RHCs - The Basics, Part I TOP |
Slide 1:
RHC Technical Assistance Call
May 10, 2006
Presented By:
Bill Finerfrock
Executive Director
National Association of
Rural Health Clinics
202-543-0348
info@narhc.org
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Slide 2: You are encouraged to download
a copy of the
following document from the NARHC website:
www.narhc.org/uploads/pdf/RHCmanual1.pdf
Visit our homepage to see what else is available:
www.narhc.org
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Slide 3: RHCs The Basics
Rural Health Clinics must be located in
areas that are CURRENTLY designated as
underserved AND an area that is NOT an
urbanized area (as defined by the Bureau of
the Census)
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Slide 4: For purposes of the RHC program,
currently means not more than three years old.
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Slide 5: RHCs The Basics
Urbanized area
(UA) An area consisting of a central place(s) and adjacent
territory with a
general Population density of at least 1,000 people per square
mile of land area that together have a minimum residential
population of at least 50,000 people.
The Census Bureau uses published criteria to determine the
qualification and boundaries of UAs. A densely settled area
that has a census population of at least 50,000. At least
35,000 people in an urbanized area (UA)a must live in territory
that is not part of one or more military reservations, or
it is classified as an urban cluster. A UA generally consists
of a geographic core of block groups or blocks that have a
population density of at least 1,000 people per square mile,
and adjacent block groups and blocks with at least 500 people
per square mile. A UA may consist of all or part of one or
more incorporated places and/or census designated places,
and may include area adjacent to the place(s).
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Slide 6: RHCs
The Basics
To qualify for RHC status, a clinic must be LOCATED in a
federally designated shortage area:
- Health Professional Shortage Area Population or Geographic; OR
- Medically Underserved Area (Geographic only); OR
- Area designated by the Governor as Underserved for purposes of establishing an RHC
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Slide 7: RHCs
The Basics
How do I find out if my community is
underserved AND in a non-urbanized area?
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Slide 8: RHCs
The Basics
Urbanized Area
Contact the Census Bureau
www.census.gov/geo/www/ua/ua_2k.html
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Slide 9: Census 2000 Urban and Rural Classification
Welcome to the U.S. Census Bureau's Urban
and Rural Classification
Web page. At this site you will be able to locate information
about the
Census 2000 urban and rural delineations and to review the
criteria the
Census Bureau used to delineate urban and rural areas based
on the
results of Census 2000.
The Census Bureau identifies and tabulates data for the urban
and rural
populations and their associated areas solely for the presentation
and
comparison of census statistical data. If a federal, state,
local, or tribal agency uses these urban and rural criteria
in a nonstatistical program, it is that agency's responsibility
to ensure that the results are appropriate for such use. It
also is that agency's responsibility to ensure that it has
provided the necessary tools for use in that agency's programs.
The Census Bureau will be glad to answer questions about
the Census 2000 urban and rural criteria and products. However,
the Census Bureau is not qualified to provide information
or assistance to users concerning the uses of urban and/or
rural data in the programs of other agencies, nor does it
have the resources to perform research to determine whether
or not a locality or specific address is inside or outside
an urbanized area or urban cluster.
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Slide 10: Locating Urbanized Area and Urban
Cluster Boundaries
Information about products, including TIGER/Line files, boundary
files and maps, available to assist data users in locating
Urbanized Area and Urban Cluster boundaries.
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Slide 11: RHCs The Basics
www.census.gov/geo/www/ua/uaucbndy.html
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Slide 12: Locating Urbanized area and Urban
Cluster Boundaries
There are several products available to assist data users
in locating
Urbanized Area and Urban Cluster boundaries. The Census Bureau
will be glad to answer questions about the products listed
below.
However, the Census Bureau does not have the resources to
perform
research to determine whether or not a locality or specific
address is
inside or outside an urbanized area or urban cluster.
American FactFinder online mapping and data dissemination
tool.
This application shows the uncorrected UA and UC boundaries
as
reported in the May 1, 2002 Federal Register notice, and do
not reflect
those that were reported in the August 23, 2002 or November
20, 2002
Federal Register notices. Data are available for the uncorrected
Urbanized Areas and Urban Clusters in Census 2000 Summary
File 3
and in the Final National Census 2000 SF1. Use the Reference
Maps
feature to display the boundaries for these uncorrected entities.
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Slide 13: Urban Area Maps (Census 2000)
These maps illustrate the uncorrected boundaries and extent
of the
Census 2000 UAs and UCs. These maps are available in PDF format
for viewing and downloading from the Census Bureau's Map Products
Web page. These maps represent the UAs and UCs as reported
in the
May 1, 2002 Federal Register and do not reflect the corrections
that
were reported in the August 23, 2002 or November 20, 2002
Federal
Register notices. (The Census Bureau will produce corrected
maps for
affected urban areas at a later date.) Paper copies of these
maps are
available for purchase from the Census Bureau's Customer Service
Center (301-763-4636).
