III. CALCULATING POPULATION TO PROVIDER RATIOSPrimary Care

III-1

Calculating Population to Provider Ratios (Primary Care)Objective:

Participants will understand how to:

1) Identify all primary care providers 2) Calculate Full-Time-Equivalency (FTE)3) Determine the population to provider ratiosfor primary care geographic and population designations

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Population to Provider Ratios Needed for Designation (Primary Care)Contiguous Areas are overutilized if: > 2,000:1

1 - See Appendix V for additional information on calculating infant mortality rates 2 - See Appendix V for information on insufficient capacityGeographic Area: 3,500:1A rational service area: county or sub-county (MSSA)

Geographic Area w/Unusually High Needs: 3,000:1

A rational service area plus one of the following:a) More than 20% of the population has incomes at or below 100% of the Federal poverty level; or b) More than 100 births per year per 1,000 women ages 15-44; orc) More than 20 infant deaths per 1,000 live births1; or d) Meets insufficient capacity criteria2

Population Groups: 3,000:1A rational service area plus meets the requirements of the specific designation category (e.g. low-income, homeless, etc.)III-*

Population Side of the Ratio

Geographic Area Designations

B. Population Designations

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A. Geographic DesignationsResident Civilian Population = Total permanent population in the service area (non-institutionalized population)Excludes: inmates or individuals in institutions (e.g. nursing homes, prisons, college dormitories, military installations, Native Americans on reservations, etc.)

Source: 2010 U.S. Census and 5-year American Community Survey Population Estimates.Migrant FarmworkersData from the 2000 Migrant and Seasonal Farmworker Enumeration Profiles Study, or other approved source (must include methodology)TouristsFormula: 0.25 X [fraction of year present] X [average daily number of tourists] (Use local data, which must include methodology and length of stay.)Seasonal Residents Those who maintain a residence in the area, but inhabit it for only 2-8 month year (Use census or local data, which must include methodology.)

HomelessLocal data (must include methodology)III-*Note: cannot add any of the above to Mental HealthCan add

B. Population DesignationsLow-Income PopulationNumber of individuals in the service area that are at or below 200%of the Federal poverty level Must be > 30% of the population in the service area Source: 2006-2010 5-year ACS Population Estimates

Can add: Migrant FarmworkersData from the 2000 Migrant and Seasonal Farmworker Enumeration Profiles Study, or other approved source (must include methodology) Homeless Local data (must include methodology).

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Migrant Farmworkers Total 200% population for entire county This number is the 200% population for the proposed area This number is the migrant farm workers in the county of your proposed area This is the number of months per season for your county MFW added to 100% Civilian Population Proposed Area Modoc 98 III-*

200% Poverty PopMigrant Farm Workers Modoc 98 2460394Pop 200%Poverty Total 4164200% population for proposed area 24602460 / 4164 =59.07%Migrant Farm Workers 394 394 * 59.07% = 233Percentage of MFW for the year MFW Season in / 12 4.5 / 12 =37.5%Total MFW for MSSA37.5% * 233 =87

Migrant Farmworker PopulationNumber of individuals in the service area who are migrant farmworkersadjusted for the fraction of the year they are in the service area.

Source: State/local data & 2000 Migrant & Seasonal Farmworker Enumeration Profiles StudyEx:Napa County, CaliforniaAgricultural Season = 4 months4/12 = .333Migrant Farmworker Pop = 5,6595,659 X .333 = 1,884 Total Migrant Farmworker Population = 1,884

Native American/Native AlaskanNumber of individuals in the service area that are Native Americans or Native Alaskans Source: 2000 census dataIII-*B. Population Designations (continued)

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MIGRANT AND SEASONAL FARMWORKER

ENUMERATION PROFILES STUDY

CALIFORNIA

FINAL

prepared for the

Migrant Health ProgramBureau of Primary Health CareHealth Resources and Services Administration byAlice C. Larson, Ph.D.Larson Assistance ServicesP.O. Box 801Vashon Island, WA 98070206-463-9000 (voice)206-463-9400 (fax)las@wolfenet.com (e-mail)

