1. HPSA Training for Provider Partners: Data Collection & Timeline Anne Dopp, WI DHS Primary Care Office Aleks Kladnitsky, WI Primary Health Care Assoc. May 20, 2013

2. 5/20/13 Protecting and promoting the health and safety of the people of Wisconsin 2 Increased understanding of Health Professional Shortage Areas (HPSAs) application process: o Definitions, criteria & benefits o Timelines o Clinic and physician data collection o Options to improve data collection/reporting Expected Outcomes:

3. HPSA Definitions & Disciplines Federally defined threshold indicating a significant shortage of primary care physicians, dentists or psychiatrists for a specific area. Shortage Disciplines: o Primary Care Physician o Dentist o Psychiatrist 5/20/13 Protecting and promoting the health and safety of the people of Wisconsin 3

4. HPSA Types o Geographic – shortage for entire population. o Low-income population – shortage for population below 200% of federal poverty. o Facility – shortage for certain facilities (Corrections, State Mental Hospitals). o Automatic HPSA for safety net facilities (CHCs, RHCs, Tribal Centers). 5/20/13 Protecting and promoting the health and safety of the people of Wisconsin 4

5. HPSA Criteria o Rational Service Area, o Percent of population below poverty, o Population to physician FTE ratio, o Contiguous area resources not available, o Nearest source of non-designated care, o HPSA score. 5/20/13 Protecting and promoting the health and safety of the people of Wisconsin 5

6. HPSA-Linked Benefits Provider payment incentives: o Medicare 10% bonus payment for physicians, o Medicaid 20% bonus payment for certain primary care services, o Federal RHC certification and cost-based payment. Provider recruitment & retention o National Health Service Corps loan repayment, o Wisconsin Health Professions Loan Assistance, o J-1 visa waiver for foreign medical graduates. 5/20/13 Protecting and promoting the health and safety of the people of Wisconsin 6

7. Physician & Clinic Data o State does not have a database with detailed physician and clinic data required for HPSA applications. o WI Primary Care Office (PCO) and contracted HPSA staff at WPHCA worked over past three years to establish a HPSA provider database. o WI HPSA database can now be used to review, update, and add data for new areas. 5/20/13 Protecting and promoting the health and safety of the people of Wisconsin 7

8. Frequency for HPSA Data Collection Each HPSA must be reviewed every three years o Review is based on date of last update (2010’s due in 2013). o Federal due date for reviews is Sept. 30 th of each year. o Need to do some HPSA reviews early to level out the number due per year (14 due in 2013, 58 due in 2014). o Annual HPSA reviews are given priority. o Requests for new HPSAs will be reviewed as time allows. o Cannot guarantee that a HPSA is eligible for re-designation. 5/20/13 Protecting and promoting the health and safety of the people of Wisconsin 8

9. HPSA Provider Surveys o Conducted by contracted HPSA staff at WPHCA. o Done throughout the year (Oct. – Sept. cycle). o Physician data must be less than two years old. o Must get a 2/3 or higher HPSA survey response for physicians per area to estimate for entire area. o Surveys are only done as needed for HPSA reviews. 5/20/13 Protecting and promoting the health and safety of the people of Wisconsin 9

10. How to check when a HPSA was last updated o Use federal HPSAFind web site See handout with screen shots o See Wisconsin PCO web page for list of HPSA reviews that are due: http://www.dhs.wisconsin.gov/health/primarycare /HPSA-Reviews.htm http://www.dhs.wisconsin.gov/health/primarycare /HPSA-Reviews.htm 5/20/13 Protecting and promoting the health and safety of the people of Wisconsin 10

11. Which clinics get HPSA surveys? o All clinics in the HPSA service area with physicians providing direct, outpatient care. o Primary care HPSA: family practice, internal medicine, pediatrics, Ob/Gyn, and general practice physicians. o Mental Health HPSA: general and child psychiatrists. o Sometimes clinics in additional areas, when the HPSA service area needs to be revised to be “rational.” o All clinics in contiguous areas that are not a HPSA & are within a “30-minute travel ring” of the HPSA center. 5/20/13 Protecting and promoting the health and safety of the people of Wisconsin 11

