III. CALCULATING POPULATION TO PROVIDER RATIOS

Primary Care

III-1

Calculating Population to Provider Ratios (Primary Care)

Objective:

Participants will understand how to:

1) Identify all primary care providers 2) Calculate Full-Time-Equivalency (FTE)3) Determine the population to provider ratios

for primary care geographic and population designations

III-2

Population to Provider Ratios Needed for Designation

(Primary Care)

Contiguous Areas are overutilized if: > 2,000:1

1 - See Appendix V for additional information on calculating infant mortality rates 2 - See Appendix V for information on insufficient capacity

Geographic Area: ≥ 3,500:1A rational service area: county or sub-county (MSSA)

Geographic Area w/Unusually High Needs: ≥ 3,000:1A rational service area plus one of the following:

a) More than 20% of the population has incomes at or below 100% of the Federal poverty level;

or b) More than 100 births per year per 1,000 women ages 15-44; or

c) More than 20 infant deaths per 1,000 live births1; or

d) Meets insufficient capacity criteria2 Population Groups: ≥ 3,000:1

A rational service area plus meets the requirements of the specific designation category (e.g. low-income, homeless, etc.)

III-3

Population Side of the Ratio

A.Geographic Area Designations

B. Population Designations

:

III-4

________________

A. Geographic DesignationsResident Civilian Population = Total permanent population in the service

area (non-institutionalized population)

Excludes: inmates or individuals in institutions (e.g. nursing homes, prisons, college dormitories, military installations, Native Americans on reservations, etc.)

Source: Must use 2007 Claritas Population Estimates, effective 2010.

Can add:i. Migrant Farmworkers

Data from the 2000 Migrant and Seasonal Farmworker Enumeration Profiles Study, or other approved source (must include methodology)

ii. Tourists Formula: 0.25 X [fraction of year present] X [average daily number of tourists] (Use local data, which must include methodology and length of stay.)

iii. Seasonal Residents Those who maintain a residence in the area, but inhabit it for only 2-8 monthyear (Use census or local data, which must include methodology.)

iv. Homeless Local data (must include methodology)

III-5

B. Population DesignationsLow-Income PopulationNumber of individuals in the service area that are at or below 200%of the Federal poverty level

Must be > 30% of the population in the service area Source: 2005 Claritas Population Estimates

Medicaid-Eligible PopulationNumber of individuals in the service area that are eligible for Medicaid

Must have > 30% of the population in the service area with incomes < 200% of the Federal poverty level Source: Department of Health Care Services

Homeless PopulationNumber of individuals in the service area that are homeless

Source: 2000 census data, or local data (must include methodology)

III-6

Migrant Farmworker Population

Number of individuals in the service area who are migrant farmworkersadjusted for the fraction of the year they are in the service area.

Source: State/local data & 2000 Migrant & Seasonal Farmworker Enumeration Profiles Study

Ex: Napa County, CaliforniaAgricultural Season = 4 months4/12 = .333Migrant Farmworker Pop = 5,6595,659 X .333 = 1,884

Total Migrant Farmworker Population = 1,884

Native American/Native AlaskanNumber of individuals in the service area that are Native Americansor Native Alaskans Source: 2000 census data

III-7

B. Population Designations (continued)

III-8

MIGRANT AND SEASONAL FARMWORKER

ENUMERATION PROFILES STUDY

CALIFORNIA

FINAL

prepared for the

Migrant Health ProgramBureau of Primary Health CareHealth Resources and Services Administration

byAlice C. Larson, Ph.D.Larson Assistance ServicesP.O. Box 801Vashon Island, WA 98070206-463-9000 (voice)206-463-9400 (fax)las@wolfenet.com (e-mail)

September, 2000

Use information in highlighted column.