September, 2000

Use information in highlighted column.TABLE THREECALIFORNIA ALL AGRICULTURAL WORKERS ESTIMATESFINALIII-*

CountyAdjusted MSFW Farmworker EstimatesMigrant FarmworkersSeasonal FarmworkersNon-Farmworkers In Migrant HouseholdsNon-Farmworkers In Seasonal HouseholdsMSFW Farmworkers And Non-FarmworkersAlameda1,1485316161956992,043Alpine000000Amador7373413961254491,311Butte7,2633,3633,9001,2364,42612,925Calaveras13563732383241Colusa13,9326,4507,4812,3718,49024,792Contra Costa2,4701,1441,3264201,5054,395Del Norte6042803251033681,076El Dorado9604445151635851,708Fresno145,91967,56178,35924,82888,917259,665Glenn3,7471,7352,0126382,2836,668Humboldt9354335021595701,664Imperial29,31213,57215,7414,98817,86252,162Inyo7133381243126Kern92,14242,66249,48015,67856,148163,968Kings16,5927,6828,9102,82310,11129,526Lake2,9111,3481,5634951,7745,181Lassen54425229293331968Los Angeles14,1806,5667,6152,4138,64125,234Madera29,67613,74015,9365,04918,08352,809Marin6973233741194251,240Mariposa49232683087Mendocino6,1422,8443,2981,0453,74310,930Merced26,10012,08414,0164,44115,90446,445Modoc8513944571455191,515Monterey86,94140,25346,68714,79352,978154,712Napa12,2225,6596,5632,0807,44721,748Nevada2069511035125366Orange11,2845,2256,0601,9206,87620,081

III-*Use information in highlighted column.NOTE: County numbers have been rounded and, therefore, may not add to totals.

CountyAdjusted MSFW Farmworker EstimatesMigrant FarmworkersSeasonal FarmworkersNon-Farmworkers In Migrant HouseholdsNon-Farmworkers In Seasonal HouseholdsMSFW Farmworkers And Non-FarmworkersPlacer8023714311374891,428Plumas7133381243126Riverside34,99116,20118,7905,95421,32262,267Sacramento7,8453,6324,2131,3354,78013,960San Benito7,3003,3803,9201,2424,44812,991San Bernardino7,0123,2463,7651,1934,27312,477San Diego19,7199,13010,5893,35512,01635,090San Francisco34315918458209610San Joaquin60,18427,86532,31910,24136,674107,099San Luis Obispo11,8965,5086,3882,0247,24921,168San Mateo4,0841,8912,1936952,4897,267Santa Barbara31,38114,53016,8525,34019,12355,844Santa Clara10,5974,9065,6911,8036,45718,858Santa Cruz19,2488,91210,3363,27511,72934,252Shasta5,6672,6243,0439643,45310,084Sierra211014Siskiyou3,3981,5731,8255782,0716,047Solano6,5283,0233,5061,1113,97811,617Sonoma15,7177,2778,4402,6749,57827,969Stanislaus36,72017,00119,7196,24822,37665,344Sutter14,1776,5647,6132,4128,63925,228Tehama3,8251,7712,0546512,3316,807Trinity8338451451148Tulare73,81034,17439,63612,55944,977131,346Tuolumne23510912640143417Ventura35,18116,28918,8925,98621,43862,605Yolo14,7946,8507,9442,5179,01526,326Yuba5,3492,4772,8729103,2599,519State Total938,758434,645504,113159,732572,0421,670,532

Provider Side of the Ratio:III-*

STEPS1)Identify all primary care physicians in the area to be designated.

2)Determine the number of hours each primary care physician works in direct patient care (office and hospital inpatient) serving the population to be designated.

3)Calculate the FTE for each primary care physician serving the population to be designated.

4)Calculate the population to provider ratio.

