. DISCLAIMER: Video will be taken at this clinic and potentially used in Project ECHO promotional materials. By attending this clinic, you consent to have your photo taken and allow Project ECHO to use this photo and/or video. If you don’t want your photo taken, please let us know. Thank you! ECHO Nevada emphasizes patient privacy and asks participants to not share ANY Protected Health Information during ECHO clinics. .
. Julie Kotchevar, PhD Brian Sandoval Interim Administrator Governor Vacant Richard Whitley, MS Chief Medical Officer Director Hea ealth Ca h Care e Sh Shortages es i in N Nevada da Scott Jones, PhD Manager, Primary Care Office scottjones@health.nv.gov, 775-684-4047 February 5, 2018 .
. Primary Care Office Function Funded by Identify Health Provider Shortages in Nevada Target Federal and State resources to these shortage J-1 Visa Waiver areas Program Overcome Shortages or Prevent Worsening of Shortages .
. He Heal alth P Profess ssion onal al Shortag age Area ( a (HP HPSA) A) • Health Professional Shortage Areas (HPSAs) are designated by Health Resources Services Administration (HRSA) as having shortages of primary care, dental care, or mental health providers • HPSAs are required to be updated with new data approximately every 3 years (July 2017 and then 2020) Benefits: • HPSAs allow health care providers at sites in the areas to access and be competitive for J-1 Visa Waiver Program 60% Loan Repayment of Healthcare sites have Center for Medicare $50,000 Loan Repayment nursing educational loans reduced paperwork to and Medicaid Services for licensed health for working at a non- recruit foreign doctors to (CMS) physician bonus providers working in an profit critical shortage practice in underserved payment underserved area at an facility area approved site .
. Heal alth P Prof ofessi ssional S Shor ortage A Areas as S Subtypes Primary Care, Dental Health, Mental Health Geographic: Total population compared to total providers Population: Sub-population compared to providers that serve that population, e.g.: low-income Facility: Safety net facility that provides care to underserved populations 5 of 8 .
. Primary Care HPSAs: Geographic vs Low Income .
. Dental HPSAs: Geographic vs Low Income .
. HPSA Designation Process *Designation data is collected and uploaded into the Shortage Designation Management System †Total civilian noninstitutionalized population obtained from the 2014 ACS 5 Year Census Data (S2701) †Number of infant deaths, number of infant births, and low birth weight births obtained from the CDC Natality file: 2010-2014 †Provider hours, locations and patient percentages of Medicaid and Sliding Fee Scale are self-reported by practice sites on surveys administered by PCO. .
. (Nearest Source of Care) Infant Health Index Water Fluoridation MH .
. Data Sources for HPSAs Direct Provider Surveys by the PCO Federal Data: Medicaid claims data, US Census, CDC, NPI, SAMHSA State Data: DHHS Data Analytics, licensing data local and county data .
. Shortage Designation Management System (SDMS) • Online system created by HRSA for states to analyze and submit applications for HPSAs .
. SDMS Area Analysis .
. 2016-2017 Update of All Health Professional Shortage Areas .
. 2016 Designations and Poverty Levels Outside of Primary Care HPSAs in Clark County .
. Existing Clark County Primary Care and Proposed HPSA Update Results Current Updated HPSA Name Designation Type HPSA Notes Score Score Indian Springs HPSA Geographic 14 14 Combine with two other Low Income - Central Las HPSA Population 18NS projected HPSAs for a score Vegas of 16 Low Income - East Central Las 16-17Geographic HPSA with HPSA Population 16 Vegas score of 16-17 also possible 16Geographic HPSA with Low Income - Laughlin HPSA Population 16 score of 16 also possible 16Geographic HPSA with Low Income - Mesquite HPSA Population 12 score of 10 also possible Update of geographic Low Income - South Central HPSA Population 10 10 boundaries results in score Las Vegas of 16 Low Income - West Central HPSA Population 13 16 Las Vegas Northern Clark Service Area HPSA Geographic 14 14 .
. Mental Health HPSA Designations Possible Updates .
. Updated 2017 HPSA Designations .
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. Data Support and Collaboration With State Partners .
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. Washoe County Community Health Needs Assessment Among total residents in the county, 304,844 or 71.88% of residents were • located within a primary care HPSA in 2017. The increase from previous years is mostly due to a change in the geographic area that was newly designated as primary care HPSA in 2017. The primary care physician workforce would need to increase by 157% in • Washoe County to meet the demands of the populations within these HPSAs. https://www.washoecounty.us/health/files/data-publications-reports/2018-2020%20CHNA_FINAL.pdf .
. Population Below 200% Total Yearly Federal Medicaid FTE Paid Medicaid Medicaid Poverty Level Per 100,000 at (FPL) County Claims* FTE** 200% FPL Esmeralda 0 0.00 499 0.00 Eureka 0 0.00 332 0.00 Storey 0 0.00 824 0.00 Humboldt 0 0.00 4888 0.00 Pershing 0 0.00 1870 0.00 White Pine 36 0.01 2935 0.31 Churchill 475 0.12 8976 1.32 Lyon 1420 0.36 19378 1.83 Lander 182 0.05 1666 2.73 Douglas 1652 0.41 12506 3.30 Lincoln 228 0.06 1413 4.03 Nye 3055 0.76 17964 4.25 Mineral 314 0.08 1817 4.32 Elko 2320 0.58 12503 4.64 Carson City 6595 1.65 19516 8.45 Clark 254252 63.56 748627 8.49 Washoe 67482 16.87 149861 11.26 *Total Yearly Paid Medicaid claims include claims incurred by general and pediatric dentists **One Medicaid Full Time Equivalent (FTE) represents one dentist providing the equivalent of 40 hours of care to Medicaid patients. The Medicaid FTE is calculated by dividing total yearly Medicaid claims by 4000. 4000 equals one Medicaid dental FTE according to federal shortage designation policy. .
. Using HPSAs for Targeting Federal and State Resources to Areas of Need .
. National Health Service Corps Loan Repayment Award Application Cycle Opens Yearly in January The NHSC Loan Repayment Program offers two levels of funding, based upon the need of the community in which a provider works, as defined by Health Professional Shortage Area (HPSA) score Initial Award Amounts 2 Years Full-time 4 Years Half-time 2 Years Half-time Sites with HPSA Up to $50,000 Up to $50,000 Up to $25,000 Score of 14+ Sites with HPSA Up to $30,000 Up to $30,000 Up to $15,000 Score of 0-13 With continued service, NHSC providers may be able to pay off all of their student loans. Continuation Award Amounts Full-Time Half-Time 3rd year of NHSC Service $20,000 $10,000 4th year of NHSC Service $20,000 $10,000 5th year + of NHSC Service $10,000 $5,000 .
. NHSC Site Requirements Site is in a HPSA See all patients regardless of ability to pay Offers discounts for uninsured individuals based on family size and income Offer competitive salary and benefits .
. NHSC Impact on Nevada .
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. The Conrad 30/J-1 Visa Waiver Program Internationally trained doctors can work in the United States after training • in return for treating patients for three years in an underserved area Health facility treats all patients regardless of ability to pay and has discounts for low-income patients Health facility treats patients from underserved areas Health facility has tried to recruit a US doctor and not been successful Doctor needs to get a three year contract that protects the doctor and provides a fair wage .
. Primary Care Office Function Funded by Identify Health Provider Shortages in Nevada Target Federal and State resources to these shortage J-1 Visa Waiver areas Program Overcome Shortages or Prevent Worsening of Shortages .
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