Provider Retention in High Need Areas. Data Sets

12/22/2014

NHSC Administrative File

The NHSC administrative file provided to us by HRSA represents a panel of 22,703 participants who entered the NHSC programs over the period 2000-2013. The NHSC administrative file contains information on where each participant was located each year during the participant’s program (down to the zip code level). Participants are tracked annually from their entry year until 2013, but only while they are in the program. Of the total number of providers, 10,123 are physicians, 6,850 are nurse practitioners (NP) or physician assistants (PA) and the remaining 5,730 individuals represent other providers, such as dental or behavioral health providers. This database contains information on participant demographics and award/service characteristics, including: age, gender, race/ethnicity, award year, entry year, type of award, length of initial service obligation, funds received, practice type, provider type, location, and separation year. Table II.1 provides a breakdown of the number of NHSC enrollees by entry year, provider type, gender, program type, average age on entry, and race/ethnicity.

Table II. 1: Select Socio-Demographic Characteristics of NHSC Enrollees by Entry Year

Entry Year

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

Total

918

1,062

1,462

2,395

3,005

3,412

3,367

3,209

3,142

4,081

6,710

9,650

9,424

8,275

Type

MDs

591

684

872

1,362

1,680

1,989

2,005

1,951

1,945

2,331

3,274

4,331

4,205

3,730

NP/PAs

227

254

391

636

807

863

798

764

725

1,044

2,008

2,975

2,827

2,410

Other

100

124

199

397

518

560

564

494

472

706

1,428

2,344

2,392

2,135

Gender

Females

520

619

910

1,504

1,876

2,167

2,166

2,085

2,070

2,769

4,740

6,932

6,823

6,002

Males

398

443

552

891

1,129

1,245

1,201

1,124

1,072

1,312

1,970

2,718

2,601

2,273

Program

LRP

807

880

1,185

2,057

2,620

2,952

2,839

2,632

2,563

3,475

6,148

9,125

8,892

7,752

SP

111

182

277

338

385

460

528

577

579

606

562

525

532

523

Age

36.5

36.8

37.3

37.4

37.4

37.3

37.4

37.3

37.3

37.1

37.4

37.8

37.9

38.0

Race/Ethnicity

White

89

250

475

918

1,245

1,408

1,375

1,332

1,331

1,774

3,622

5,876

5,976

5,290

Black

18

35

56

99

129

183

186

175

183

228

554

972

1,031

975

Hispanic

801

759

881

1,283

1,492

1,657

1,663

1,553

1,455

1,802

1,735

1,581

1,258

1,013

Other

10

18

50

95

139

164

143

149

173

277

799

1,221

1,159

996

The number of new NHSC participants has increased substantially over the last few years, with most of this increase reflected in an expansion in the number of women, non-physicians and White providers. In Appendix Table B.1 we present the distribution of the NHSC workforce by provider discipline.

In Table II.2 we present the number of records on NHSC providers by entry cohort.

Table II. 2: Number of Records on NHSC Providers by Entry Cohort

Entry Year

Years Served in NHSC

1

2

3

4

5

6

7

8

9

10

11

12

13

14

2000

918

645

351

221

117

65

41

24

22

19

15

13

11

8

2001

438

438

251

161

90

43

25

16

13

10

7

4

3

 

2002

714

714

363

219

121

63

40

23

14

13

9

6

 

 

2003

1,237

1,237

584

313

181

108

66

45

35

22

15

 

 

 

2004

1,151

1,151

545

318

156

101

55

36

23

17

 

 

 

 

2005

1,342

1,342

611

341

178

107

64

38

24

 

 

 

 

 

2006

1,071

1,071

563

363

172

101

59

28

 

 

 

 

 

 

2007

1,032

1,032

571

339

178

90

44

 

 

 

 

 

 

 

2008

989

989

622

391

193

103

 

 

 

 

 

 

 

 

2009

1,849

1,849

1,212

647

324

 

 

 

 

 

 

 

 

 

2010

3,425

3,425

1,779

1,127

 

 

 

 

 

 

 

 

 

 

2011

4,009

4,009

1,835

 

 

 

 

 

 

 

 

 

 

 

2012

2,382

2,382

 

 

 

 

 

 

 

 

 

 

 

 

2013

2,146

 

 

 

 

 

 

 

 

 

 

 

 

 

Total

22,703

 

 

 

 

 

 

 

 

 

 

 

 

 

The main disadvantage of the NHSC administrative data file is that it does not include information on where participants were located after program completion. Also, it does not contain the participant’s National Provider Identification (NPI) number, or other unique identifiers which would enable us to track their location after program completion. We therefore rely on additional data sources to identify the participants’ NPI and then subsequently determine where they were located after program completion. These four data sources, which are also used to identify non-participant providers, include:

  • AMA Physician Master Files of various years since 2000;

  • Medicare Providers File developed from Medicare claims data over the period 2005-2011; and

  • Optum Corporation’s Provider 360 File, a proprietary file containing comprehensive information on most medical providers in the United States.