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STEP 1Identify all primary care physicians in the area to be designated.

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List all primary care Doctors of Medicine (M.D.) and Doctors of Osteopathy (D.O.) who:1) Provide direct patient care in the service area, and 2) Practice principally in one of the six primary care specialties: General Practice Family Practice General Internal Medicine Pediatrics Gerontology Obstetrics and Gynecology

Physicians engaged solely in administration, research, or teaching Hospital staff physicians involved exclusively in inpatient or emergency room care Locum tenens serving less than 1 year (on contract) Physicians who are suspended under provisions of the Medicaid-Medicare Anti- Fraud and Abuse Act for a period of 18 months or more Mid-levels

Include in survey, but reduce the following providers FTE to 0.0III-*

Physicians who serve in the NHSC Scholarship or Loan Repayment Programs. Physicians who serve under a J-1 or H-1B waiver Physicians who are Federal providers (e.g., Commissioned Officers at Indian Health Services or Bureau of Prisons)

Include physicians who are planning on retiring within six months, but are still seeing patients

Include in Survey but reduce FTE to zero

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Include the following providers FTE:

All primary care M.D.s and D.O.s who provide direct patient care inthe service area, including those who:

Serve in State Scholarship or Loan Repayment Programs

Serve at Indian Health Clinics and are not Federal providers

Plan on retiring but are still seeing patients III-*

State Licensure Lists: http://www2.dca.ca.gov/pls/wllpub/wllquery$.startup National, State, and Local Medical Association DirectoriesLocal Hospital Admitting Physician ListingsAmerican Osteopathic Association (AOA) Physician ListingMedicare and Medicaid Practitioner ListsLocal Telephone Directory/ Yellow Pageswww.vitals.com

http://www.healthgrades.com/

Sources of Provider DataUse several of these sources to assure a complete listing of physicians is being used.III-* https://www.breeze.ca.gov/

STEP 2

Determine the number of hours each primary care physician works in direct patient care (office and hospital inpatient) serving the population to be designated. III-*

Designation Types and Whom to Include in the Provider Count

DESIGNATION TYPE:III-*

COUNT ALL PRIMARY CARE PROVIDERS WHO SERVE ALL PERSONS:Geographicin the service areaLow-Income Populationin the service area that have incomes < 200% of the Federal poverty level (Medicaid and Posted Sliding Fee)

Providers Total Physicians: 5 III-*

Physician NameSpecialty Location of Practice/CTHours of Direct Pt. Care/Week Hosp. Hours 1) L. McCoy, D.O. Gen.Prac. 19 Main Street City, CA 90001 CT 531 48Included2) D. Scully, MD Pediatrics 11 Park Place City, CA 90001 CT 54030Included

3) B Spock, M.D. Int. Med. 6 Muldar Ave City CA 90002 CT 538 15 Included

4) M. Welby, M.D.Ob-Gyn 3306 Russia Blvd City, CA 90002 CT 543 25 Not Included

5) Y. Zhivago, D.O. Fam. Prac. 99 Bones Drive City, CA 90003 CT 5390Full TimeAdministration

STEP 3Calculate the FTE for each primary care physician serving the population to be designated.III-*

FTE Calculation 40 hours = 1.0 FTE

Every 4 hours ( day) is counted as 0.1 FTE

A provider serving more than 40 hours a week is counted as 1.0 FTE

Only the Total (or Total Low-Income) FTE is rounded to the nearest tenth of a percent:Examples:0.875= 0.9 0.817= 0.8 0.83 = 0.8 0.85 = 0.9

Interns and residents are counted as 0.1 FTE (40 hours = 0.1 FTE)Note:The FTE for low-income population designations is based on the average number of hours per week spent with Medicaid and Sliding Fee Scale (SFS) patients. It is not based on whether the provider is accepting new Medicaid patients.For each physician, include the number of hours of direct patient care provided (office and hospital inpatient) in the service area:III-*