TABLE THREECALIFORNIA ALL AGRICULTURAL WORKERS ESTIMATES

FINAL

County

AdjustedMSFW

FarmworkerEstimates

MigrantFarmworkers

SeasonalFarmworkers

Non-FarmworkersIn Migrant

Households

Non-FarmworkersIn SeasonalHouseholds

MSFWFarmworkers

And Non-Farmworkers

Alameda 1,148 531 616 195 699 2,043

Alpine 0 0 0 0 0 0

Amador 737 341 396 125 449 1,311

Butte 7,263 3,363 3,900 1,236 4,426 12,925

Calaveras 135 63 73 23 83 241

Colusa 13,932 6,450 7,481 2,371 8,490 24,792

Contra Costa 2,470 1,144 1,326 420 1,505 4,395

Del Norte 604 280 325 103 368 1,076

El Dorado 960 444 515 163 585 1,708

Fresno 145,919 67,561 78,359 24,828 88,917 259,665

Glenn 3,747 1,735 2,012 638 2,283 6,668

Humboldt 935 433 502 159 570 1,664

Imperial 29,312 13,572 15,741 4,988 17,862 52,162

Inyo 71 33 38 12 43 126

Kern 92,142 42,662 49,480 15,678 56,148 163,968

Kings 16,592 7,682 8,910 2,823 10,111 29,526

Lake 2,911 1,348 1,563 495 1,774 5,181

Lassen 544 252 292 93 331 968

Los Angeles 14,180 6,566 7,615 2,413 8,641 25,234

Madera 29,676 13,740 15,936 5,049 18,083 52,809

Marin 697 323 374 119 425 1,240

Mariposa 49 23 26 8 30 87

Mendocino 6,142 2,844 3,298 1,045 3,743 10,930

Merced 26,100 12,084 14,016 4,441 15,904 46,445

Modoc 851 394 457 145 519 1,515

Monterey 86,941 40,253 46,687 14,793 52,978 154,712

Napa 12,222 5,659 6,563 2,080 7,447 21,748

Nevada 206 95 110 35 125 366

Orange 11,284 5,225 6,060 1,920 6,876 20,081

III-9

III-10

Use information in highlighted column.

County

AdjustedMSFW

FarmworkerEstimates

MigrantFarmworkers

SeasonalFarmworkers

Non-FarmworkersIn Migrant

Households

Non-FarmworkersIn SeasonalHouseholds

MSFWFarmworkers

And Non-Farmworkers

Placer 802 371 431 137 489 1,428

Plumas 71 33 38 12 43 126

Riverside 34,991 16,201 18,790 5,954 21,322 62,267

Sacramento 7,845 3,632 4,213 1,335 4,780 13,960

San Benito 7,300 3,380 3,920 1,242 4,448 12,991

San Bernardino 7,012 3,246 3,765 1,193 4,273 12,477

San Diego 19,719 9,130 10,589 3,355 12,016 35,090

San Francisco 343 159 184 58 209 610

San Joaquin 60,184 27,865 32,319 10,241 36,674 107,099

San Luis Obispo 11,896 5,508 6,388 2,024 7,249 21,168

San Mateo 4,084 1,891 2,193 695 2,489 7,267

Santa Barbara 31,381 14,530 16,852 5,340 19,123 55,844

Santa Clara 10,597 4,906 5,691 1,803 6,457 18,858

Santa Cruz 19,248 8,912 10,336 3,275 11,729 34,252

Shasta 5,667 2,624 3,043 964 3,453 10,084

Sierra 2 1 1 0 1 4

Siskiyou 3,398 1,573 1,825 578 2,071 6,047

Solano 6,528 3,023 3,506 1,111 3,978 11,617

Sonoma 15,717 7,277 8,440 2,674 9,578 27,969

Stanislaus 36,720 17,001 19,719 6,248 22,376 65,344

Sutter 14,177 6,564 7,613 2,412 8,639 25,228

Tehama 3,825 1,771 2,054 651 2,331 6,807

Trinity 83 38 45 14 51 148

Tulare 73,810 34,174 39,636 12,559 44,977 131,346

Tuolumne 235 109 126 40 143 417

Ventura 35,181 16,289 18,892 5,986 21,438 62,605

Yolo 14,794 6,850 7,944 2,517 9,015 26,326

Yuba 5,349 2,477 2,872 910 3,259 9,519

State Total 938,758 434,645 504,113 159,732 572,042 1,670,532

NOTE: County numbers have been rounded and, therefore, may not add to totals.

2007 Claritas Population Estimates (Dashboard)

III-11

Source: HWDD - Access Database

For Geographic HPSAs and MUAs, always use Civilian Population not Total Population.

