Shortage designations
Identifying healthcare shortages
Shortage designations are used to improve access to primary care, dental, and mental health providers. PCRH collaborates with communities and healthcare facilities to designate shortage areas so that resources can be allocated to those locations. The information below describes different types of shortages.
Health Professional Shortage Areas (HPSAs):
A HPSA is an area that has been determined to have too few primary care, dental care, and/or mental health care providers to meet the needs of the population. The Utah Primary Care Office (PCO) assesses the primary care and workforce needs of the state and submits applications to the Health Resources and Services Administration, Shortage Designation Branch, for specific areas to be designated as HPSAs.
HPSA Types:
Geographic: a high population to provider ratio in a rational, geographic area, or lower ration within a high need demonstrated by specific health indicators.
Population: a large percentage of a specific, high-risk population group (e.g. low-income, homeless, etc.) within a geographic area and a high population to provider ratio.
Facility: a public or private non-profit facility that serves high needs populations (e.g. correctional facility, federally qualified health centers, and state mental hospitals).
Benefits of HPSA designation
A HPSA designation allows resources to be prioritized to the areas of highest need in order to address healthcare and workforce needs in those areas. Many state and federal programs rely on HPSA designations.
- National Health Service Corps (NHSC): NHSC administers student loan repayment and scholarship programs to healthcare providers who work in federally designated HPSAs. Learn more about Utah's loan repayment programs.
- Conrad State 30/J-1 Visa Waiver Program: this allows foreign physicians to waive the requirement of returning to their home country for two years upon completing their residency. A physician needs to be working in a HPSA or a facility that serves patients living within a HPSA to qualify. Learn more about Utah's physician immigration options.
- Medicare Bonus Payment: if a facility is located in a geographic HPSA, Medicare will pay a ten percent bonus for all services provided by physicians to Medicare beneficiaries.
- Rural Health Clinic (RHC) Certification: a facility in a rural, designated shortage area can be certified as an RHC. The Center for Medicare and Medicaid Services will provide financial incentives for all eligible providers in RHCs. Learn more about Utah's Rural Health Clinics.
HPSA designation methodology
Rational Service Area (RSA):
The first step to creating a HPSA is to determine the area the HPSA will encompass, called a rational service area (RSA). The RSA can be either a partial county, an entire county, or multiple counties; however, it must have a population less than 250,000. The RSA is selected based on a geographic area and/or the demographics of the area. Justification for the rationality of the area is required. The RSA is then analyzed to determine if it meets the minimum population to provider ratio. If it does, the system automatically selects a population center. From the population center, the furthest distance someone could travel in a given amount of time is determined, based on road accessibility and terrain. This is called the travel polygon. The amount of time assigned varies based on the HPSA discipline* (i.e. primary care, dental, or mental health).
Contiguous Areas (CA):
A contiguous area (CA) is any area that is not part of the RSA, but is within the travel polygon. Each CA is evaluated based on demographics and providers in the area to determine if services in that area would be accessible to people residing in the RSA.
Nearest Source of Care (NSC):
After all of the CAs have been analyzed, the nearest source of care (NSC), is designated. The NSC is the closest provider to the population center, outside the RSA, that is accessible to the population of the RSA. Accessibility is determined by population to provider ratio, in the CA the NSC is located in, and whether or not they serve underserved patients.
HPSA Scoring:
Once all of the components of the HPSA have been analyzed, a score is then assigned, indicating the degree of the shortage. Several factors are considered when assigning the score: the population to provider ratio, the percent of the population at or below 100% of the federal poverty level, travel time to the NSC, and other factors that vary based on HPSA discipline*. A higher score means a higher degree of shortage, and higher priority for federal resources to help address the issue.
Final Steps:
Once all of these steps have been completed, the PCO submits a request to HRSA for approval as an official shortage designation. Upon approval from HRSA, the designation is official and HPSA benefits are then available.
Learn more about scoring health professional shortage areas by visiting HRSA's website.
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