Adjustment of FTE if hospital inpatient hours not available: Use for physicians whose office hours are < 40 and information on hours spent in inpatient care is not available

Multiply office hours X appropriate factor

Cannot exceed 1.0 FTE If specialty information is not known then use the default which is 1.6 III-*

Primary Care Specialty Adjustment Factor General/Family Practice 1.4 Gerontology 1.4 Pediatrics 1.4 General Internal Medicine 1.8 Obstetrics/Gynecology 1.9

FTEs - Geographic Designation Total Physicians: 5 Total FTE: 3.125=3.11 Dr. Scully spends 10 hours/week doing research.2 Dr. Spock chooses to work only 15 hours/week.3 Dr. Welby has an unknown number of hospital inpatient hours so the adjustment factor is used4 Dr. Zhivago spends full-time in administration.III-*

Physician NameSpecialty Location of Practice/CT Hours of Direct Patient Care/Week Hosp. Hours FTE 1) L. McCoy, D.O. Gen.Prac.19 Main Street City, CA 90001 CT 531 48Included1.0(48/40=1.2=1.0)2) D. Scully, MD 1 Pediatrics11 Park PlaceCity, CA 90001CT 54030Included0.8(30/40=.75=.8)3) B Spock, M.D. 2Int. Med. 6 Muldar Ave City, CA 90002 CT 538 15 Included0.4(15/40=.375=.4)4) M. Welby, M.D.3Ob-Gyn 3306 Russia Blvd City, CA 90002 CT 543 25 Not Included1.0(25 x 1.9 = 47.5/40=1.2=1.0)5) Y. Zhivago, D.O. 4 Fam. Prac. 99 Bones Drive City, CA 90003 CT 5390---0.0(0/40=.0)

FTEs - Low-Income Designation Total Physicians: 5 Total Low-Inc FTE: 1.615=1.6 1 Dr. Scully spends 10 hours/week doing research.2 Dr. Spock chooses to work only 15 hours/week.3 Dr. Welby has an unknown number of hospital inpatient hours so the adjustment factor is used4 Dr. Zhivago spends full-time in administration.III-*

Physician NameHours of Direct Pt. Care/Week Hosp. Hours FTE %Medi -Cal%SFS% of Low-IncomeTotal Low-Inc FTE1) L. McCoy, D.O. 48Included1.064%15%79%(64%+15%=79%)0.79(.79 x 1.0 = .79 )

2) D. Scully, MD 1 30Included0.7535%8%43%(35%+8%=43%)0.32(.43 x .75 = .32)3) B Spock, M.D. 215 Included0.37560%40%100%(60%+40%=100%).375(1 x .375 = .375)4) M. Welby, M.D. 325 Not Included(25x1.9= 47.5/40= 1.2)1.013%0%13%0.13(.13 x 1=.13)5) Y. Zhivago, D.O. 4 0Included0.00%0%0%0.00

Survey Physicians to Determine Their FTE Survey all primary care physicians in service area Must attempt to contact physician at least 3 times Minimum two-thirds response rate requiredCalculation of Non-Responders Ex: Elk Grove, California - 20 providers15 - respond to survey 5 - no response after repeated telephone calls Response rate 15/20 = 75% Total FTE for the 15 responders= 9.5 Left off

1) Divide FTE of responders (9.5) by the number of responders (15) for the average FTE of responders (.63)

2) Multiply number of non-responders (5) by the average FTE of responders (.63) for FTE of non-responders (3.16=3.2)

3) Add FTE of responders (9.5) and non-responders (3.2) for total FTE = 12.7 Average response rate applied to non-respondersIII-*

STEP 4Calculate the population to provider ratio.III-*

Population to Provider Ratios

Civilian Population Ratio:Civilian Population = 20,900Primary Care Physician FTE = 3.8 (20,900 / 3.8 = 5,500:1)

Civilian Population (High Needs) Ratio:Civilian Population = 20,900Primary Care Physician FTE = 6.9 (20,900 / 6.9 = 3,029:1) (100% Federal poverty level at 21.1%)

