What is a ‘HPSA’?

You’ve been told you need to get one, but what is a HPSA?

First, it’s pronounced “hip-suh” and it is an acronym for Health Professional Shortage Area. It’s a special designation that can be approved by the U.S. Health Resources and Services Administration (HRSA) for communities or clinics that show HRSA they have too few doctors to meet local needs. A HPSA can demonstrate a shortage of doctors for a defined geographic area, for a population, or for a clinic site. From there, HPSAs reflect shortages for primary care physicians, dentists or mental health professionals.

Each combination of designation types and categories has a level of benefit that follows to local physicians and medical offices. The most sought after designation has been the “geographic primary care” designation. For communities that do gain a geographic designation, physicians and mid-levels (physician assistants, nurse practitioners and nurse midwives) working in the HPSA are eligible for the additional 10 percent Medicare bonus payment for specific services. Through the end of 2015, general surgeons in HPSAs are eligible for a 20-percent Medicare bonus. There are also some additional short-term programs that were recently funded by Congress for an undetermined amount of time.
The HPSA program as it appears today is the result of legislation from the 1970s and 1980s to direct Federal support and money to communities that were most in need at that time. Rather than depending on expert testimony or lobbying efforts in Washington, D.C., Congress created HPSAs and closely related Medically Underserved Areas as a way to objectively identify areas in need of extra support.

Although based on rules and guidelines from the 1970s, the basic form of a HPSA has never been changed, while the details required to “prove” a HPSA are updated from time to time by the U.S. Deptartment of Health and Human Services, the parent agency for HRSA.

As a rule HPSAs can be broken down into three categories:

  • A Primary Health Care HPSA acknowledges the physician shortage in a service area. The physician shortage is calculated from pediatrics, ob/gyn, general internal medicine, and family practice physicians only.
  • A Dental Health Care HPSA acknowledges the shortage of dentists in a service area. The dental shortage is calculated from general dentists only; however, age and auxiliary assistance are also factors.
  • A Mental Health Care HPSA acknowledges the shortage of psychiatrists and core mental health professionals in a service area. The psychiatric shortage is calculated from ratios of population to mental health providers.

And each category has four types:

  • Geographic HPSA: A Geographic HPSA is for a region that is determined to be a sound Rational Service Area (RSA). It can be a portion of a city or a county, or it can be an entire county. It is based on primary care hours for general population.
  • Low-Income Population HPSA: A Low-Income Population HPSA is for a region that is determined to be a sound Rational Service Area focusing on only that population living below the 200-percent of the Federal Poverty Level. The shortage of primary care physicians is based on the time spent serving this population.
  • Specialty Population HPSA: A Specialty Population HPSA is for a region that is determined to be a sound Rational Service Area focusing on only that population which may fall into one of the following populations: Medicaid populations below the 100-percent Federal Poverty Level; ethnicity; homeless; migrant farm workers.
  • Facility HPSA: A Facility HPSA is a HPSA for any of the following facilities: State and Federal Prisons, correctional facilities, community health centers, rural health clinics, and Federally Qualified Health Centers (FQHC).
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