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: ≥ 3,500:1

A rational service area: county or sub-county (MSSA)

Geographic Area w/Unusually High Needs: ≥ 3,000:1

A 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; orc) 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: 2010 U.S. Census and 5-year American Community Survey Population Estimates.

Migrant Farmworkers

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

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

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.)

HomelessLocal data (must include methodology)

III-5Note: cannot add any of the above to Mental Health

Can

ad

d

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: 2006-2010 5-year ACS Population Estimates

Can add:

a) Migrant Farmworkers

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

b) Homeless Local data (must include methodology).

III-6

Migrant Farmworkers

200% Poverty Pop Migrant Farm Workers

Modoc 98 2460 394

Pop 200%Poverty Total 4164

200% population for proposed area 2460

2460 / 4164 = 59.07%

Migrant Farm Workers 394

394 * 59.07% = 233

Percentage of MFW for the year

MFW Season in / 12 4.5 / 12 =

37.5%

Total MFW for MSSA 37.5% * 233 = 87

Total 200% population for entire county This number is the 200% population for the proposed area This number is the migrant farm workers in the county of your proposed area This is the number of months per season for your county MFW added to 100% Civilian Population

Proposed Area Modoc 98

III-7

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-8

B. Population Designations (continued)

III-9

MIGRANT AND SEASONAL FARMWORKER

ENUMERATION PROFILES STUDY

CALIFORNIA

FINAL

prepared for the

Migrant Health ProgramBureau of Primary Health CareHealth Resources and Services Administration

by

Alice 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-10

III-11

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 1,670,532NOTE: County numbers have been rounded and, therefore, may not add to totals.

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

IdentifyIdentify all primary care all primary care physiciansphysicians in in the area to be designated.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

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. 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 within six months, but are still seeing patients

Include in Survey but reduce FTE to zero

III-16

Include 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-17

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

www.vitals.com

http://www.healthgrades.com/

Sources of Provider Data

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

III-18

https://www.breeze.ca.gov/

STEP 2

Determine the Determine the numbernumber of of hourshours each each primary care physician works in direct primary care physician works in direct patient care (office and hospitalpatient care (office and hospitalinpatient) serving the population to be inpatient) serving the population to be designated.designated.

III-19

Designation Types and Whom to Include in the

Provider Count

COUNT ALL PRIMARY CAREPROVIDERS WHO SERVE ALL PERSONS:

Geographic in the service area

Low-Income Population in the service area that have incomes

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

DESIGNATION TYPE:

III-20

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 Time

Administration

Total Physicians: 5

III-21

STEP 3

Calculate the Calculate the FTEFTE for each primary for each primary care physician serving the care physician serving the populationpopulation to be designated.to be designated.

III-22

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 Total 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-23

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-24

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 Place

City, CA 90001

CT 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-25

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 used

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

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 Left off

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-27

STEP 4

Calculate the population to providerCalculate the population to provider ratio. ratio.

III-28

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-29

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-30

Contiguous Area ResourcesContiguous Area Resources

III-31

Contiguous Area ResourcesContiguous 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-32

STEPS

1) Identify the boundaries of eachcontiguous area.

2) Evaluate each area to determine availability of resources.

III-33

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).

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-34

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-35

A. 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 > 20%)

Low-Income HPSA Geographic HPSA, Low-Income HPSA

III-36

B. 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 2 * N or plus 15% for percentages below 15 to determine 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 2 * N or plus 15% for percentages below 15 to determine

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-37

B. Determine if Significant Socio-Economic/DemographicDisparities or Physical Barriers Exist (continued)

Rule of Thumb: 2 * N with poverty or plus 15% for percentagesbelow 15.

Examples:

Note: Using the lower number between proposed areas and contiguous areas for calculating disparity is suggested.

III-38

Proposed Area: MSSA 78.2b – Pico-Union in Los Angeles County

Summary: Civilian Pop: 146,918

Below 200% Pov:

68.95%

Below 100% Pov:

33.76%

White Pop:

33.21%

Black Pop: 6.23%

Hispanic Pop:

70.11%

MSSA 78.2v – Carson/Compton West/RanchoDominguez:

2* 29.40= 58.8%, is there a disparity here?

Summary: Civilian Pop: 106,413

Below 200% Pov: 29.40%

Below 100% Pov: 9.75%

White Pop: 24.24%

Black Pop: 21.80%

Hispanic Pop: 40.19%

HPSA: NoIf looking at the 100% pov., 9.75+15=24.75%, is there a disparity there?

C. 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-39

Service Area Travel CalculationPrimary Health Care

Interstate Roads: 25 miles X 1.2 = 30 minutes

Primary Roads (include surface streets): 20 miles X 1.5 = 30 minutes

Secondary Roads (mountainous terrain or unpaved road): 15 miles X 2.0 = 30 minutes

Dental and Mental Health Care

Interstate Roads: 30 miles X 1.33 = 40 minutes

Primary Roads (include surface streets): 25 miles X 1.6 = 40 minutes

Secondary Roads (mountainous terrain or unpaved road) 20 miles X 2.0 = 40 minutes

III-40

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.

If the MSSA doesn’t meet this requirement the next step is to show that there is a 30% or greater public transportation ridership use in the MSSA and Provide documentation to back up the claim.

III-41

D. 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.

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).

Population to Provider Ratio: PRIMARY HEALTH CARE: > 2,000:1 primary care physician

III-42

Determine the Nearest Source of Non-Designated Care

Needed for HPSA score:

Geographic Designation: Can be in a Low-Income HPSA Population Designation: 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, phone number, specialty, 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 including miles and minutes of travel time.

For population center info: http://oshpd.ca.gov/HWDD/MSSA/index.html

III-43

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.

III-44

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 Google map with

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

III-45

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.

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-46

For All Designation Requests:

For Public Transportation Routes:

Travel time, based on non-rush hour bus schedules (i.e. 10:00 am) 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 Provide 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-47

Websites

California Public Transit Information and Maps:http://maps.google.com

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

U.S. Census Bureau – American Factfinder

http://factfinder2.census.gov/faces/nav/jsf/pages/index.xhtml

MSSA Data:

http://oshpd.ca.gov/HWDD/MSSA/index.html

III-48

III-49

III-50

III-51

III-52

III-53

III-54

Geographic PC PHYSICIAN SURVEY SAMPLE

III-55

LOW-INCOME PC PHYSICIAN SURVEY SAMPLE

III-56

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 DesignationProcess 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 FORDESIGNATION8

Ratio >3500

Evaluate forInsufficientCapacity

7

III-57