Wednesday, February 16, 2011

Negotiated Rulemaking, Fifth Meeting, Day 1

The fifth meeting of the HRSA Negotiated Rulemaking Committee to reconsider how the federal government designates Health Professional Shortage Areas (HPSA) and Medically Underserved Areas (MUA) begins this morning in Rockville, MD. Here are links to the last meeting in January: day 1, day 2, day 3.

This morning the technical subcommittees will meet and the full meeting begins at 1pm and runs through Friday. First step today will be receiving the reports and recommendations from subcommittees that are organized around the parts of the statutorily-determined components of the MUA designation:
  • health status
  • ability to pay
  • accessibility
  • provider availability
Basically, we are getting to the point of deciding how we will operationalize these concepts and put them together in useable manner.

On the HPSA side, we will also begin making decisions about what providers to count toward primary care, how to weight them, and eventually have to set standards for designation. The work of the provider availability subcommittee informs the HPSA designation as well.

There are myriad issues to be considered and decided upon for both MUA and HPSA. I will blog about the meeting and do so by updating this post.

2:30pm. Productive subgroup meetings in the morning and now the full committee is receiving subgroup committee reports.

The subgroup working on provider availability (how to measure the supply of primary care) has made the most progress and is probably closest to having a recommendation about what types of providers to count. Key issues will remain the weighting of certain groups that provide primary care, and the relationship between secondary data and local areas completing surveys of local supply to produce the most accurate FTE primary care available in a local area.

For all of the presentations, the issue of what is the rational service area comes quickly. We are working on that tomorrow. For the early testing of the health status component of the MUA measure we have used the county and PCSAs.

5:00pm: good progress made. There has been convergence among several of the subgroups in terms of questions and issues. There are some inevitable muddles with variables potentially 'showing up' in different parts of an MUA designation that will have to be worked through.

We are currently discussing the draft recommendations of the provider subgroup to tentatively adopt a definition of primary provider for the purpose of identifying HPSA shortage areas and capturing provider availability in a MUA designation.

5:25pm: trying to get to a vote on the list of providers to count as primary care providers for the purposes of designation. Biggest change as compared to what is currently done is the adding of some non-physician primary care providers (e.g., Nurse Practitioners, Physician Assistants). Many issues still to determine in terms of how counts will be finalized for designation, but this is a big (tentative) step so that we can begin to see the distribution of providers using these definitions. Entirely new thresholds will have to be developed given the addition of non-physician primary care providers.

5:37pm: consensus obtained on primary care providers to count. woot woot!


  1. Don, nice summary again as usual. You could be (are) a reporter. But hey you make the meeting sound more rosy than it actually seemed in person! :-) Tim

  2. Hey Tim. Trying to build on the positive....there is of course contention, but I do think we made progress. I actually think the bar for 'improving the way it is done now' is pretty low so think we should be able to develop something that is better.