Provider Side of the Ratio

:____

III-12

STEPS

1) Identify all primary care physicians in the area to be designated.

2) Determine the number of hours each primary care physician works in direct patient care (office and hospital inpatient) serving the population to be designated.

3) Calculate the FTE for each primary care physician serving the population to be designated.

4) Calculate the population to provider ratio.

III-13

STEP 1

Identify all primary care physicians in the area to be designated.

III-14

List all primary care Doctors of Medicine (M.D.) and Doctors of Osteopathy (D.O.) who:

1) Provide direct patient care in the service area, and 2) Practice principally in one of the six primary care specialties:

General Practice Family Practice General Internal Medicine Pediatrics Gerontology Obstetrics and Gynecology

Physicians engaged solely in administration, research, or teaching Hospital staff physicians involved exclusively in inpatient or emergency room care Locum tenens serving less than 1 year (on contract) Physicians who are suspended under provisions of the Medicaid-Medicare Anti- Fraud and Abuse Act for a period of 18 months or more Mid-levels, Physician Assistants, & Family Nurse Practitioners

Include in survey, but reduce the following provider’s FTE to 0.0

III-15

Physicians who serve in the NHSC Scholarship or Loan Repayment Programs, including if it is a “Federal” or “State” program.

Physicians who serve under a J-1 or H-1B waiver Physicians who are Federal providers (e.g., Commissioned

Officers at Indian Health Services or Bureau of Prisons)

Include physicians who are planning on retiring but are still seeing patients

Note: Survey located in “Step-by-Step Guidelines” outlines recommended questions.

Gather More Information About Each Provider

III-16

State Licensure Lists:http://www2.dca.ca.gov/pls/wllpub/wllquery$.startup

National, State, and Local Medical Association Directories

Local Hospital Admitting Physician Listings

American Osteopathic Association (AOA) Physician Listing

Medicare and Medicaid Practitioner Lists

Local Telephone Directory/ Yellow Pages

Commercially Developed Listings (CD-ROM)

www.vitals.com

Sources of Provider Data

Use several of these sources to assure a complete listing of physicians is being used.

III-17

http://www.doctors.at/state/CA/A/0/

STEP 2

Determine the number of hours each primary care physician works in direct patient care (office and hospitalinpatient) serving the population to be designated.

III-18

Designation Types and Whom to Include in the Provider Count

COUNT ALL PRIMARY CAREPROVIDERS WHO SERVE ALL PERSONS:

Geographic in the service areaLow-Income Population in the service area that have incomes

< 200% of the Federal poverty level (Medicaid and Posted Sliding Fee)

Medicaid-Eligible Population in the service area that are Medicaid-enrolled

Homeless Population in the service area that are homeless

Migrant Farmworker Population in the service area that are migrant farmworkers

Native American/ Native Alaskan

in the service area that are Native American or Native Alaskan

DESIGNATION TYPE:

III-19

Providers Physician Name Specialty Location of

Practice/CTHours of Direct Pt. Care/Week

Hosp. Hours

1) L. McCoy, D.O. Gen.Prac. 19 Main Street City, CA 90001 CT 531

48 Included

2) D. Scully, MD Pediatrics 11 Park Place City, CA 90001 CT 540

30 Included

3) B Spock, M.D. Int. Med. 6 Muldar Ave City CA 90002 CT 538

15 Included

4) M. Welby, M.D. Ob-Gyn 3306 Russia Blvd City, CA 90002 CT 543

25 Not Included

5) Y. Zhivago, D.O.

Fam. Prac. 99 Bones Drive City, CA 90003 CT 539

0 Full TimeAdministration

Total Physicians: 5 III-20

STEP 3

Calculate the FTE for each primary care physician serving the population to be designated.

III-21

FTE Calculation

40 hours = 1.0 FTE

Every 4 hours (½ day) is counted as 0.1 FTE

A provider serving more than 40 hours a week is counted as 1.0 FTE

Only the Total (or Low-Income) FTE is rounded to the nearest tenth of a percent:

Examples: 0.875= 0.9 0.817= 0.8 0.83 = 0.8 0.85 = 0.9

Interns and residents are counted as 0.1 FTE (40 hours = 0.1 FTE)

Note:The FTE for low-income population designations is based on the average number of hours per week spent with Medicaid and Sliding Fee Scale (SFS) patients. It is not based on whether the provider is accepting new Medicaid patients.

