RD61 - Primary Care Workforce and Health Access Initiatives Annual Report


Executive Summary:
Section 32.1-122.22 of the Code of Virginia requires the Virginia Department of Health (VDH) to submit an annual report on recruiting and retaining health care providers for underserved populations and areas throughout the Commonwealth. The annual report is to include:

(i) the activities and accomplishments during the reporting period;
(ii) planned activities for the coming year;
(ii) the number and type of providers who have been recruited by VDH to practice in medically underserved areas and health professional shortage areas (HPSAs);
(iv) the retention rate of providers practicing in these areas; and
(v) the utilization of the scholarship and loan repayment programs authorized in Article 6 (§32.1-122.5 et seq.), as well as other activities in the Appropriation Act for provider recruitment and retention.

During the reporting period July 1, 2003 through June 30, 2004, the VDH Office of Health Policy and Planning (OHPP) made significant contributions to efforts and activities that promote recruiting and retaining health care providers for underserved populations and areas throughout the Commonwealth. The OHPP provided information and assistance regarding primary care practice opportunities; collaborated in the building of health access networks through public private partnerships; gave technical assistance and information to improve health care access for vulnerable and uninsured populations; and held the 2nd Annual Governor’s Conference on Covering the Uninsured.

The OHPP reviewed requests and submitted applications for designation of primary care, dental, and mental Health Professional Shortage Areas (HPSA). In addition, the OHPP administered state and federal loan repayment programs and scholarship programs. It is noted that health care providers who participate in these programs further support the OHPP’s mission as participants are required to provide medical service with designated underserved populations or areas of the state designated as underserved.

The report shows newly designated and re-designated primary care, dental, and mental HPSA, even though the OHPP had staffing changes with the departure of Chandra Shrestha, Ph.D.(July 2003) and the addition of Lilia Mayer, Ed. M., as designation policy analyst (May 2004). During the reporting period, the HPSA designations were as follows: nineteen new primary care HPSAs; fifteen re-designated primary care areas; twenty-three new prison designations; sixteen county re-designations of mental HPSA; seven new prison dental HPSA. OHPP submitted HPSA applications on behalf of the Department of Corrections to address shortages of health professionals in Virginia’s state prisons. Twenty-four prisons received a primary care, a mental health and/or a dental health designation. In addition, six census tracts in low income areas of the City of Lynchburg and one census tract in Northampton County received new Medically Underserved Population (MUP) designations. The Lunenburg Medical Center received a new Comprehensive Health Center (CHC) designation, made possible by OHPP’s approved application for Greensville County as a Low Income HPSA population.

An important activity of OHPP is the identification and elimination of barriers to health care access for vulnerable and uninsured populations. Health status statistics have consistently shown that racial minorities and rural communities are comprised of vulnerable populations. The most significant disparities exist between black and white persons, and between rural and urban residents. The OHPP addresses these health disparities through programs in the Office of Minority Health (OMH), which includes working with community-based organizations to conduct health education and risk reduction activities at the community level.

In addition, OHPP works with providers throughout the state to address barriers to health care imposed by travel. Through the utilization of telehealth, rural providers are able to consult with specialists and participate in continuing education. Telehealth is the use of electronic information and telecommunications technologies to support long-distance clinical healthcare, patient and professional health-related education, public health, and health administration.

For this reporting period, the OHPP collaborated with the University of Virginia (UVA) to provide technical support to Bath, Giles, and Patrick Counties where telemedicine equipment was installed in Critical Access Hospitals located in those counties. Technical support was also provided to Wythe County Community Hospital and St. Mary’s Hospital’s telemedicine unit in Dickenson County, as well as all of the VDH sites in Southwest Virginia that use telemedicine for the Care Connection for Children. This program serves children with special healthcare needs. OHPP federal grant funds and UVA assistance also allowed the telemedicine network to expand by including the Community Health Center of Martinsville-Henry, the Lunenburg County Community Health Center, and Page County Memorial Hospital.

In an effort to reduce disparities in rural areas, the OHPP administers the Medicare Rural Hospital Flexibility Program. The goal of this program is to preserve rural hospitals and improve the rural health system. Four hospitals have been federally certified as Critical Access Hospitals (CAH). They are: R. J. Reynolds-Patrick County Memorial Hospital; Bath County Community Hospital; Carilion Giles Memorial Hospital; and Dickenson County Hospital. Dickinson County Hospital closed for a year and reopened in late 2003 as a CAH, made possible by grant funds and technical assistance from OHPP. Page County Memorial Hospital, Shenandoah Memorial Hospital, and Stonewall Jackson Hospital also received OHPP grant funds and technical assistance to explore the feasibility of CAH conversion and pursue CAH certification.

Other efforts designed to increase health care providers in medically underserved areas and administered by OHPP include: the Conrad State-30 program, state and federal loan repayment programs, and state and federal scholarship programs. The Conrad State-30 Program is a federal program that permits VDH to act as an interested state agency and request visa waivers for 30 American-trained foreign physicians. Employment in medically underserved and health professional shortage areas of the Commonwealth allows these physicians to remain in the United States. The scholarship programs include: Virginia Medical Scholarship Program, Mary Marshall Nursing Scholarship Program, and the Nurse Practitioner/Nurse Midwife Scholarship Program. The loan repayment programs include: Virginia Loan Repayment Program, and the National Health Service Corps-State Loan Repayment Program. The OHPP provided direct assistance with the placement of sixteen healthcare providers. There are 212 scholarship and loan recipients practicing in underserved areas of the Commonwealth and these recipients owe a total of 281 years of service.

In conclusion, the annual report provides a detailed summary including locations, specialty of placements, and referrals made during the reporting period. The report also identifies future initiatives.