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Slide 14: RHCs The Basics
Image:
Map of the United States with Urban Areas highlighted
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Slide 15: RHCs The Basics
Image:
Map of North Dakota with Urban Areas highlighted
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Slide 16: RHCs
The Basics
Image:
Detail Map of North Dakota with Urban Areas highlighted
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Slide 17: RHCs
The Basics
Image:
Detail Map of Fargo, North Dakota with Urban Areas highlighted.
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Slide 18: Lists of Urbanized Areas and
Urban Clusters
The Census Bureau has prepared the following four files that
list the Census 2000 UAs and UCs, their populations, population
densities (square miles) and land area measurements (in square
meters):
- Alphabetically-sorted list of UAs
- Alphabetically-sorted list of UCs
- State-sorted list of UAs that shows the portion of the UA's population within the specified state for UAs that extend into two or more states
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Slide 19: RHCs The Basics
North
Dakota
- Bismarck, ND
- Fargo, ND--MN 106577(PT)
- Grand Forks, ND--MN 49229(PT)
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Slide 20: RHCs
The Basics
Shortage Area Designations
- Health Professional Shortage Area; OR
- Medically Underserved Area; OR
- Governor's designated Area
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Slide 21: RHCs
The Basics
Health Professional Shortage Areas (HPSA)_
Area can be either a geographic HPSA OR
a population HPSA designation.
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Slide 22: Geographic
HPSA
Part I -- Geographic Areas
A geographic area will be designated as having a shortage
of primary
medical care professionals if the following three criteria
are met:
1. The area is a rational area for the delivery of primary
medical care services.
2. One of the following conditions prevails within the area:
(a) The area has a population to full-time-equivalent primary
care physician ratio of at least 3,500:1.
(b) The area has a population to full-time-equivalent primary
care physician ratio of less than 3,500:1 but greater than
3,000:1 and has unusually high needs for primary care services
or insufficient capacity of existing primary care providers.
3. Primary medical care professionals in contiguous areas
are
overutilized, excessively distant, or inaccessible to the
population of
the area under consideration.
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Slide 23: Rational Areas for the Delivery
of Primary Medical
Care Services.
A county, or a group of contiguous counties
whose population centers are within 30
minutes travel time of each other.
The following areas will be considered rational areas for
the delivery of primary medical care services:
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Slide 24:
(ii)
A portion of a county, or an area made up of portions of more
than one county, whose population, because of topography,
market or transportation patterns, distinctive population
characteristics or other factors, has limited access to contiguous
area resources, as measured generally by a travel time greater
than 30 minutes to such resources.
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Slide 25:
(iii) Established neighborhoods and communities within metropolitan
areas which display a strong self-identity (as indicated by
a homogeneous socioeconomic or demographic structure and/or
a tradition of interaction or interdependency), have limited
interaction with contiguous areas, and which, in general,
have a minimum population of 20,000.
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Slide 26:
The
following distances will be used as guidelines in determining
distances corresponding to 30 minutes travel time:
- Under normal conditions with primary roads available: 20 miles.
- In mountainous terrain or in areas with only secondary roads available: 15 miles.
- In flat terrain or in areas connected by interstate highways: 25 miles
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Slide 27:
The population count used will be the total permanent resident
civilian population of the area, excluding inmates of institutions
with the following adjustments, where appropriate:
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Slide 28:
Seasonal residents, i.e., those who maintain a residence
in the area but inhabit it for only 2 to 8 months per year,
may be included but must be weighted in proportion to the
fraction of the year they are present in the
area.
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Slide 29:
Other tourists (non-resident) may be included in an area's
population but only with a weight of 0.25, using the following
formula: Effective tourist contribution to population = 0.25
x (fraction of year tourists are present in area) x (average
daily number of tourists during portion of year that ourists
are present).
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Slide 30:
Migratory workers and their families may be included in an
area's population, using the following formula: Effective
migrant contribution to population = (fraction of year migrants
are present in area) x (average
daily number of migrants during portion of year that migrants
are present).
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Slide 31: Counting of Primary Care
Practitioners
All non-Federal doctors of medicine (M.D.) and doctors of
osteopathy (D.O.) providing direct patient care who practice
principally in one of the four primary care specialities --
general or family practice, general internal
medicine, pediatrics, and obstetrics and gynecology -- will
be counted.