For each physician, include the number of hours of direct patient care provided (office and hospital inpatient) in the service area:

III-22

Adjustment of FTE if hospital inpatient hours not available: Use for physicians whose office hours are < 40 and information on

hours spent in inpatient care is not available

Multiply office hours X appropriate factor

Cannot exceed 1.0 FTE

Primary Care Specialty Adjustment Factor General/Family Practice 1.4

Gerontology 1.4

Pediatrics 1.4

General Internal Medicine 1.8

Obstetrics/Gynecology 1.9

If specialty information is not known then use the default which is 1.6

III-23

Physicians under contract with the NHSC Federal Scholarship or Loan Repayment Programs (this does not apply to physicians in the State Loan Repayment Program)

Other Federal providers (e.g., Commissioned Officers at Indian Health Service or Bureau of Prison sites, etc.)

Physicians who are graduates of foreign medical school who are not citizens or lawful permanent residents (including those with J-1 or H-1B visas)

Note:List these physicians in the application but adjust their FTE to 0.0

Include in survey, but reduce the following provider’s FTE to 0.0:

III-24

Do NOT reduce the following provider’s FTE:

All primary care M.D.s and D.O.s who provide direct patient care in

the service area, including those who:

Serve in State Scholarship or Loan Repayment Programs

Serve at Indian Health Clinics and are not Federal providers

Plan on retiring but are still seeing patients

III-25

FTEs - Geographic Designation Physician Name Specialty Location of

Practice/CT Hours of Direct

Patient Care/Week

Hosp. Hours

FTE

1) L. McCoy, D.O. Gen.Prac. 19 Main Street City, CA 90001 CT 531

48 Included 1.0(48/40=1.2=1.0)

2) D. Scully, MD 1 Pediatrics 11 Park PlaceCity, CA 90001CT 540

30 Included 0.8(30/40=.75=.8)

3) B Spock, M.D. 2

Int. Med. 6 Muldar AveCity, CA 90002CT 538

15 Included 0.4(15/40=.375=.4)

4) M. Welby, M.D.3 Ob-Gyn 3306 Russia BlvdCity, CA 90002CT 543

25 Not Included

1.0(25 x 1.9 = 47.5/40=1.2=1.0)

5) Y. Zhivago, D.O. 4

Fam. Prac. 99 Bones DriveCity, CA 90003CT 539

0 --- 0.0(0/40=.0)

Total Physicians: 5 Total FTE: 3.125=3.11 – Dr. Scully spends 10 hours/week doing research.2 – Dr. Spock chooses to work only 15 hours/week.3 – Dr. Welby has an unknown number of hospital inpatient hours so the adjustment factor is used

4 – Dr. Zhivago spends full-time in administration.III-26

FTEs - Low-Income Designation

Total Physicians: 5 Total Low-Inc FTE: 1.615=1.6 1 – Dr. Scully spends 10 hours/week doing research.2 – Dr. Spock chooses to work only 15 hours/week.3 – Dr. Welby has an unknown number of hospital inpatient hours so the adjustment factor is used4 – Dr. Zhivago spends full-time in administration. III-27

Physician Name Hours of Direct Pt.

Care/Week

Hosp. Hours FTE

%Medi -

Cal

%SFS

% of Low-Income

Total Low-Inc FTE

1) L. McCoy, D.O.

