What Is Medical Underservice?

Tomorrow through Friday, the Negotiated Rulemaking Committee on the Designation of HSPAs and MUAs created by section 5602 of the ACA will begin its 11th in person meeting in Rockville, MD. Health Professional Shortage Areas (HPSA) and Medically Underserved Areas (MUA) are used to identify areas and populations that are eligible to receive key safety net resources such as National Health Service Corps providers or funds to support Community Health Centers. The methods used to designate these areas are largely unchanged since the 1970s and need updating.

I am a member of this committee, and we must submit our recommendations to the Secretary of HHS by October 31, 2011; under the Negotiated Rulemaking Act of 1990 any recommendations must be unanimous. Achieving a unanimous recommendation for such a complicated issue is a challenge to say the least. A quick count of my calendar shows that we will have spent around one and-a-half months of work days together since September 2010 and innumerable conference calls in between.

I think that we have managed to get on roughly the same track for considering changes to the HPSA methodology, in large part because we have a shared understanding of what “health professional shortage” means. It has been harder for our committee to agree to a practical definition of “what is medical underservice?” and more precisely, whether designation of eligible areas for resources should define a standard below which no community or population should fall even if the resources to bring this about are not available, or whether we should be identifying the “worst of the worst” right off the bat. Myriad practical issues flow out of this subtle distinction.

I don’t really know how it will turn out, and I have a certain exhaustion about the process at this point. However, as I packed last night for the last meeting, I realized that I will miss seeing these new friends and colleagues once the committee is dissolved. We came together from different perspectives to seek to improve the functioning of our nation’s crucial safety net. Here’s hoping we can reach a compromise this week, and kick the ball down the field a bit for the good of our country.

About Don Taylor
Professor of Public Policy at Duke University (with appointments in Business, Nursing, Community and Family Medicine, and the Duke Clinical Research Institute). I am one of the founding faculty of the Margolis Center for Health Policy, and currently serve as Chair of Duke's University Priorities Committee (UPC). My research focuses on improving care for persons who are dying, and I am co-PI of a CMMI award in Community Based Palliative Care. I teach both undergrads and grad students at Duke. On twitter @donaldhtaylorjr

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