Rhode Island - The Robert Graham Center
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Transcript Rhode Island - The Robert Graham Center
Rhode Island:
A Brief State of the
State
D Roxanne Richards
May 24, 2012
Today’s Objectives
Rhode Island Characteristics
Workforce characteristics
Current Primary Care Workforce
Training milieu
Primary Care Infrastructure
Demographics
Economy
Mapping Need
Key Disparities
Trends
In the News
Recent Legislative Actions and Agency Programs
Rhode Island Characteristics
State of Rhode Island and
Providence Plantations
Rhode Island in United States (zoom) (extra close) (US48).svg from Wikimedia Commons1
Metropolitan vs.
Non-metropolitan Areas
“The Health of Rhode Island Non-Metropolitan Communities”, Office of Primary Care and Rural Health, November 2011.
Ethnicity Composition
Census 2010 Quick Facts: Rhode Island
Metropolitan vs.
Non-metropolitan
“The Health of Rhode Island Non-Metropolitan Communities”, Office of Primary Care and Rural Health, November 2011;
Fact Finder 2, US Census Bureau
Mapping Poverty:
Population at or below 100% FPL
UDS Mapper, http://www.udsmapper.org, accessed May 23, 2012
Insurance Rates and
Healthcare Expenditures
Insured by public plan: 21% (US average 20%)4
Total Uninsured: 199,100 (13%) (US average 18%)4
Uninsured under 100% FPL: 41% (US average 41%)
Uninsured 100-138% FPL: 10% (US average 13%)
Uninsured 139-250% FPL: 24% (US average 24%)
Uninsured 251-399% FPL: 12% (US average 13%)
Uninsured 400%+ FPL: 13% (US average 10%)
HC expenditures per capita (2009): $8309 (US average $6815)4
Insurance Rates and
Healthcare Expenditures
Kaiser Family Foundation, StateHealthFacts.org
Insurance Rates:
Compared to Neighboring States
Fact Finder 2, US Census Bureau
Economy and Politics
Based in service industries7
Healthcare (1st)
Tourism (2nd)
Manufacturing (3rd)
Recent Tax Reform (June 2010)2
Make RI more business-friendly
Reliably Democratic state2
Has voted for Democratic nominees for president in
all but 7 elections since 1908
Health Reform:
Where is RI at in the process?
HIE established
PCIP in place
State is active purchaser
Currently 149 enrollees
Medicaid Expansion Estimates (KFF.org):
% change in enrollment: + 20.0% (US average +27.4%)
% change in STATE spending: +0.7% (US average +1.4%)
% change in FEDERAL spending: 14.6% (US average +22.1%)
Kaiser Family Foundation, StateHealthFacts.org
Workforce Characteristics
Current PC Provider Supply:
Total Active Physicians per Population
AAMC Physician Workforce State Profiles
Current PC Provider Supply:
Active PC Physicians per Population
AAMC Physician Workforce State Profiles
Current Nurse Practitioner Supply
“Total Nurse Practitioners, 2011”, Kaiser Family Foundation
Current Physician Assistant Supply
“Total Physician Assistants, 2011”, Kaiser Family Foundation,
Distribution of All RI Physicians:
RI AHEC Primary Care Mapping Project (2008)
RI AHEC Primary Care Mapping Project (2008)
Distribution of PC Physicians:
RI AHEC Primary Care Mapping Project (2008)
RI AHEC Primary Care Mapping Project (2008)
Physician Density by Municipality:
RI AHEC Primary Care Mapping Project (2008)
RI AHEC Primary Care Mapping Project (2008)
Physician Training:
UME in New England Region26
RI: one private (Brown University, Alpert Medical
School)
MA: one public, three private
CT: one public, one private
NH: one private
VT: one public
ME: one private
NY: five public, eight private
Tuition and Student Fees Reports, AAMC, 2010
Physician Retention: UME
AAMC Physician Workforce State Profiles
Physician Training:
GME in New England Region
ACGME data from AMA-MF
Physician Retention: GME
AAMC Physician Workforce State Profiles
Migration of Physicians into RI:
Most Common GME States,
All Physicians
ACGME data from AMA-MF
Migration of Physicians into RI:
Most Common GME States,
PC Physicians
ACGME data from AMA-MF
Primary Care Infrastructure
Mapping Need in RI:
HPSA’s
UDS Mapper, udsmapper.org
Mapping Need in RI:
MUA’s/MUP’s
UDS Mapper, udsmapper.org
Mapping Need in RI:
Section 330 Grantee Access Points
UDS Mapper, udsmapper.org
Key Disparities in RI
GIS mapping used
to
target resources30
Lead poisoning in
children
At-risk populations for
Tobacco Abuse
"Using Geographic Information to Target Health Disparities: State Experience”, 2011.
