Provider Retention in High Need Areas. Retention Measures Using the Second Analytic Dataset

12/22/2014

So far, we have discussed retention statistics using only the first analytic dataset, which is based on NHSC, Medicare and P360 data. While this analytic dataset is very useful in that it tracks the participants’ and non-participants’ location over time, the number of participants identified in this dataset may be arguably viewed as small (around 9,000 providers of the total of 22,703). We address this issue by presenting in Tables III.1-III.3 the retention rates of NHSC participants using the second analytic dataset. However, despite the fact that we observe about 18,500 participants in that dataset, we can only construct retention rates as of December 2013, the time when the P360 data was recorded. As in the case of the first analytic dataset, we dropped participants who appear in our data only in 2013, and thus, of the initial 18,500 participants we matched with P360 data, we ended up using a number of 11,210 participants for the retention analyses we present below.

Table III. 1: Retention Rates of NHSC Participants as of December 2013—Primary Care

Year of Exit
from NHSC

HPSA & same county

HPSA & other county

Non-HPSA & same county

Non-HPSA & other county

Total matched
in P360 data

2000

35

54

23

39

151

2000

23.18%

35.76%

15.23%

25.83%

 

2001

34

48

15

43

140

2001

24.29%

34.29%

10.71%

30.71%

 

2002

36

65

11

35

147

2002

24.49%

44.22%

7.48%

23.81%

 

2003

79

88

23

43

233

2003

33.91%

37.77%

9.87%

18.45%

 

2004

149

158

50

93

450

2004

33.11%

35.11%

11.11%

20.67%

 

2005

196

205

45

103

549

2005

35.70%

37.34%

8.20%

18.76%

 

2006

216

188

57

117

578

2006

37.37%

32.53%

9.86%

20.24%

 

2007

184

170

49

94

497

2007

37.02%

34.21%

9.86%

18.91%

 

2008

188

162

42

89

481

2008

39.09%

33.68%

8.73%

18.50%

 

2009

184

158

45

74

461

2009

39.91%

34.27%

9.76%

16.05%

 

2010

229

195

56

90

570

2010

40.18%

34.21%

9.82%

15.79%

 

2011

499

418

128

172

1217

2011

41.00%

34.35%

10.52%

14.13%

 

2012

640

524

131

163

1458

2012

43.90%

35.94%

8.98%

11.18%

 

Total

2,669

2,433

675

1,155

6,932

Total

38.50%

35.10%

9.74%

16.66%

 

The rates in Tables III.1-III.3 indicate the fraction of participants who remain in the same HPSA or any HPSA between the time of service completion and December 2013. As a result, the fraction remaining in HPSAs for the cohort of providers exiting NHSC in 2012 represents a 1-year retention rate, for those exiting in 2011 it is a 2-year rate and so on. Although the rates in Table V.1 are not directly comparable to the rates plotted in Figure V.1, they nonetheless paint a similar picture regarding the retention of participants in HPSAs after service completion. For instance, the one-year retention rate in same HPSA same county of primary care participants who left service in 2012 was 43.9% (Table III.1), compared to 48.5% in Figure III.1. Similarly, the two-year retention rate was 41.0% (Table III.1), while the two-year retention rate was 4.07% in Figure III.1.

Given that the retention rates in Tables III.1-III.3 are inherently cohort-specific, we constructed cohort-specific retention rates using the first analytic dataset (Tables B.4 and B.5 in Appendix B). Tables A.4 and A.5 allow for a direct comparison between the retention rates from the first analytic dataset and the retention rates from the second analytic dataset (in Tables III.1 and III.2). As the retention rates from the first analytic dataset are virtually indistinguishable from the retention rates from the second analytic dataset, we conclude that the first dataset provides a comprehensive and representative picture of the entire sample of NHSC participants.