48 Included 1.0 64% 15% 79%(64%+15%=79%)

0.79(.79 x 1.0 = .79 )

2) D. Scully, MD 1

30 Included 0.75 35% 8% 43%(35%+8%=43%)

0.32(.43 x .75 = .32)

3) B Spock, M.D. 2

15 Included 0.375 60% 40% 100%(60%+40%=100%)

.375(1 x .375 = .375)

4) M. Welby, M.D. 3

25 Not Included(25x1.9= 47.5/40=

1.2)

1.0 13% 0% 13% 0.13(.13 x 1=.13)

5) Y. Zhivago, D.O. 4

0 Included 0.0 0% 0% 0% 0.00

Survey Physicians to Determine Their FTE Survey all primary care physicians in service area Must attempt to contact physician at least 3 times Minimum two-thirds response rate required

Calculation of Non-Responders Ex: Elk Grove, California - 20 providers

15 - respond to survey 5 - no response after repeated telephone calls

Response rate 15/20 = 75% Total FTE for the 15 responders= 9.5

1) Divide FTE of responders (9.5) by the number of responders (15) for the average FTE of responders (.63)

2) Multiply number of non-responders (5) by the average FTE of responders (.63) for FTE of non-responders (3.16=3.2)

3) Add FTE of responders (9.5) and non-responders (3.2) for total FTE = 12.7

Average response rate applied to non-responders

III-28

Estimate Medi-Cal FTE Using Claims Data (Low-Income Designations)

Include all primary care physicians accepting Medi-Cal, even if they are not accepting new patients.

5,000 Claims (fee-for-service) = 1 FTE

For Medi-Cal Managed Care counties, a survey is required to determine each provider’s percent of current caseload of managed care patients.

Source: Dept. of Health Care Services – Health Care Statistical Section

III-29

STEP 4

Calculate the population to provider ratio.

III-30

Population to Provider Ratios

Civilian Population Ratio:Civilian Population = 20,900Primary Care Physician FTE = 3.8

(20,900 / 3.8 = 5,500:1)

Civilian Population (High Needs) Ratio:Civilian Population = 20,900Primary Care Physician FTE = 6.9

(20,900 / 6.9 = 3,029:1) (100% Federal poverty level at 21.1%) 

Low Income Population (200% Poverty) Ratio:Low Income Population = 10,137 (49.47%)PC Physician Serving that Population = 1.6

(10,137 / 1.6 = 6,336:1)

III-31

What to Include in the Population to Provider Ratio Primary Care Section of your Application

Population

Cover letter with summary findings Total adjusted population Source of data and methodology if using source other than Claritas

List of ProvidersInclude the Following for Each Provider: Name Location:

Non-metro areas - name of town Metro areas – complete address with zip code, and CT if available

Degree (M.D. or D.O.) Specialty (GP, FP, OB-GYN, IM, PEDS, Gerontology) Average number of hours per week in direct patient care in the area Inpatient care hours or adjustment to total hours Percentage of practice that is Medicaid (for low-income and Medicaid-eligible designations) Percentage of practice that is Sliding Fee Scale (for low-income designations) FTE total for each provider rounded to the nearest tenth of a percent Description of how information was obtained (sources, methods of gathering data)

Totals and Ratio Total number of providers Total FTE Population to provider ratio Explanation of any high need indicators

III-32

What Not to Include in Your Application

Information on the weather or climate

Information on road conditions, construction, or number of avalanches

Personal statements of driving time

Average number of funerals

History of the early settlers of the area

Newspaper articles

Pictures of the mayor

General information on access issues that is not specific to the area or population

Copies of old applications

III-33

Contiguous Area Resources

III-34

Contiguous Area Resources

Objective:Participants will understand how to identify contiguous areas, determine if they have resources, and if the resources are excessively distant, overutilized, or inaccessible to the population of the area proposed for designation.

Purpose of Contiguous Area Analysis: To identify nearby sources of care and determine if they are inaccessible to the population in the proposed service area

III-35

STEPS

1) Identify the boundaries of eachcontiguous area.

2) Evaluate each area to determine availability of resources.

III-36

1) Identify the Boundaries of Each Contiguous Area

A. Identify on a map the boundaries and population center of the proposed service area.

B. Determine the contiguous areas in all directions within 30 minutes from the proposed area’s population center.

C. Map the boundaries of each contiguous area in all directions (North, East, South, & West).

Boundaries The boundaries of each contiguous area may be based on:

• Travel time (30 minutes)• Socio-economic/demographic

characteristics• Established neighborhoods• Physical barriers• Designated HPSA

The boundaries of contiguous areas are often (not always) based on the same census delineation as the proposed area:

Proposed service area = whole countyContiguous areas = whole counties

Proposed service area = census tracts (MSSA)Contiguous areas = census tracts (MSSA) III-37

2) Determine Availability of Resources

A. Check the HPSA list to determine if any of the contiguous areas are designated as HPSA and therefore considered inaccessible.

