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Video will be taken at this clinic and potentially used in Project ECHO promotional materials. By attending this clinic, you consent to have your photo taken and allow Project ECHO to use this photo and/or video. If you don’t want your photo taken, please let us know. Thank you! ECHO Nevada emphasizes patient privacy and asks participants to not share ANY Protected Health Information during ECHO clinics.

Hea ealth Ca h Care e Sh Shortages es i in N Nevada da

Brian Sandoval Governor Richard Whitley, MS Director Julie Kotchevar, PhD Interim Administrator Vacant Chief Medical Officer

Scott Jones, PhD Manager, Primary Care Office scottjones@health.nv.gov, 775-684-4047 February 5, 2018

Primary Care Office Function

Funded by

Target Federal and State resources to these shortage areas

J-1 Visa Waiver Program

Overcome Shortages or Prevent Worsening of Shortages Identify Health Provider Shortages in Nevada

He Heal alth P Profess ssion

• nal

al Shortag age Area ( a (HP HPSA) A)

• Health Professional Shortage Areas (HPSAs) are

designated by Health Resources Services Administration (HRSA) as having shortages of primary care, dental care,

• r mental health providers
• HPSAs are required to be updated with new data

approximately every 3 years (July 2017 and then 2020) Benefits:

• HPSAs allow health care providers at sites in the areas to

access and be competitive for

$50,000 Loan Repayment for licensed health providers working in an underserved area at an approved site 60% Loan Repayment of nursing educational loans for working at a non- profit critical shortage facility Healthcare sites have reduced paperwork to recruit foreign doctors to practice in underserved area

J-1 Visa Waiver Program

Center for Medicare and Medicaid Services (CMS) physician bonus payment

5 of 8

Heal alth P Prof

• fessi

ssional S Shor

• rtage A

Areas as S Subtypes

Facility: Safety net facility that provides care to underserved populations Population: Sub-population compared to providers that serve that population, e.g.: low-income Geographic: Total population compared to total providers Primary Care, Dental Health, Mental Health

Primary Care HPSAs: Geographic vs Low Income

Dental HPSAs: Geographic vs Low Income

HPSA Designation Process

*Designation data is collected and uploaded into the Shortage Designation Management System †Total civilian noninstitutionalized population obtained from the 2014 ACS 5 Year Census Data (S2701) †Number of infant deaths, number of infant births, and low birth weight births obtained from the CDC Natality file: 2010-2014 †Provider hours, locations and patient percentages of Medicaid and Sliding Fee Scale are self-reported by practice sites on surveys administered by PCO.

Water Fluoridation Infant Health Index MH (Nearest Source of Care)

Data Sources for HPSAs

Direct Provider Surveys by the PCO Federal Data: Medicaid claims data, US Census, CDC, NPI, SAMHSA State Data: DHHS Data Analytics, licensing data local and county data

Shortage Designation Management System (SDMS)

• Online system created by HRSA for states to analyze

and submit applications for HPSAs

SDMS Area Analysis

2016-2017 Update of All Health Professional Shortage Areas

2016 Designations and Poverty Levels Outside

• f Primary Care HPSAs in Clark County

Existing Clark County Primary Care and Proposed HPSA Update Results

HPSA Name Designation Type Current HPSA Score Updated Score Notes Indian Springs HPSA Geographic 14 14 Low Income - Central Las Vegas HPSA Population 18NS Combine with two other projected HPSAs for a score

• f 16

Low Income - East Central Las Vegas HPSA Population 16 16-17Geographic HPSA with score of 16-17 also possible Low Income - Laughlin HPSA Population 16 16Geographic HPSA with score of 16 also possible Low Income - Mesquite HPSA Population 12 16Geographic HPSA with score of 10 also possible Low Income - South Central Las Vegas HPSA Population 10 10 Update of geographic boundaries results in score

• f 16

Low Income - West Central Las Vegas HPSA Population 13 16 Northern Clark Service Area HPSA Geographic 14 14

Mental Health HPSA Designations Possible Updates

Updated 2017 HPSA Designations

Data Support and Collaboration With State Partners

Washoe County Community Health Needs Assessment

• Among total residents in the county, 304,844 or 71.88% of residents were

located within a primary care HPSA in 2017. The increase from previous years is mostly due to a change in the geographic area that was newly designated as primary care HPSA in 2017.

• The primary care physician workforce would need to increase by 157% in

Washoe County to meet the demands of the populations within these HPSAs.

https://www.washoecounty.us/health/files/data-publications-reports/2018-2020%20CHNA_FINAL.pdf

County Total Yearly Paid Medicaid Claims* Medicaid FTE** Population Below 200% Federal Poverty Level (FPL) Medicaid FTE Per 100,000 at 200% FPL Esmeralda 0.00 499 0.00 Eureka 0.00 332 0.00 Storey 0.00 824 0.00 Humboldt 0.00 4888 0.00 Pershing 0.00 1870 0.00 White Pine 36 0.01 2935 0.31 Churchill 475 0.12 8976 1.32 Lyon 1420 0.36 19378 1.83 Lander 182 0.05 1666 2.73 Douglas 1652 0.41 12506 3.30 Lincoln 228 0.06 1413 4.03 Nye 3055 0.76 17964 4.25 Mineral 314 0.08 1817 4.32 Elko 2320 0.58 12503 4.64 Carson City 6595 1.65 19516 8.45 Clark 254252 63.56 748627 8.49 Washoe 67482 16.87 149861 11.26 *Total Yearly Paid Medicaid claims include claims incurred by general and pediatric dentists **One Medicaid Full Time Equivalent (FTE) represents one dentist providing the equivalent of 40 hours of care to Medicaid patients. The Medicaid FTE is calculated by dividing total yearly Medicaid claims by 4000. 4000 equals one Medicaid dental FTE according to federal shortage designation policy.

Using HPSAs for Targeting Federal and State Resources to Areas of Need

National Health Service Corps Loan Repayment Award

Application Cycle Opens Yearly in January Continuation Award Amounts Full-Time Half-Time 3rd year of NHSC Service $20,000 $10,000 4th year of NHSC Service $20,000 $10,000 5th year + of NHSC Service $10,000 $5,000 Initial Award Amounts 2 Years Full-time 4 Years Half-time 2 Years Half-time Sites with HPSA Score of 14+ Up to $50,000 Up to $50,000 Up to $25,000 Sites with HPSA Score of 0-13 Up to $30,000 Up to $30,000 Up to $15,000 With continued service, NHSC providers may be able to pay off all of their student loans.

The NHSC Loan Repayment Program offers two levels of funding, based upon the need of the community in which a provider works, as defined by Health Professional Shortage Area (HPSA) score

NHSC Site Requirements

• Site is in a HPSA
• See all patients regardless of ability to pay
• Offers discounts for uninsured individuals

based on family size and income

• Offer competitive salary and benefits

NHSC Impact on Nevada

The Conrad 30/J-1 Visa Waiver Program

• Internationally trained doctors can work in the United States after training

in return for treating patients for three years in an underserved area Health facility treats all patients regardless of ability to pay and has discounts for low-income patients Health facility treats patients from underserved areas Health facility has tried to recruit a US doctor and not been successful Doctor needs to get a three year contract that protects the doctor and provides a fair wage

Primary Care Office Function

Funded by

Target Federal and State resources to these shortage areas

J-1 Visa Waiver Program

Overcome Shortages or Prevent Worsening of Shortages Identify Health Provider Shortages in Nevada