Key Disparities in RI
2011 Health Disparities Profiles31
“Rhode Island has one of the highest rates of death due
to coronary heart disease” (rank 48th in US)
“Some of the lowest rates of death due to stroke (3rd),
unintentional injuries (11th) and suicide (6th)…obesity
(10th)…and a relatively low rate or current smoking (14th)”
High rates of preventive care (cholesterol screening,
routine check up in last 2 years, dental visit in last year;
placing 3rd in each), but large disparity in rate of
cholesterol screening for Hispanic population
High rates of insurance (17th), but significantly lower in
Hispanic population
“Health Disparities Profiles: 2011 Edition.” Washington, DC: DHHS Office on Women’s Health. 2011
Key Disparities in RI
Office
of Primary Care and Rural Health (OPCRH)
Possible Barriers Identified:
Access
to Care
HPSA’s
Insurance/Ongoing Source of Care
Public Transportation
Key Disparities in RI
Office
of Primary Care and Rural Health (OPCRH)
Possible Barriers Identified:
Access to Care
HPSA’s
Insurance/Ongoing Source of Care
Public Transportation
Key Disparities in RI
Office
of Primary Care and Rural Health (OPCRH)
Possible Barriers Identified:
Access to Care
HPSA’s
Insurance/Ongoing Source of Care
Public Transportation
Key Disparities in RI
Office
of Primary Care and Rural Health (OPCRH)
Possible Barriers Identified:
Access to Care
HPSA’s ???
Insurance/Ongoing Source of Care
Public Transportation
Key Disparities in RI
Office
of Primary Care and Rural Health (OPCRH)
Five Barriers to ACCESSING Care
Inadequate capacity of dental services
Inadequate supply of mental
health services
Lack of knowledge of resources
Individual stigma around receiving services and
benefits
Inadequate public transportation
Trends in Rhode Island
In The News…
“RI Foundation Grant Supports
“UnitedHealthcare donates
Inspiring Mentorships”
$250K to physicians loan
forgiveness program”
April 2011, http://www.giving.brown.edu37
October 11, 2011, http://www.pbn.com
Recent RI Legislative Actions and
DOH Programs
New Osteopathic School Approved
by RI House,
May 16, 201236
Letter from “Rhode Island Primary Care Physician
Advisory Committee” to RI DOH Director Dr
Michael Fine, January 9, 201242
RI Medicaid Global Waiver Program (2008-2013)43
Recent DOH Reports
Impact of Primary Care on Healthcare Cost and
Population Health: A Literature Review, Feb 201246
“An Independent Evaluation of Rhode Island’s Global
Waiver”, The Lewin Group, December 6, 201145
The Health of Rhode Island Non-Metropolitan
Communities, 201122
Healthy Rhode Island 2010
Healthy RI Task Force: Getting National health Reform
Right for Rhode Island, Sept 201032
Summary
Rhode Island Characteristics
Metro vs Non-metro
Barriers
to access
Lower participation in programs such as WIC
Wealthier, Younger, more Caucasians, bigger divide
in education
Average rates of insurance overall
Above average HC expenditure per capita
Summary
Workforce
Higher numbers of specialists and PC physicians
Lower rates of NP’s and PA’s
Few training programs
Lower rates of retention
Summary
PC Infrastructure
17 HPSA’s
RI no stranger to GIS mapping
High rates of death from CHD
Lower rates of smoking, obesity than national
average
Non-metro areas with barriers to access
In The News
Healthcare Reform
Medicaid Budget
Support for Primary Care via loan forgiveness,
mentorship programs, etc
Questions, Discussion…
References
(correlate with RI_full_outline.docx)
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http://en.wikipedia.org/wiki/Rhode_Island (accessed May 4, 2012)