Low Income Population (200% Poverty) Ratio:Low Income Population = 10,137 (49.47%)PC Physician Serving that Population = 1.6(10,137 / 1.6 = 6,336:1)III-*

What to Include in the Population to Provider Ratio Primary Care Section of your ApplicationPopulation

Cover letter with summary findingsTotal adjusted populationSource of data and methodology if using source other than Claritas

List of ProvidersInclude the Following for Each Provider:Name Location: Non-metro areas - name of town Metro areas complete address with zip code, and CT if available Degree (M.D. or D.O.)Specialty (GP, FP, OB-GYN, IM, PEDS, Gerontology)Average number of hours per week in direct patient care in the areaInpatient care hours or adjustment to total hoursPercentage of practice that is Medicaid (for low-income and Medicaid-eligible designations)Percentage of practice that is Sliding Fee Scale (for low-income designations)FTE total for each provider rounded to the nearest tenth of a percent Description of how information was obtained (sources, methods of gathering data)

Totals and RatioTotal number of providersTotal FTE Population to provider ratio Explanation of any high need indicatorsIII-*

Contiguous Area ResourcesIII-*

Contiguous Area ResourcesObjective:Participants will understand how to identify contiguous areas, determine if they have resources, and if the resources are excessively distant, overutilized, or inaccessible to the population of the area proposed for designation.

Purpose of Contiguous Area Analysis: To identify nearby sources of care and determine if they are inaccessible to the population in the proposed service area

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STEPS1) Identify the boundaries of each contiguous area.

2)Evaluate each area to determine availability of resources.

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1) Identify the Boundaries of Each Contiguous AreaIdentify on a map the boundaries and population center of the proposed service area.Determine the contiguous areas in all directions within 30 minutes from the proposed areas population center.Map the boundaries of each contiguous area in all directions (North, East, South, & West).The boundaries of contiguous areas are often (not always) based on the same census delineation as the proposed area:

Proposed service area = whole countyContiguous areas = whole counties

Proposed service area = census tracts (MSSA)Contiguous areas = census tracts (MSSA)III-*

2) Determine Availability of Resources A.Check the HPSA list to determine if any of the contiguous areas are designated as HPSA and therefore considered inaccessible.

If it is not inaccessible HPSA, then

B.Determine if there are significant socio-economic/demographic disparities or physical barriers.

If there are not significant socio-economic/demographic disparities orphysical barriers, then

C.Determine if the contiguous areas providers are located > 30 minutes away from the population center of the proposed area and are therefore inaccessible due to excessive distance.

If they are not excessively distant, then

D.Determine if the resources in the contiguous area exceed the population-to-provider ratio and are therefore overutilized.

If they are not overutilized, this area cannot be designated.

(Consider a different kind of designation.)

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A. Check the HPSA Status of Each Contiguous Area and Determine if This Type of HPSA Is Inaccessible to the Proposed Area

If the proposed service Then the contiguous area area is: is inaccessible if it is a:

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Geographic without high needsGeographic HPSAGeographic with high needsGeographic HPSA, Low-Income HPSA (based on 100% poverty indicator > 20%)Low-Income HPSAGeographic HPSA, Low-Income HPSA

B. Determine if Significant Socio-Economic/DemographicDisparities or Physical Barriers ExistSignificant demographic disparities between the population in the service area and the population in the contiguous area result in the population being isolated from nearby resources

(A 2 * N or plus 15% for percentages below 15 to determine disparity between the population in the service area and the population in the contiguous area) Significant socio-economic disparities: 100% poverty rate or 200% poverty rate (A 2 * N or plus 15% for percentages below 15 to determine disparity between the poverty in the service area and the poverty in the contiguous area)Significant physical barrier: mountains, large parks, bodies of water, highways, railway yards, industrial areas, etc. result in the population being isolated from nearby resourcesIII-*

B. Determine if Significant Socio-Economic/DemographicDisparities or Physical Barriers Exist (continued)Rule of Thumb: 2 * N with poverty or plus 15% for percentagesbelow 15.Examples:

Note: Using the lower number between proposed areas and contiguous areas for calculating disparity is suggested.