If it is not inaccessible HPSA, then

B. Determine if there are significant socio-economic/demographic disparities or physical barriers.

If there are not significant socio-economic/demographic disparities orphysical barriers, then

C. Determine if the contiguous area’s providers are located > 30 minutes away from the population center of the proposed area and are therefore inaccessibledue to excessive distance.

If they are not excessively distant, then

D. Determine if the resources in the contiguous area exceed the population-to-provider ratio and are therefore overutilized.

If they are not overutilized, this area cannot be designated.

(Consider a different kind of designation.)

III-38

Check the HPSA Status of Each Contiguous Area and Determine if This Type of HPSA Is Inaccessible to the Proposed Area

If the proposed service Then the contiguous area area is: is inaccessible if it is a:

Geographic without high needs Geographic HPSA

Geographic with high needs Geographic HPSA, Low-Income HPSA (based on 100% poverty indicator)

Low-Income HPSA Geographic HPSA, Low-Income HPSA

Medicaid Eligible HPSA Geographic, Low-Income, or Medicaid Eligible

Poverty Population HPSA Geographic, Low-Income, Medicaid Eligible or Poverty HPSA

III-39

Determine if Significant Socio-Economic/DemographicDisparities or Physical Barriers Exist

Significant demographic disparities between the population in the service area and the population in the contiguous area result in the population being isolated from nearby resources

(A 30% or more disparity between the population in the service area and the population in the contiguous area)

Significant socio-economic disparities: 100% poverty rate or 200% poverty rate

(A 30% or more disparity between the poverty in the service

area and the poverty in the contiguous area)

Significant physical barrier: mountains, large parks, bodiesof water, highways, railway yards, industrial areas, etc. result in the population being isolated from nearby resources

III-40

Determine if Providers are Excessively Distant

1) Develop a list of providers in the contiguous area 2) Map their office locations 3) Contiguous area will be measured from the same starting point (which is the population center of the proposed area)

Providers > 30 minutes from the population center are excessively distant

Primary Health Care: > 30 minutes

Interstate Roads - 25 miles X 1.2 = 30 minutes Primary Roads - 20 miles X 1.5 = 30 minutes

Secondary Roads - 15 miles X 2.0 = 30 minutes

III-41

Determine if Providers are Excessively Distant (continued)

Inner Portions of Metropolitan Areas:

Distance is based on time using public transportation* during non-rush hour.

Bus routes and schedules must be described (provide narrativedescription and include bus schedule if possible).

Public Transportation can be used only in Inner City/Metro areas for Geographic designations, where the 100% poverty rate is ≥ 20%, or for Population designations regardless of the 100% poverty rate.

III-42

Determine if Contiguous Areas are Overutilized

Calculate FTE - use same method as used for the proposed service area.

If needed, survey providers and determine FTE serving the population. Use same surveying method as used for the proposed service area. If applying for low-income designation, gather Medi-Cal and sliding fee scale percentages to calculate low-income FTE.

Explain how the information was obtained and calculated, and include population, total FTE, and population to provider ratio.

Population to Provider Ratios:

PRIMARY HEALTH CARE: > 2,000:1 primary care physician

III-43

Example

Inner Portions of Metropolitan Areas

ASAPS Map Analysis Looking at a Geographic

Designation for MSSA 78.2aaa

III-44

ASAPS Mapping - we zoom in to the county and keep zooming in to get to the MSSA layer.

III-45

Once we have zoomed into the MSSA layer, then we define the proposed area. The purple area is our proposed RSA (MSSA 78.2aaa – Watts in LA County).

Yellow triangle is the most populated, CT 5414.00

The black polygon is the 5 mile travel distance radius - PC

100% and 200% poverty rateWe have to use ASAPS Population and Poverty level – ASAPS hasthe most recent 2009 Claritas population data. III-46

This is still the same MSSA 78.2aaa in Los Angeles County

On this map we are showing the 5 mile travel distance (black line) and the 30 minute travel distance polygon (green line)

III-47

Since 100% poverty rate is over 20% and this MSSA is in the Inner Portions of Metropolitan Area, we can use public transportation, so everything within and touching the black 5 mile polygon has to be analyzed and is considered a contiguous area. Over 20% applies to Geo designation and for LI designation Inner Portions Metropolitan Area 100% poverty does not have to be over 20%

III-48

Census Tract 5414.00 in MSSA 78.2aaa is the most populated CT. See yellow triangle.

