Measuring the Potential Impact of Health Reform on the Primary Care Workforce
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Health Reform on the Primary Care Workforce Session 3141: Health Administration Roundtable I - Workforce Issues Yvette Mendez, MPA The Rhode Island Foundation Cindy J Wong, PhD Research & Evaluation Consultant American Public Health Association (APHA) 141 st Annual Meeting Boston, MA Monday, November 4, 2013 10:30 am-12:00 pm BCEC 255
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Measuring the Potential Impact of Health Reform
on the Primary Care WorkforceSession 3141: Health Administration Roundtable I -
Workforce Issues
Yvette Mendez, MPA The Rhode Island Foundation
Cindy J Wong, PhDResearch & Evaluation Consultant
American Public Health Association (APHA) 141st Annual Meeting
Boston, MA
Monday, November 4, 201310:30 am-12:00 pm
BCEC 255
Measuring the Potential Impact of Health Reform
on the Primary Care WorkforceOverview: The Affordable Care Act (ACA) is expected to substantially raise the numbers of Americans with health insurance across the country. Primary care provider (PCP) shortages are predicted to intensify as a result of the national health reform. To measure the ACA's potential impact on the primary care workforce in Rhode Island, a situational analysis was completed. This presentation will discuss current statewide workforce initiatives and the results of the analysis. Our research questions were: How many PCPs are active in Rhode Island? How many are needed? What is the potential impact of health reform on the primary care workforce?
Learning Objectives: Identify data sources for health workforce study; Analyze potential impact of ACA on primary care workforce in states and counties
Measuring the Potential Impact of Health Reform
on the Primary Care Workforce
“The experiences of other industrialized countries show that ensuring access to primary care – one of the goals of U.S. health reform – can provide the groundwork for efforts to improve overall care and population health while also controlling costs. ”
- Robert L. Phillips, Jr., M.D., M.S.P.H., in the Journal of the American Board of Family Medicine
Measuring the Potential Impact of Health Reform
on the Primary Care Workforce
Primary care is essential in building a robust health care system that contributes to:
• Lowered costs• Improvements in quality• Expanded access to care
Measuring the Potential Impact of Health Reform
on the Primary Care WorkforceHealth Reform – Affordable Care Act
(ACA)
• Increase the Number of Americans with Health Insurance• Increase the Demand for Primary Care
Services• Lead to Shortages in Primary Care
Workforce (?)
Measuring the Potential Impact of Health Reform
on the Primary Care WorkforceThe Robert Wood Johnson Foundation & Urban Institute estimate:• 27.8 million nonelderly adults will enroll
in health insurance in the U.S. • The national uninsurance rate will fall
from 18.6 to 8.3%• The greatest decline will be in the lowest-
income populations
Source: The Robert Wood Johnson Foundation/Urban Institute 2010
Measuring the Potential Impact of Health Reform
on the Primary Care WorkforceResearch Questions - The Rhode
Island Foundation
• How many primary care providers are practicing in Rhode Island per 100,000 population?• How many are needed?
• What impact will the health care reform have on the primary care workforce?
Measuring the Potential Impact of Health Reform
on the Primary Care WorkforceHow many Primary Care Providers are in Rhode Island? 2011 # Primary Care
Providers (PCPs)Census
Population2011
PCPs per 100,000 population
Rhode Island 1,233 1,051,302 117.3 Bristol County 89 49,800 178.7 Kent County 155 165,535 93.6 Newport County 79 82,695 95.5 Providence County 772 626,709 123.2 Washington County 138 126,563 109.0
Source: Health Resources and Services Administration (HRSA), Area Health Resource File 2012-2013 (AHRF) http://arf.hrsa.gov/. Notes: The most recent AHRF (2012-2013) reports 2011 primary care provider figures. AHRF includes the following health professions under primary care: medical doctors (MD), doctors of osteopathic medicine (DO), and physician assistants (PA). The primary care providers in the table includes the total number of: non-federal, non-resident MDs and DOs, and active physician’s assistants. The calculation excludes: physician/MD/DO hospital residents and inactive physician assistants. The AHRF does not include nurse practitioner data in primary care providers. The ratio per 100,000 is calculated using 2011 U.S. Census population estimate for RI accessed from the same file (AHRF 2012-2013).
Measuring the Potential Impact of Health Reform
on the Primary Care WorkforceHow many Primary Care Providers are needed?