Census 2010 Quick Facts: Rhode Island,
http://quickfacts.census.gov/qfd/states/44000.html (accessed May 4, 2012)
http://news.providencejournal.com/breaking-news/2010/06/carcier-signs-law-changinginc.html (accessed May 4, 2010)
http://www.statehealthfacts.org/healthreformsource.jsp?rgn=41 (accessed May 3, 2012)
http://www.theagapecenter.com/Hospitals/Rhode-Island.htm#R (accessed May 7th, 2012)
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“Focus on Health Reform: How Competitive Are State Insurance Markets? “ Kaiser Family
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AAMC Physician Workforce State Profiles,
https://www.aamc.org/initisiatives/workforce/reports/profiles/, accessed May 15, 2012
Christian S, Dower C, O’Neil E, “Overview of Nurse Practitioner Scopes of Practice in the
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Christian S, Dower C, O’Neil E, “Chart Overview of Nurse Practitioner Scopes of
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“Professional Issues: Physician Assistant Scope of Practice”, American Academy of
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2011. R.I. GEN LAWS §5-54-8, and 14-140-033 R.I. CODE R. §1.10 as accessed from
http://www.aapa.org/uploadedFiles/content/The_PA_Profession/Federal_and_Stat
e_Affairs/Resource_Items/Rhode%20Island%202011.pdf (accessed May 22, 2012)
Connecticut, Physician Assistants: State Laws and Regulations, 12th Edition, January
2011. CONN. GEN. STAT. §20-12d, CONN. GEN. STAT. §20-12a(7)(A), and CONN. GEN.
STAT. §20-12a(7)(B), as accessed from
http://www.aapa.org/uploadedFiles/content/The_PA_Profession/Federal_and_Stat
e_Affairs/Resource_Items/Connecticut%202011.pdf (accessed May 22, 2012)
Massachusetts, Physician Assistants: State Laws and Regulations, 12th Edition,
January 2011. MASS. GEN. LAWS ch. 112, §9E, MASS. GEN. LAWS ch. 94C, §7(g), and
263 MASS. CODE REGS. 5.07, as accessed from
http://www.aapa.org/uploadedFiles/content/The_PA_Profession/Federal_and_Stat
e_Affairs/Resource_Items/Massachusetts%202011.pdf (accessed May 22, 2012)
Maine, Physician Assistants: State Laws and Regulations, 12th Edition, January 2011.
02-373-2 ME. CODE R. §6 and 02-373-2 ME. CODE R. §6(A)(2), as accessed from
http://www.aapa.org/uploadedFiles/content/The_PA_Profession/Federal_and_Stat
e_Affairs/Resource_Items/Maine%202011.pdf (accessed May 22, 2012)
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New Hampshire, Physician Assistants: State Laws and Regulations, 12th Edition,
January 2011. N.H. CODE ADMIN. R. ANN. MED 603.01 and N.H. CODE ADMIN. R.
ANN. MED 612. 01, as accessed from
http://www.aapa.org/uploadedFiles/content/The_PA_Profession/Federal_and_Stat
e_Affairs/Resource_Items/New%20Hampshire%202011.pdf (accessed May 22,
2012)
Vermont, Physician Assistants: State Laws and Regulations, 12th Edition, January
2011. 13-141-001 VT. CODE R. §5.1 and VT. STAT. ANN. tit. 26 §1735 and 13-141-001
VT. CODE R. §5.2, as accessed from
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“The Health of Rhode Island Non-Metropolitan Communities”, Office of Primary
Care and Rural Health, November 2011.
Fact Finder 2, US Census Bureau, http://factfinder2.census.gov/, accessed May 23,
2012
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Tuition and Student Fees Reports, AAMC,
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23,2012
RI AHEC Primary Care Mapping Project http://med.brown.edu/ahec/mapping_project/,
accessed May 23, 2012
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