Allocating resources to underserved areas

I am in Rockville, MD, serving on the HRSA Negotiated Rulemaking committee that is updating the way that the federal government designates Health Professional Shortage Areas (HPSA) and Medically Underserved Areas (MUA). The current designation methods are essentially unchanged since the 1970s. These designations make localities eligible for resources such as National Health Service Corps providers, Community Health Centers and the Medicare Physician Bonus Payment program.

This committee was created by the Affordable Care Act, and began meeting in September, 2010 (today is the 26th day we have met since then!). We are moving toward completing our recommendations that will be submitted to the Secretary of HHS by October, 2011, which will then be put forth as an interim final rule.

As Aaron recently noted, the ACA also created a Health Workforce Commission to look broadly at the primary care needs of the nation and the barriers to training them. However, this group has been unable to even begin its work due to Republicans in Congress blocking funding for this Commission. The work of the two groups is certainly related. The one on which I am serving is an attempt to improve the means of allocating finite resources to those areas and populations with the highest needs and/or most extreme deprivation of providers. The Health Workforce Commission was designed to identify ways to more generally expand the supply of primary care providers.

There are differences between these two groups. The Negotiated Rulemaking Committee on which I serve was created for the discrete task of updating the HPSA and MUA designation rules and it will then disband. Its work was explicitly funded by the ACA, probably due to the short term nature of our work. The Health Workforce Commission is meant to be an ongoing group, acknowledging the longstanding nature of the well known problems of creating the primary care workforce that our nation needs. Its funding is therefore dependent upon the normal appropriation process in Congress. The need for more primary care providers is about as bipartisan a topic imaginable. Even that is now caught up in partisan squabbling.


You can follow links in this post to get the gory details of the previous meetings. Tomorrow and Friday I will link pdf documents in this post that updates our work this week.


Negotiated Rulemaking

I have been in Bethesda, MD yesterday and today (actually in a meeting room with no windows) serving as a member of the HRSA Negotiated Rulemaking Committee that is charged with re-writing the federal regulations governing how Health Professional Shortage Areas (HPSA) and Medically Underserved Areas (MUA) are designated. The current rules have been in effect since the 1970s.

These designations make communities eligible for federal resources designed to improve access to primary care for underserved communities and populations. Key programs that depend upon these designation methods to allocate resources include Community Health Centers, the National Health Service Corps, and the Medicare HPSA Physician bonus payment. The Negotiated Rulemaking Committee was created by the Affordable Care Act, and we are scheduled to produce our interim rule in October, 2011. Here is a post from the March, 2011 meeting; if you want to know more, you can follow that link to previous meetings (7 meetings since September, 2010). If you followed me over from my blog, you know that I live-blogged these meetings in the past but those long, chaotic posts seem inappropriate for TIE. Instead, here is a pdf with an overview of the first half of the April meeting that ends tomorrow (HRSANegRegAprilmtg1). I will post a second pdf here tomorrow with notes on the remainder of this meeting.

As a side note, I prefer my sausage light on the sage, heavy on the pepper….