III-49

All the contiguous areas in the black polygon and touching the black polygonmust be analyzed to be consistent with the Federal criteria.

III-50

List of all the contiguous areas and a closer look at the contiguous areas

III-51

On this map I am showing theContiguous areas that are HPSADesignated – but always double check on theHRSA website database for designations

III-52

Inner Portions of Metropolitan Area

(Primary Care HPSA)

Proposed Area: MSSA 78.2aaa – Watts in Los Angeles County: 

Summary: Civilian Pop: 86,197Below 200% Pov: 69.57%

*Below 100% Pov: 39.28% White Pop: 19.11% Black Pop: 32.27% Hispanic Pop: 54.40% 65 year or older Pop: 5.30% Infant Mortality Rate: 6.80

 

*High Need Indicator:100% of Poverty Rate > 20%

III-53

III-54

III-55

Inner Portions of Metropolitan Areas (Contiguous Areas)

Proposed Area: MSSA 78.2aaa – Watts in Los Angeles County

Summary: Civilian Pop: 86,197

Below 200% Pov:

69.91%

Below 100% Pov:

38.48%

White Pop:

19.11%

Black Pop:

32.27%

Hispanic Pop:

66.81%

65 year or older Pop:

5.30%

Infant Mortality Rate:

6.80

Area 3 (E) – MSSA 78.2v – Carson/Compton West/Rancho Dominguez:

There is 30% Socio-Economic disparitySummary: Civilian Pop: 111,759

Below 200% Pov: 31.25%

Below 100% Pov: 11.48%

White Pop: 24.54%

Black Pop: 23.89%

Hispanic Pop: 33.84%

65 year or older Pop: 10.64%

Infant Mortality Rate: 6.31

HPSA: No

78.2v

Also can be ruledout as excessivelydistant

III-56

Defining ASAPS Maps

• Black Polygon around the proposed areais a 5 miles radius for Primary Care and 7 miles radius is for Dental and Mental Health

• Green Polygon around the proposed areais a 30 minutes and 40 minutes is for Dental & Mental Health

• Purple dots you see on the ASAPS map is the provider locations

• Lines going diagonally means that the MSSA is a designated HPSA (\\\\ this means LI) (////// means Geo)

• On some of the Frontier area maps you will see the black Polygon only , which mean the proposed area doesn’t have any contiguous areas

III-57

Defining ASAPS Maps• If using the public transportation in an inner

Metro area for your HPSA designation, you only analyze the areas that are in the black Polygon (5 mile or 7 mile radius ) – this rule applies to Los Angeles, San Francisco, and parts of Fresno, etc. Inner Metro area is defined through ASAPS when creating maps for a particular MSSA. Please call SDP staff when beginning your application process.

• In order to use public transportation, the 100% poverty level must be > 20%.for Geo designation, however for LI designation 100% poverty it does not have to be over 20%

III-58

Determine the Nearest Source of Non-Designated Care

Needed for HPSA score: Cannot be a HPSA (of any type) Cannot have significant socio-economic/demographic differences or physical barriers Can be excessively distant Can be overutilized

For all applications: Provide a road map with the proposed service area and contiguous areas outlined. On the map, indicate the population center of the proposed service area, the nearest

source of care, and the route between these points. Provide the name and address of the nearest source of care, route, miles, and minutes.

For inner portions of metropolitan areas, include:

Bus route information from the population center of the proposed area to the nearest source of care, and

Miles and minutes of travel time

III-59

Time Saving Tips

Survey providers only if necessary:

In contiguous areas, calculate the population to provider ratio counting each provider as 1.0 FTE. If area meets ratio of > 2,000:1, do not survey (Geographic only).

Collect all possible information in one survey (e.g. Medi-Cal and sliding fee scale even for an area designation).

Work with State licensing department to obtain information on providers.