Table III. 2: Retention Rates of NHSC Participants as of December 2013—
Mental Health

Year of Exit
from NHSC

HPSA & same county

HPSA & other county

Non-HPSA & same county

Non-HPSA & other county

Total matched
in P360 data

2000

16

15

3

4

38

2000

42.1%

39.5%

7.9%

10.5%

 

2001

19

13

2

8

42

2001

45.2%

31.0%

4.8%

19.0%

 

2002

19

20

3

9

51

2002

37.3%

39.2%

5.9%

17.6%

 

2003

41

30

5

21

97

2003

42.3%

30.9%

5.2%

21.6%

 

2004

68

60

14

28

170

2004

40.0%

35.3%

8.2%

16.5%

 

2005

69

58

18

25

170

2005

40.6%

34.1%

10.6%

14.7%

 

2006

107

67

11

28

213

2006

50.2%

31.5%

5.2%

13.1%

 

2007

83

79

16

35

213

2007

39.0%

37.1%

7.5%

16.4%

 

2008

72

76

18

25

191

2008

37.7%

39.8%

9.4%

13.1%

 

2009

81

62

24

25

192

2009

42.2%

32.3%

12.5%

13.0%

 

2010

111

89

26

27

253

2010

43.9%

35.2%

10.3%

10.7%

 

2011

289

195

71

76

631

2011

45.8%

30.9%

11.3%

12.0%

 

2012

398

285

71

108

862

2012

46.2%

33.1%

8.2%

12.5%

 

Total

1,373

1,049

282

419

3,123

Total

44.0%

33.6%

9.0%

13.4%

 

Another advantage of the second analytic dataset was that it allowed us to construct retention rates for providers in Dental Health HPSAs. These rates could not have been constructed with data from the first analytic dataset, as the sample size of dental health providers billing Medicare was extremely limited. As can be noticed in Table III.3, the retention rates of dental health participants were similar to the retention rates of providers in primary care and mental health HPSAs.

Table III. 3: Retention Rates of NHSC Participants as of December 2013—
Dental Health

Year of Exit
from NHSC

HPSA & same county

HPSA & other county

Non-HPSA & same county

Non-HPSA & other county

Total matched
in P360 data

2000

9

10

3

3

25

2000

36.0%

40.0%

12.0%

12.0%

 

2001

11

12

4

10

37

2001

29.7%

32.4%

10.8%

27.0%

 

2002

13

14

5

11

43

2002

30.2%

32.6%

11.6%

25.6%

 

2003

19

16

11

17

63

2003

30.2%

25.4%

17.5%

27.0%

 

2004

30

27

9

23

89

2004

33.7%

30.3%

10.1%

25.8%

 

2005

22

38

13

22

95

2005

23.2%

40.0%

13.7%

23.2%

 

2006

30

44

18

16

108

2006

27.8%

40.7%

16.7%

14.8%

 

2007

21

31

9

25

86

2007

24.4%

36.0%

10.5%

29.1%

 

2008

19

22

9

13

63

2008

30.2%

34.9%

14.3%

20.6%

 

2009

22

26

10

24

82

2009

26.8%

31.7%

12.2%

29.3%

 

2010

29

27

9

14

79

2010

36.7%

34.2%

11.4%

17.7%

 

2011

66

53

16

32

167

2011

39.5%

31.7%

9.6%

19.2%

 

2012

96

82

12

28

218

2012

44.0%

37.6%

5.5%

12.8%

 

Total

387

402

128

238

1,155

Total

33.5%

34.8%

11.1%

20.6%

 

Finally, Tables B.6 and B.7 in Appendix B show no substantial variation in the retention rates of providers by provider type. Primary care participants are slightly more likely to stay in the same HPSA same county and less likely to stay in HPSAs in other counties than NP/PAs, while mental health physicians are in general less likely than NP/PAs to remain in HPSAs. We will return to this issue in Chapter V to determine whether differences in retention rates remain after we adjust for the provider’s age, gender and other individual level and local area characteristics.

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