Selected Benchmarks• HRSA Health Professional Shortage Area (HPSA)
designation = 50 primary care providers per 100,000 population• Council on Graduate Medical Education (COGME)
federal advisory committee recommendation = 60 to 80 providers per 100,000 population
Sources: Health Resources and Services Administration: Primary Medical Care HPSA Designation Overview http://bhpr.hrsa.gov/. Council on Graduate Medical Education. (1996, November). Patient Care Physician Supply and Requirements: Testing COGME Recommendations http://www.hrsa.gov/advisorycommittees/bhpradvisory/cogme/.
Measuring the Potential Impact of Health Reform
on the Primary Care WorkforceRI Primary Care Providers (MD/DO/PA) per 100,000 with HRSA Benchmark (2010-2011)
RHODE ISLAND Bristol County Kent County Newport County Providence County
Washington County
020406080
100120140160180200
111.6
174.4
92.1 89.3
113.1 119.7117.3
178.7
93.6 95.5
123.2109.0
20102011
Sources: Health Resources and Services Administration (HRSA), Area Resource File 2011-2012 (ARF) and Area Health Resource File 2012-2013 (AHRF) http://arf.hrsa.gov
HRSA Primary Care Health Professional Shortage Area: < 50 PCPs per 100,000 population
Measuring the Potential Impact of Health Reform
on the Primary Care Workforce
RHODE ISLAND Bristol County Kent County Newport County Providence County
Washington County
020406080
100120140160180200
89.6
166.4
72.282.0
87.896.192.4
174.7
71.388.3 91.4 94.8
Primary Care Physicians (MD & DO only ) to 100,000 Population with COGME Benchmark
(2010-2011)20102011
Sources: Health Resources and Services Administration (HRSA), Area Resource File 2011-2012 (ARF) and Area Health Resource File 2012-2013 (AHRF) http://arf.hrsa.gov
COGME Adequate PCP Benchmark: 60-80 PCPs per 100,000 population
Measuring the Potential Impact of Health Reform
on the Primary Care WorkforceHRSA-Designated Primary Care Health Professional Shortage Areas 2013
Bristol County: No HPSAs Providence County:Kent County: No HPSAs • Rhode Island Adult Correctional
InstitutionNewport County: • Thundermist Healthcare• East Bay Community Action
Program• Blackstone Valley Community
HealthcareWashington County: • Providence Community Health
Center• Bayside Family Healthcare, Inc. • Northwest Community Health
Center• Wood River Health Services • Chad Brown Health Center• Narrangansett Indian Tribe Health
Program• Tri-Town Community Action
ProgramProvidence County: • Comprehensive Community
Action, Inc.• Woonsocket City• Providence City• Central Falls City• Pawtucket City
Source: Health Resources and Services Administration: Shortage Designation: Health Professional Shortage Areas & Medically Underserved Areas/Populations Retrieved 10/31/2013 from http://bhpr.hrsa.gov/shortage/index.html
Measuring the Potential Impact of Health Reform
on the Primary Care WorkforceWhat is the potential impact of the
Affordable Care Act (ACA) on the PCP workforce in Rhode Island?
• 125,029 persons < 65 without health insurance (2012)
• 14.3% Uninsurance Rate Statewide (2012)
• 15.7% Uninsurance Rate Providence County (2009)
• 70% of Rhode Island’s total uninsured population resides in Providence County
Sources: The Economic Progress Institute (2013 Sept) Press Release: 125,000 Rhode Islanders under Age 65 Lacked Health Insurance in 2012. http://www.economicprogressri.org. Health Resources and Services Administration (HRSA), Area Health Resource File 2012-2013 (AHRF) http://arf.hrsa.gov/.
Measuring the Potential Impact of Health Reform
on the Primary Care WorkforceRhode Island Uninsurance Rates & PCPs Needed per Uninsured Population
Gaining Coverage under ACAPersons < 65 without
Health Insurance
(2012)
< 65 Uninsurance
Rate (2012)
Rhode Islanders
Newly Eligible for Coverage
via ACA Medicaid Expansion
Rhode Islanders
Newly Eligible for Coverage
via RI Healthcare Exchange
Total Rhode Islanders
Newly Eligible for Coverage
Under ACA
Rhode Island Statewide
125,029 14.3% 45,000 44,000 89,000
PCPs needed for Rhode Islanders who are newly eligible for health insurance coverage under ACA‡
27.0 - 36.0 26.4 - 35.2 53.4 - 71.2
Sources: The Economic Progress Institute (2013 Sept) Press Release: 125,000 Rhode Islanders under Age 65 Lacked Health Insurance in 2012. http://www.economicprogressri.org. Council on Graduate Medical Education (1996), Patient Care Physician Supply and Requirements: Testing COGME Recommendations. ‡ The number of PCPs needed is calculated using COGME benchmark of 60-80 PCPs per 100,000 and the estimated number of uninsured Rhode Islanders who will gain eligibility for coverage, as reported by The Economic Progress Institute.