Use claims data for Medicaid FTE (works only in fee-for-service Medicaid).

III-60

What to Include in the Contiguous Area Resources Section of Your Application

Map with Census Delineations

Name and boundaries of proposed service area Name and boundaries of contiguous areas Population center for the proposed service area Helpful: current designation status of each of the contiguous areas

Road Map

Outline of proposed area boundaries Location of nearest source of non-designated care For automobile transportation – a copy of Rand McNally map with

route details For public transportation – start and end points of route

III-61

For Contiguous Areas that are not Excluded with Current Designations and Whose Providers are Excessively Distant

Travel time to closest provider from population center of service area, including miles, route, and type of road; or public transportation information, including bus routes, start/end points, miles, minutes, and source; include bus schedule if available

For Contiguous Areas that are not Excluded with Current Designationsand have Access Barriers

Description of any significant socio-economic/demographic disparities (e.g.,demographic data on racial/ethnic composition or income levels comparingproposed service area population to population in the contiguous area, andsource of data), or

Description of any significant physical barrier

For Contiguous Areas that are not Excluded with Current Designations and are Overutilized

Population to provider ratios, and Description of how information was obtained

What to Include in the Contiguous Area Resources Section of Your Application (continued)

III-62

For All Designation Requests:

For Public Transportation Routes:

Travel time, based on non-rush hour bus schedules Start/End point of route Include time waiting for transfers while in route Map showing proposed area boundaries, start and end points of bus route Bus schedules, if available Cite source of information

(Public Transportation can be used only in Inner City/Metro areas for Geographic designations, where the 100% poverty rate is ≥ 20%, or for Population designations regardless of the 100% poverty rate.)

Address of nearest source of non-designated, accessible care, including address, miles and minutes via public transportation if metropolitan area

Location of nearest source on road map (see above)

What To Include In The Contiguous Area Resources Section of Your Application (continued)

III-63

Examples

Worksheets

III-64

Sample HPSA Worksheets

Inner Portions of a Metropolitan Area

III-65

III-66

III-67

III-68

III-69

III-70

78.2bbb

III-71

Websites

Bay Area Public Transit (San Francisco):http://tripplanner.transit.511.org/mtc/XSLT_TRIP_REQUEST2?language=en

Southern California Public Transit (San Diego):http://www.sdcommute.com/

Los Angeles County Metropolitan Transportation Authority:http://www.metro.net/default.asp

2000 CT Locator:http://www.ffiec.gov/Geocode/default.aspx

U.S. Census Bureau – American Factfinder:http://factfinder.census.gov/home/saff/main.html?_lang=en

III-72

III-73

III-74

III-75

III-76

III-77

III-78

Geographic PC PHYSICIAN SURVEY SAMPLE

III-79

LOW-INCOME PC PHYSICIAN SURVEY SAMPLE

III-80

APPLY FOR DESIGNATION

No ContiguousArea ConditionsMet

1or more Contiguous Area ConditionsMet for EACH Contiguous Area

Evaluate ContiguousArea

STOP:Area Not QualifiedFor Designation

Calculate Population-to-Physician Ratio

Define Rational ServiceArea

Determine Physician FTEs

Determine Service AreaPopulation

Evaluate Service Area for High-Need Indicators

STOP:Area Not QualifiedFor Designation

STOP:Area Not QualifiedFor Designation

No HighNeed IndicatorsPresent

1 or more High-Need IndicatorsPresent

Process Model for Geographic Primary Care Health Professional Shortage Area Designation

To Use: Follow arrows. Numbers are reference citations only. Refer to correspondingly numbered pages following for additional information on steps in numbered boxes

2

3

4 6

9

1

5

9 8

Ratio < 3000

9

Ratio 3000-3499

Evaluate Contiguous Area

5

1 or fewerInsufficientCapacityIndicatorsPresent

2 or moreInsufficientCapacityIndicatorsPresent

1 or more ContiguousArea Conditions Met for EACH ContiguousArea

No ContiguousArea ConditionsMet

STOP:Area Not QualifiedFor Designation

9

APPLY FORDESIGNATION 8

Ratio >3500

Evaluate forInsufficientCapacity

7

III-81