RD143 - Annual Report on the Primary Care Workforce and Health Access Initiatives


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;

(iii) 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, 2004 through June 30, 2005, 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 substantially completed grant activities to increase the number of insured Virginians.

The two most significant contributions the OHPP made toward efforts and activities to improve the number of health care providers assisting in underserved areas during the reporting period was the development of a rational service area plan and a statewide health workforce study. Both of these studies will help inform health workforce planning activities.

A rational service area plan allows for the strategic placement of federally designated health professional shortage areas that are data-driven. Currently, designations are submitted to HRSA on a first-come, first served basis. An area’s successful designation can often preclude adjacent areas from receiving a designation even though the adjacent area may have higher needs. The rational service area plan is in its final stages and will be submitted to HRSA within the next few months for approval. States with approved rational service area plans have the ability to utilize the federal ASAPS database to include in their HPSA applications. HPSA applications with ASAPS data are reviewed by HRSA in less than a third of the time it takes for HRSA to verify data coming from other sources. Thus, there are many benefits that will inure to Virginia once the rational service area plan is completed.

Virginia contracted with Dr. Stephen Mick of Virginia Commonwealth University to develop an objective health workforce study. A number of national studies offer conflicting data regarding whether there will be a physician shortage or surplus in the upcoming years. The uncertainty around the physician shortage/surplus argument underscores the need for objective studies that assess the current and projected supply of physicians. The few studies that exist suggest that Virginia has fewer physicians per population than the country as a whole, a higher population growth rate, and a greater reliance on international medical graduates. Data-driven public health policy cannot be realized when a vacuum of data exists as it does in Virginia.

The proposed workforce study will be the first of its kind thereby representing a watershed event for the state and the nation.

To overcome the weaknesses exhibited by traditional health workforce studies, the proposed study will predict physician supply adequacy in five to ten year intervals based on robust data sets and differing methodologies for estimating physician demand. Physicians in Virginia were surveyed during the renewal of their medical licenses regarding the scope of their practices in the upcoming years. Questions included the number of hours of week that they work, number of years before retirement, possibility of adding a partner, ability to accept new patients, days new patients have to wait before getting an appointment, etc. These data will be supplemented by the AMA and AOA Physician Masterfiles for Virginia.

Comprehensive analyses will then be performed to more descriptively identify the supply of physicians. The responses to the questions will be tabulated and matched with the physician’s specialty and ZIP code. The ZIP code will then be placed into one of several different geographical areas- counties, towns, health planning regions, and primary care service areas (PCSAs). PCSA data describe utilization patterns for a specific geographic area. The use of PCSAs represents a significant advantage for Virginia, as they are the basis for its ongoing rational service area study as well as the basis for which HRSA is considering new shortage designation application efforts. Virginia is fortunate to have Dr. Stephen Mick leading these efforts as he developed PCSAs for the entire nation on HRSA’s behalf.

While the above activities are noteworthy and will prove to have long-range benefits, they have taken up considerable staff time. These major efforts were conducted by OHPP staff members as a person who had been newly hired to assume these responsibilities separated from the office. During the reporting period, the number of applications submitted to HRSA was not as great as in the past, but the geographic areas included in each application is greater than those sent in during earlier years.

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 in areas of the state designated as underserved.

During the reporting period, a number of designation requests were reviewed and OHPP submitted HPSA designation requests as follows: one new primary care HPSA; two re-designated primary care areas; and one dental HPSA. There were no Medically Underserved Areas or Medically Underserved Populations applications submitted to HRSA during the reporting period.

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 include 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 program. 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; Carillon Giles Memorial Hospital; Shenandoah Memorial Hospital; Stonewall Jackson Hospital; and Dickenson County Hospital. Dickinson County

Hospital closed for a year and reopened in late 2004 as a CAH, made possible by grant funds and technical assistance from OHPP. Page County Memorial Hospital, Shendandoah Memorial Hospital, and Stonewall Jackson Hospital have 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.