Measuring the Potential Impact of Health Reform
on the Primary Care Workforce1 in 4 Rhode Island physicians will reach retirement age in the next 5 years:
25%Age 60+ years
Total Active Physicians in Rhode Island (2010) = 3,500
Active Physicians near Retirement Age (60+ yrs) = 825Source: Association of American Medical Colleges, 2011 State Physician
Workforce Book: Rhode Island Physician Workforce Profile https://www.aamc.org/download/152172/data/rhode_island.pdf
Measuring the Potential Impact of Health Reform
on the Primary Care WorkforcePrimary Care – Provider Workforce• Take into account retirement rates on local
and state levels, and replacement with new primary care providers• Recruitment of medical students to primary
care practice• Future innovations in health delivery – how to
assess the potential in increasing primary care workforce capacity• Inclusion of other qualified professionals (e.g.
nurse practitioners) in increasing primary care workforce capacity
Measuring the Potential Impact of Health Reform
on the Primary Care WorkforcePrimary Care – Population Needs• Consider access to and distribution of
providers by locality, insurance, and institution **How many primary care providers accept Medicaid ?**• Medically underserved communities that
already have unmet needs for primary care - will have even greater needs for primary care under ACA• Communities with growing and aging
populations (in the general population and among physicians) - will have increasing demands for primary care services
Measuring the Potential Impact of Health Reform
on the Primary Care WorkforceClosing Remarks
• Difficult to predict the precise impact of ACA in 2014 due to different reasons:
• Limitations in data & the analytic model• Uncertainty in future politics and legislation
• However, with increasing availability of online primary source trending data (e.g. AHRF/ARF) as well as census population, and benchmarks (e.g. HPSA/COGME)• We have tools to continue to assess
workforce issues, evaluate the trends, and to plan and leverage resources in the changing health policy landscape
Measuring the Potential Impact of Health Reform
on the Primary Care WorkforceThis presentation is based on: Working Paper: Rhode Island Primary Care Providers - Implications of Health Reform (Fall 2012)
Prepared for The Rhode Island Foundation by:
Cindy Wong, PhD, Research & Evaluation [email protected](831) 531-2661
Measuring the Potential Impact of Health Reform
on the Primary Care WorkforceData Sources:
• COGME Benchmark for Adequacy of Primary Care Providers: Council on Graduate Medical Education. (1996, November). Patient Care Physician Supply and Requirements: Testing COGME Recommendations http://www.hrsa.gov/advisorycommittees/bhpradvisory/cogme/Reports/eighthreport.html
• HRSA Benchmark for Primary Care Health Professional Shortage Area: Health Resources and Services Administration: Primary Medical Care HPSA Designation Overview http://bhpr.hrsa.gov/shortage/hpsas/designationcriteria/primarycarehpsaoverview.html
• Primary Care Health Professional Shortage Areas (Localities& Facilities): Health Resources and Services Administration: Shortage Designation: Health Professional Shortage Areas & Medically Underserved Areas/Populations http://www.hrsa.gov/shortage/find.html
Measuring the Potential Impact of Health Reform
on the Primary Care WorkforceData Sources (continued):
• Primary Care Providers; Census Populations (States & Counties): Health Resources and Services Administration (HRSA): Area Health Resource File 2012-2013 (AHRF) and Area Resource File 2011-2012. http://arf.hrsa.gov/
• Primary Care Physicians Workforce (States): Association of American Medical Colleges (AAMC): 2011 State Physician Workforce Data Book https://www.aamc.org/download/263512/data
• Rhode Islander Uninsurance Rates 2012 & Anticipated Number of Newly Eligible Under ACA: The Economic Progress Institute (2013 Sept) Press Release: 125,000 Rhode Islanders under Age 65 Lacked Health Insurance in 2012. http://www.economicprogressri.org.
• Infographic in Handout: Doctor by Andrew McKinley from The Noun Project. http://thenounproject.com.
Measuring the Potential Impact of Health Reform
on the Primary Care Workforce
Contact Information:
Yvette Mendez, MPAThe Rhode Island Foundation
One Union StationProvidence, RI 02903
(401) [email protected]
Cindy J Wong, PhDResearch and Evaluation
Consultant7960 Soquel Drive, B145
Aptos, CA 95003(831) 531-2661
