State Representative Diane Franklin Missouri’s 123 rd House District Rural Health Care: It’s Effect on Rural Communities Columbia, Mo. Tuesday, September 15, 2015

Where We Are Now Missouri Healthcare Workforce Registry and Exchange (MoHWoRx) Information system developed by DHSS Helps health professionals meet state registration requirements Provides information on access to health care statewide. Informs two external components: Missouri Health Professional Registry Bureau of Narcotics and Dangerous Drugs Registry

Where We Are Now MoHWoRx has gaps in accuracy and is not up-to-date. Prevents early detection of limited health care accessibility and access in terms of geography, demography and specialty care. Hinders the ability for policy makers and health community leaders to make informed efforts to expand the medical workforce in the state. This is especially a disservice to underserved areas.

A Growing Problem Missouri has a shortage of health professionals. Disproportionately spread throughout the state. Missouri trains 2.7 percent of nation’s medical school graduates. Ranks second nationally for exporting doctors to other states. Impending physician retirements will augment the issue. 40 percent of practicing physicians in Missouri are over the age of 55 and a third of Missouri nurses are over 50 years-old. We know the decline is coming, but the question is when and where will the impacts be felt most?

Rural Missouri Most in Need One in five Missourians live in an area with limited access to primary care. Much of Rural Missouri face a medical workforce population shortage. The overall number of licensed practicing physicians has increased since 2011, but rural numbers have declined.

Rural Missouri Most in Need Primary Care Health Professional Shortage Areas exist where the ration of population to physician ratio is 3,500:1

Rural Missouri Most in Need Hospitals and primary care physicians are few and far between in rural areas. Missouri Foundation for Health data shows rural Missouri population to primary care ratio is 1:1,776. Urban Missouri: 1:962.

Rural Missouri Most in Need Rural Missouri will soon have greater disproportionate supply and demand for services. Aging baby boomer population is sure to increase demand for health services across the state – both urban and rural percent of Rural Missourians are 65 or older percent of urban Missourians are 65 or older.

The Problem The current healthcare workforce database is insufficient. Impedes strong impact analysis of where and how existing and growing medical shortage. An insufficient system does not inform leaders or stakeholders where needs for funding, specialists or primary care coverage could be improved. The bottom line: Missouri’s approach to collecting health workforce data for licensing functions is removed from information detailing practice locations and characteristics.

Addressing the Problem Build on the current database to create an updated aggregate, quantitative database Would better inform state lawmakers, policy directors, medical institutions, training programs and recruitment on how to approach underserved areas. A registry-based database would keep records updated and timely for fresh indicators on where physicians are and what specialties are available in certain areas.

Addressing the Problem The Missouri Healthcare Workforce Database Advisory Board at the University of Missouri is testing a system to meet the need.

Solution: Aggregated Database Painting a vivid picture of the Missouri medical landscape: Evaluate where health care needs are with demographic information paired with primary care and specialty physician, nurse, dentist and mental health workforce data. Allow education and public health initiatives to be tailored to pinpointed medically underserved areas. Open potential for federal grants to the state as a result of more solid information and understanding of true health needs. Supplement knowledge for state and federal agencies awarding health grant funds for local medical initiatives. Guide medical education institutions to focus, or re-focus, recruitment and training efforts in different parts of the state. Permit early detection of an approaching health care workforce shortage or issue – geographically, demographically or sorted by specialization.

Missouri Legislation – HB 112 HB 112 (2015): To provide healthcare workforce analysis, is a crafted solution to address the problem. Would build on MoHWoRx to supplement current data with professional license, registration and permit data.

Missouri Legislation – HB 112 Authorization would be given to agencies to enter into a contract with DHSS, a non-profit or educational institution. State Board of Nursing Board of Pharmacy Missouri Dental Board State Board of Registration for the Healing Arts

HB 112: Private, Secure & Accurate State board with jurisdiction over the information would control and approve data collection. Qualitative data, such as identifying data necessary for registry or application, would be provided to the contractor. Geographic information Demographic information Practice Professional characteristics of license Only quantifiable data would be released to public with the creation of an aggregate workforce database. All confidential information would be closed to the public only disclosed with consent of the board/registry entity. HB 112 text: Contractors shall maintain the confidentiality of data received or collected under this subsection and shall not use, disclose, or release any data without approval of the applicable state board.

Missouri Legislation – HB 112 Would begin building health workforce data infrastructure to facilitate endeavors to meet health needs across the state at a low cost. Short term outlook: $0 - $75,500 per year for three years. Stakeholders involved with software and data development predict a comprehensive information set to be ready in three years to have a full picture to inform policy decisions.

Other States’ Success With the status quo, Missouri is falling behind several states in its ability to assess the types, number, and practice locations of its own healthcare professionals. North Carolina and Nebraska have taken steps to implement a comprehensive health care workforce database with great success. HB 112 would push a healthcare workforce analysis application, such as the Missouri Health Professions Workforce Data System, to achieve similar successes.

Moving Forward What is next for Missouri’s healthcare workforce database initiative? Telehealth a prospect. Broadband services need to expand to fully benefit rural areas. AT&T, CenturyLink Announcement Project ECHO