 MD/DO $216,951.00 $63,915-$461,038 PA $97,043.00 $34,542-$197,443 LMHP $93,098.00 $11,000-$208,000 Pharmacists $126,994.00 $59,974-$195,903

State Managed Loan Repayment Programs Requirements Providers must have an employer and local match lined up Local entity (employer or a community foundation) must agree to provide local match and verify practice Local entity fills out the second half of the application Loan requirements must be Government or Commercial educational loans only educational loans to student in student’s name are eligible loans to parents, consumer loans (ex: credit card), mortgage loans, and private loans are not eligible Health professional cannot be self-monitored. Intent of loan repayment legislation is to have community buy-in.

State Managed Loan Repayment Programs Other Requirements 2-4 year practice obligation in a designated shortage area Must be licensed to participate, but can apply up to 18 months in advance of being fully licensed (waiting list) Must be a US Citizen/National (or legal resident for the state program) Cannot participate in multiple programs simultaneously Waitlist is currently 1 year or longer

State Managed Loan Repayment Programs Benefits Maximum of $100,000 - $200,000 over 2-4 years for physicians, dentists, and psychologists Maximum of $50,000 - $100,000 over 2-4 years for all other eligible professions Loan repayment no longer taxable income (effective January 1, 2009 as per P.L. 111-148, 3/23/10)

Federal Shortage Areas are designated using the federal criteria which is more challenging to meet than Nebraska state shortage area criteria which is based on the ratio of provider to population ratios to eliminate health care provider access at the county level.

We don’t recommend it! The Statute that created our state program is very strict – the only way out of a contract is through permanent disability or death. You can usually move to working for another employer as long as they’re located in a shortage area. You need to be sure you can stay in the area for 2-3 years when you sign this contract

What are we doing to assist rural and underserved communities in Nebraska We work with health care providers and communities to match the resources we are given to maximize the effects of each loan repayment program. We work with training programs, Area Health Education Centers, Rural Health Advisory Commission and others to aid the pipeline of health care providers to underserved areas.

Recruitment and Retention We can assist by approving positions openings on the Rural Recruitment and Retention Network (www.3rnet.org) We survey and monitor the retention of obligated healthcare providers through HPTS and Retention Management System.

Where to Look for a JOB These recruitment web sites are focused on serving the underserved and many times will provide assistance with student loans. National Rural Recruitment and Retention Network https://www.3rnet.org/ National Health Service Corps – NHSC Connector https://connector.hrsa.gov/connector/

Healthcare Professional Data Rural Nebraska 2016 vs 2017 MDs - Rural Nebraska 2016 - 992 2017 - 987 Net Change - decrease of 5 The decrease of 5 is actually made up of: - 87 MDs no longer identified as practicing in Rural NE + 82 MDs identified as newly practicing in Rural NE 169 Actual Change

Healthcare Professional Data 2016 vs 2017 MDs - Rural Nebraska - 87 MDs not longer identified as practicing in Rural NE 26% retired, 5% deceased, 6% license inactive, 9% move to Urban NE, 28% left NE, 26% unknown can also identify – Age brackets, specialties, education location + 82 MDs identified as newly practicing in Rural NE

Federally managed – federal funds Tom handles the federal shortage area designations NLRP – state funds SLRP – federal funds

Multi-State Retention Collaborative and Data Management System 2013 - 2019 Federally managed – federal funds Tom handles the federal shortage area designations NLRP – state funds SLRP – federal funds

Federally managed – federal funds Tom handles the federal shortage area designations NLRP – state funds SLRP – federal funds

Questions? Contact: Tom Rauner or Rachael Wolfe 402-471-2337 Thomas.Rauner@Nebraska.gov or Rachael.Wolfe@Nebraska.gov