12. Source of clinic list for surveys o Wisconsin HPSA provider database. o Clinic contacts in database and physician recruiters. o Clinics can email updates for clinic locations and contact people via PCO HPSA web page. o Network clinic help is especially needed to reach small private clinics to complete HPSA surveys. 5/20/13 Protecting and promoting the health and safety of the people of Wisconsin 12

13. HPSA Surveys: Data Needed o Clinic data: Location, discounted care policy, and contact person information. o Physician/psychiatrist information: Work address, license no., year of birth, and specialty, Hours per week of outpatient & inpatient care, Percent patients on Medicaid & discounted care, Wait time for appointments. o Do not need to report changes in between surveys. 5/20/13 Protecting and promoting the health and safety of the people of Wisconsin 13

14. HPSA Surveys: Privacy o Data must be shared securely (email or phone). o Cannot accept faxed or mailed paper surveys (it cannot be imported into HPSA database). o See separate list of data elements from PCO web http://www.dhs.wisconsin.gov/health/primarycare/HPSA- Reviews.htm http://www.dhs.wisconsin.gov/health/primarycare/HPSA- Reviews.htm 5/20/13 Protecting and promoting the health and safety of the people of Wisconsin 14

15. HPSA Surveys: Timeline o Oct - Nov: PCO releases list of HPSAs due for update via web and email notices. o Dec - March: HPSA team calls/emails clinic contact to update sites and confirm contact person. o Dec - June: HPSA team calls clinic contact, gives password, and sends survey by email. o Dec - July: Clinics review & update survey data * (*more detail on “non-responses” later). 5/20/13 Protecting and promoting the health and safety of the people of Wisconsin 15

16. HPSA Surveys: Timeline Continued o March - Aug: HPSA team analyzes data and prepares HPSA applications for update. o Sept. 30 th : Annual HPSA update applications are due to HRSA (1 year after update list 1 st sent out). o PCO sends out 30-day public notices for review. o Oct - Dec: HRSA reviews & makes decisions on applications. Approvals added to HPSAFind. o PCO sends out notice of approvals & denials. 5/20/13 Protecting and promoting the health and safety of the people of Wisconsin 16

17. HPSA Surveys: Timeline for Withdrawals o Oct - Nov: HPSAs that no longer qualify are changed to “Proposed for Withdrawal” & immediately lose eligibility for NHSC assistance. o July of next year: Federal Register list published & “Proposed for withdrawal” become “Withdrawn.” o January of next year: “Withdrawn” geographic HPSAs lose the Medicare HPSA bonus payment. 5/20/13 Protecting and promoting the health and safety of the people of Wisconsin 17

18. HPSA Surveys: Follow-up for “Non-responses” Surveys are due back two weeks after sent to clinics: o At 1 week - Reminder to clinic by phone/email. o At 2 weeks - Late Notice to clinic by phone/email. o At 3 weeks – At-risk notice is sent to all providers in area, HPSA is set aside, and HPSA will be converted to proposed for withdrawal and lose HPSA-linked benefits. 5/20/13 Protecting and promoting the health and safety of the people of Wisconsin 18

19. HPSA Survey: Excel file Use of the Excel file to review, update and add clinic and physician data: o Questions? 5/20/13 Protecting and promoting the health and safety of the people of Wisconsin 19

20. Other options to improve HPSA data collection? Can Networks submit data for all sites & all primary care physicians at one time? o Compatible format for importing data. o Submit data every two years. o Incomplete data needed for HPSAs would need to be followed up. Better ways to keep clinic and contact list updated? 5/20/13 Protecting and promoting the health and safety of the people of Wisconsin 20

21. Other options to improve HPSA data collection? Other options or discussion? Thank you for your willingness to look for ways to improve the data collection/reporting process. 5/20/13 Protecting and promoting the health and safety of the people of Wisconsin 21