WASHINGTON — A new analysis released today by the Geiger Gibson/RCHN Community Health Foundation Research Collaborative at the George Washington University School of Public Health and Health Services provides an in-depth examination of public comments submitted in response to a proposed rule to narrow the federal definition of medical underservice. The proposed rule, issued by the Health Resources and Services Administration (HRSA) in early 2008, is crucial because it is used to determine the availability of basic health care resources distributed through dozens of federal and state programs, including the community health centers program. The Notice of Proposed Rulemaking, which sought to revise the methodology used to designate Health Professional Shortage Areas (HPSA) and Medically Underserved Areas and Populations (MUA/P), was withdrawn on July 23 following evidence of its potential adverse impact on hundreds of communities currently served by these programs. An earlier report by the Collaborative assessed the possible consequences of the proposed rule.

In its July 23 withdrawal notice, HRSA cited receipt of “many substantive comments on the proposed rule,” a reference to the hundreds of comments submitted during the public comment period, which ended June 30 this year following two extensions. This latest Collaborative report, Designation of Medically Underserved and Health Professional Shortage Areas: Analysis of the Public Comments on the Withdrawn Proposed Regulation analyzes these comments.

Of the 725 comments filed, more than half opposed the proposed regulation and only 6 percent explicitly supported it, including those which conditioned their support on the adoption of suggested modifications. Highlights of these suggestions are as follows:

  • A call for greater stakeholder involvement through the use of a formal Negotiated Rulemaking process
  • Greater clarity in terms of both methodological issues and policy implications
  • Elimination of the proposal to combine the medical underservice and health professional shortage area designation processes in order to preserve the concept of medical underservice, which by law and practice, is distinct from the concept of health professional shortage
  • The development of need measures that more accurately reflect actual conditions of health care access
  • Correction of multiple data and methodological problems, particularly problems associated with how the number of primary health care providers are counted in estimating shortages

The analysis underscores the high degree of interest in the issue as well as the need to use a comprehensive engagement stakeholder strategy – potentially through a formal Negotiated Rulemaking process – in developing a new regulation.

Chief among HRSA’s proposals that merit closer scrutiny is the agency’s proposal to merge the MUA/P and HPSA designations. The MUA/P designation is used to target resources to communities and populations at risk for significant disparities in health and health care while the HPSA designation is intended to guide the deployment of primary health care professionals into geographic shortage areas. In many instances these two targets may overlap, but many communities without a geographic primary care provider shortage also have populations who lack access to basic health care because of poverty, a lack of health insurance, elevated health risks, racial, ethnic and cultural isolation, and other factors that lead to disparities in health and health care.

“Comments on the proposed rule from health centers and concerned parties across the country highlighted issues with the data and methodology,” said Julio Bellber, president and CEO of the RCHN Community Health Foundation. “HRSA’s withdrawal of this proposal provides an opportunity for a future approach that better addresses these critical stakeholder concerns.”

“This analysis underscores the importance of a transparent rulemaking process that permits the public to understand and comment on the development of key national health policies,” added Sara Rosenbaum, JD, Hirsh Professor and Chair, Department of Health Policy.

About the RCHN Community Health Foundation
The RCHN Community Health Foundation (RCHN CHF) is a New York-based not-for-profit operating foundation dedicated to supporting and benefiting community health centers (CHCs) in New York state and nationally. The Foundation develops and supports programmatic and business initiatives related to community health center access, pharmacy and health information technology through strategic investment, research, outreach, education, and coalition building and advocacy. For more information about RCHN CHF, contact Chief Operating Officer Feygele Jacobs at 212-246-1122 ext. 712 or fjacobs@rchnfoundation.org.

About The George Washington University Medical Center
The George Washington University Medical Center is an internationally recognized interdisciplinary academic health center that has consistently provided high-quality medical care in the Washington, DC metropolitan area for 176 years. The Medical Center comprises the School of Medicine and Health Sciences, the 11th oldest medical school in the country; the School of Public Health and Health Services, the only such school in the nation’s capital; GW Hospital, jointly owned and operated by a partnership between The George Washington University and a subsidiary of Universal Health Services, Inc.; and the GW Medical Faculty Associates, an independent faculty practice plan. For more information on GWUMC, visit www.gwumc.edu.