III-*Proposed Area: MSSA 78.2b Pico-Union in Los Angeles County

Summary: Civilian Pop: 146,918Below 200% Pov: 68.95%Below 100% Pov: 33.76%White Pop: 33.21%Black Pop: 6.23%Hispanic Pop: 70.11%MSSA 78.2v Carson/Compton West/RanchoDominguez: 2* 29.40= 58.8%, is there a disparity here?

Summary: Civilian Pop: 106,413 Below 200% Pov: 29.40% Below 100% Pov: 9.75%White Pop: 24.24% Black Pop: 21.80% Hispanic Pop: 40.19%HPSA: NoIf looking at the 100% pov., 9.75+15=24.75%, is there a disparity there?

C. Determine if Providers are Excessively Distant1) Develop a list of providers in the contiguous area 2) Map their office locations 3) Contiguous area will be measured from the same starting point (which is the population center of the proposed area)

Providers > 30 minutes from the population center are excessively distant

Primary Health Care: > 30 minutes Interstate Roads - 25 miles X 1.2 = 30 minutes Primary Roads - 20 miles X 1.5 = 30 minutes Secondary Roads - 15 miles X 2.0 = 30 minutesIII-*

Service Area Travel CalculationPrimary Health Care

Interstate Roads: 25 miles X 1.2 = 30 minutes

Primary Roads (include surface streets): 20 miles X 1.5 = 30 minutes

Secondary Roads (mountainous terrain or unpaved road): 15 miles X 2.0 = 30 minutes Dental and Mental Health Care Interstate Roads: 30 miles X 1.33 = 40 minutes Primary Roads (include surface streets): 25 miles X 1.6 = 40 minutes Secondary Roads (mountainous terrain or unpaved road) 20 miles X 2.0 = 40 minutesIII-*

Determine if Providers are Excessively Distant (continued)

Inner Portions of Metropolitan Areas:

Distance is based on time using public transportation* during non-rush hour.

Bus routes and schedules must be described (provide narrativedescription and include bus schedule if possible).

Public Transportation can be used only in Inner City/Metro areas for Geographic designations, where the 100% poverty rate is 20%, or for Population designations regardless of the 100% poverty rate.

If the MSSA doesnt meet this requirement the next step is to show that there is a 30% or greater public transportation ridership use in the MSSA and Provide documentation to back up the claim.

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D. Determine if Contiguous Areas are Overutilized

Calculate FTE - use same method as used for the proposed service area.

If needed, survey providers and determine FTE serving the population. Use same surveying method as used for the proposed service area. If applying for low-income designation, gather Medi-Cal and sliding fee scale percentages to calculate low-income FTE.

Explain how the information was obtained and calculated, and include population, total FTE, and population to provider ratio.

In contiguous areas, calculate the population to provider ratio counting each provider as 1.0 FTE. If area meets ratio of > 2,000:1, do not survey (Geographic only).Population to Provider Ratio: PRIMARY HEALTH CARE: > 2,000:1 primary care physician

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Determine the Nearest Source of Non-Designated Care

Needed for HPSA score:

Geographic Designation: Can be in a Low-Income HPSAPopulation Designation: Cannot be a HPSA (of any type)Cannot have significant socio-economic/demographic differences or physical barriersCan be excessively distantCan be overutilized

For all applications:

Provide a road map with the proposed service area and contiguous areas outlined.On the map, indicate the population center of the proposed service area, the nearest source of care, and the route between these points.Provide the name, phone number, specialty, and address of the nearest source of care, route, miles, and minutes.

For inner portions of metropolitan areas, include:

Bus route information from the population center of the proposed area to the nearest source of care including miles and minutes of travel time.