Those physicians engaged solely in administration, research,
and teaching will be excluded. Adjustments for the following
factors will be made in computing the number of full-time-equivalent
(FTE) primary care physicians:
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Slide 32:
- Interns and residents will be counted as 0.1 full time equivalent (FTE) physicians.
- Graduates of foreign medical schools who are not citizens or lawful permanent residents of the United States will be excluded from physician counts.
- Those graduates of foreign medical schools who are citizens or lawful permanent residents of the United States, but do not have unrestricted licenses to practice medicine, will be counted as 0.5 FTE physicians.
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Slide 33:
Practitioners who are semi-retired, who operate a reduced
practice due to infirmity or other limiting conditions, or
who provide patient care services to the residents of the
area only on a part-time basis will be discounted through
the use of full-time equivalency figures.
A 40-hour work week will be used as the standard for determining
full-time equivalents in these cases. For practitioners working
less than a 40-hour week, every four (4) hours (or 1/2 day)
spent providing patient care, in either ambulatory or inpatient
settings, will be counted as 0.1 FTE (with numbers obtained
for FTE's rounded to the nearest 0.1 FTE), and each physician
providing patient care 40 or more hours a week will be counted
as 1.0 FTE physician. (For cases where data are available
only for the number of hours providing patient care in office
settings, equivalencies will be provided in guidelines.)
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Slide 34:
In some cases, physicians located within an area may not
be accessible to the population of the area under consideration.
Allowances for physicians with restricted practices can be
made, on a case-by-case basis.
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Slide 35: Part
II -- Population Groups
In general, specific population groups within particular
geographic areas will be designated as having a shortage of
primary medical care professional(s) if the criteria are met.
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Slide 36:
Access barriers prevent the population group from use of
the area's primary medical care providers. Such barriers
may be economic, linguistic, cultural, or architectural, or
could involve refusal of some providers to accept certain
types of patients or to accept Medicaid
reimbursement.
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Slide 37: MUA Designation
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Slide 38:
This involves application of the Index of Medical Underservice
(IMU) to data on a service area to obtain a score for the
area. The IMU scale is from 0 to 100, where 0 represents
completely underserved and 100 represents best served or least
underserved. Under the established criteria, each service
area found to have an IMU of 62.0 or less qualifies for designation
as an MUA.
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Slide 39: The
IMU involves four variables -
- ratio of primary medical care physicians per 1,000 population,
- infant mortality rate,
- percentage of the population with incomes below the poverty level, and
- percentage of the population age 65 or over.
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Slide 40: Definition
of the service area being requested for designation. These
may be defined in terms of:
- a whole county (in non metropolitan areas);
- groups of contiguous counties, minor civil divisions (MCDs), or census county divisions (CCDs) in non metropolitan areas, with population centers within 30 minutes travel time of each other
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Slide 41: The latest available data on:
- the resident civilian, non institutional population of the service area (aggregated from individual county, MCD/CCD or C.T. population data)
- the percent of the service area's population with incomes below the poverty level
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Slide 42:
- the percent of the service area's population age 65 and over
- the infant mortality rate (IMR) for the service area, or for the county or subcounty area which includes it. The latest five year average should be used to ensure statistical significance.
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Slide 43:
- The current number of full time equivalent (FTE) primary care physicians providing patient care in the service area, and their locations of practice.
- Patient care includes seeing patients in the office, on hospital rounds and in other settings, and activities such as laboratory tests and X rays and consulting with other physicians.
- To develop a comprehensive list of primary care physicians in an area, an applicant should check State and local physician licensure lists, State and local medical society directories, local hospital admitting physician listings, Medicaid and Medicare provider lists, and the local yellow pages.
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Slide 44:
There are charts which assign a IMU score for each of the
categories mentioned above.
For example, a service area with an infant mortality rate
of between 12.1 - 13.0 equates to an IMU score of 22.4. A
service area with a percentage of population over 65 of between
10.1 - 11.0 gets an IMU score of 19.6
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Slide 45:
To determine your overall score, add the individual score
for each category and you get the total IMU.
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Slide 46: Were Underserved Wyoming
% of Population in Poverty |
25.0 |
|
IMU Score |
|
10.9 |
% of population over age 65 |
20.5 |
|
IMU Score |
|
9.8 |
Infant Mortality Rate |
15.0 |
|
IMU Score |
|
20.5 |
Primary Care Physician/Pop |
0.5 |
|
IMU Score |
|
14.8 |
Total IMU |
|
56.0 |
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Slide 47:
Based upon an IMU score of 56, Were Underserved Wyoming
would qualify as a Medically Underserved Area
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Slide 48: Questions
Bill Finerfrock
Executive Director
NARHC
info@narhc.org
www.narhc.org
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