Finally, we employ data from HRSA with information on HPSA designations, types, disciplines, sites and scores. We use the most recent file of these data, which was compiled in December 31, 2013.

Below we discuss these files in turn and highlight their advantages and limitations for the current project.

AMA Physician Master Files

The AMA Master file was begun in 1986 and has been tracking physicians since then. Multiple years of AMA data were extracted to obtain information about provider location over multiple years. Each year of the AMA data file contains current information on the physicians’ locations and practices, along with information on their training. The AMA is the single most comprehensive data source on physicians practicing in the US. In theory, linking NHSC administrative data with the AMA data, it is possible to track the practice location and retention information of NHSC enrollees over the years. Each observation includes location data (such as zip code), medical school, specialty, graduation year, birth date, race, and gender. We make use of complete AMA Physician Master Files for the following years: 2000, 2007, 2008, 2010-2012, and partial files (containing only data on primary care providers) for 2003 and 2005. The number of records increased steadily from about 1.0 million physicians in 2000 to about 1.3 million in the 2011 file. However, the main limitations of these files are that they include only physicians and that the providers’ location is updated infrequently, at intervals that are often longer than one year.

Provider360

Provider360 (P360) is a comprehensive provider database developed and maintained by OptumInsight, the Lewin Group’s parent company. Optum first developed Provider360 in the early 2000s and since then has updated it on a monthly basis. Optum links numerous private and public databases to create P360, and it gathers information about each provider’s demographics, education and training, NPI and DEA numbers, and location. Importantly, Provider360 contains both physician and non-physician providers, including PAs, NPs, and mental health and dental care clinicians.

This dataset covers virtually all currently active providers and includes most of the socio-demographic variables that we observe in the NHSC data, like provider demographics or provider type, as well as additional useful variables, like the provider’s NPI, medical education and practice affiliation. The large number of common variables appearing both in the NHSC files and P360, like name, birthdate, gender and others, allows for a link between the two datasets with a good match rate.

The main limitation of P360 is that it was not designed to provide panel information about providers, so we can tell where providers are located now but not each year in the past. However, even without historical P360 data retention patterns of NHSC providers can be constructed by comparing their locations upon NHSC program completion with their current locations in P360. For instance, we can look at the cohort of students finishing their medical training in, say, 2006 and determine how many of them are still serving in HPSAs as of the current year. We return to this point in the next section of this chapter. Other useful variables available in P360 include the provider’s degree, specialty, medical school attended, residency institution, license, DEA number, hospital affiliation, practice type, practice NPI, and sanctions against the provider.

Medicare Providers File

In order to track participants and non-participants over time, we constructed a provider level dataset using the Medicare claims of providers who billed Medicare between 2005 and 2011. In this dataset the unit of observation is the provider-year, meaning that each Medicare provider is observed annually along with his or her geographical location at the zip code level. The provider’s location in a given year is based on the most frequent zip code associated with that provider’s claims during that year. The dataset includes the provider’s NPI, which allows us to identify NHSC participants and track their location in the years after their service completion.

The Medicare provider file contains 5,757,405 observations on 1,099,836 unique providers. The breakdown of unique providers by type is: 626,836 physicians, 123,223 NP/PA’s, 54,168 DO’s and 295,615 other providers.3 Table II.3 shows the number of providers by type in each year.

Table II. 3: Number of Providers by Type in Each Year (Medicare Provider Data)

Year

MDs

NP/PAs

DOs

Other

Total

2005

428,574

48,018

34,220

140,748

651,560

2006

455,974

55,222

36,941

151,324

699,461

2007

502,661

69,647

41,424

191,968

805,700

2008

521,927

78,950

43,808

205,540

850,225

2009

535,191

86,033

45,953

214,118

881,295

2010

549,627

93,847

47,948

223,727

915,149

2011

564,707

102,335

50,115

236,858

954,015

As in the case of another provider data, available to the Lewin team known as the de-Identified Normative Health Information (dNHI) data, Medicare providers also appear to be well distributed across all states during the period between 2005 and 2011 (Appendix Table B.2).4

3 These providers include both primary care practitioners and non-primary care practitioners.

4 We performed the same exercise with the OptumInsight’s medical claims database called the De-Identified Normative Health Information (dNHI) as we did with the Medicare claims data. The dNHI database includes all claims submitted to United Healthcare, as well as claims that are processed for a number of other insurers. Although it contains information on a large number of providers, the dNHI database is arguably not representative for the entire population of US providers. Also, since most providers in dNHI work in private practices, there was a risk of identifying in this dataset a disproportionate fraction of NHSC participants who work in non-HPSAs with patients that are typically not underserved. Moreover, the number of NHSC participants we identified in dNHI in addition to those identified in the Medicare data was less than 1,000. We therefore decided not to use the dNHI data for the current project.

 

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