For population center info: http://oshpd.ca.gov/HWDD/MSSA/index.html

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Time Saving Tips

Survey providers only if necessary:

In contiguous areas, calculate the population to provider ratio counting each provider as 1.0 FTE. If area meets ratio of > 2,000:1, do not survey (Geographic only).

Collect all possible information in one survey (e.g. Medi-Cal and sliding fee scale even for an area designation).

Work with State licensing department to obtain information on providers.

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What to Include in the Contiguous Area Resources Section of Your ApplicationMap with Census Delineations

Name and boundaries of proposed service area Name and boundaries of contiguous areas Population center for the proposed service area Helpful: current designation status of each of the contiguous areas

Road Map

Outline of proposed area boundaries Location of nearest source of non-designated care For automobile transportation a copy of Google map with route details For public transportation start and end points of route

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For Contiguous Areas that are not Excluded with Current Designations and Whose Providers are Excessively Distant

Travel time to closest provider from population center of service area, including miles, route, and type of road; or public transportation information, including bus routes, start/end points, miles, minutes, and source.

For Contiguous Areas that are not Excluded with Current Designationsand have Access Barriers

Description of any significant socio-economic/demographic disparities (e.g., demographic data on racial/ethnic composition or income levels comparing proposed service area population to population in the contiguous area, and source of data), or Description of any significant physical barrier

For Contiguous Areas that are not Excluded with Current Designations and are Overutilized

Population to provider ratios, andDescription of how information was obtained

What to Include in the Contiguous Area Resources Section of Your Application (continued) III-*

For All Designation Requests:

For Public Transportation Routes:

Travel time, based on non-rush hour bus schedules (i.e. 10:00 am) Start/End point of route Include time waiting for transfers while in route Map showing proposed area boundaries, start and end points of bus route Provide source of information

(Public Transportation can be used only in Inner City/Metro areas for Geographic designations, where the 100% poverty rate is 20%, or for Population designations regardless of the 100% poverty rate.)

Address of nearest source of non-designated, accessible care, including address, miles and minutes via public transportation if metropolitan area Location of nearest source on road map (see above)What To Include In The Contiguous Area Resources Section of Your Application (continued) III-*

WebsitesCalifornia Public Transit Information and Maps:http://maps.google.com

2000 CT Locator:http://www.ffiec.gov/Geocode/default.aspx

U.S. Census Bureau American Factfinderhttp://factfinder2.census.gov/faces/nav/jsf/pages/index.xhtml

MSSA Data:http://oshpd.ca.gov/HWDD/MSSA/index.html

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Geographic PC PHYSICIAN SURVEY SAMPLEIII-*

LOW-INCOME PC PHYSICIAN SURVEY SAMPLEIII-*

APPLY FOR DESIGNATION No ContiguousArea ConditionsMet1or more Contiguous Area ConditionsMet for EACH Contiguous AreaEvaluate ContiguousAreaSTOP:Area Not QualifiedFor DesignationCalculate Population-to-Physician RatioDefine Rational ServiceAreaDetermine Physician FTEsDetermine Service AreaPopulationEvaluate Service Area for High-Need IndicatorsSTOP:Area Not QualifiedFor DesignationSTOP:Area Not QualifiedFor DesignationNo HighNeed IndicatorsPresent1 or more High-Need IndicatorsPresentProcess Model for Geographic Primary Care Health Professional Shortage Area DesignationTo Use: Follow arrows. Numbers are reference citations only. Refer to correspondingly numbered pages following for additional information on steps in numbered boxes23 4691598Ratio < 30009Ratio 3000-3499Evaluate Contiguous Area51 or fewerInsufficientCapacityIndicatorsPresent2 or moreInsufficientCapacityIndicatorsPresent1 or more ContiguousArea Conditions Met for EACH ContiguousAreaNo ContiguousArea ConditionsMetSTOP:Area Not QualifiedFor Designation9APPLY FORDESIGNATION8 Ratio >3500Evaluate forInsufficientCapacity

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