Nebraska Loan Repayment Programs are Successful and A

Nebraska Loan Repayment Programs are Successful and A Good Investment Helping People Live Better Lives. 1

Health Professions Tracking Service HPTS: History • Organized in 1995 • Collaborative effort between University of Nebraska Medical Center Nebraska DHHS Office of Rural Health • Goal Document the current practice location and retention of physicians in the State of Nebraska Helping People Live Better Lives. 2

Health Professions Tracking Services • Designed to provide information not available through: • Nebraska licensure • State and federal agencies • Associations • Information databases Helping People Live Better Lives. 3

HPTS data • Enables decision makers, researchers, healthcare providers & businesses to focus on their mission • We utilize this information for designation of state and federal shortage areas Helping People Live Better Lives. 4

HPTS Survey • Surveys are tailored to the profession and facility type • Keep to the basics • Information requested includes, but is not limited to: Professionals • Demographic information • Educational background • Professional status (FT, PT, retired, etc. ) • Practice locations – primary & satellite • FTE - practice location hours • Primary specialty • Practice specialties • Preferred contact address (facility or residential) • National Practitioner Identification (NPI) Facilities • Location address (mapping & mailing) • Telephone number • Fax number • Professionals (primary & satellite) Helping People Live Better Lives. 5

HPTS Professionals- 2019 1. Physicians (MDs, DOs and TEPs) 2. Advanced Practice Registered Nurses (NPs, CRNAs, CNSs, CNMs) 3. Physician Assistants 4. Dentists 5. Pharmacists 6. Behavioral Health Professionals (Psychologists, LIMHPs, LADCs, CMSWs) 7. Physical Therapists and Occupational Therapists Helping People Live Better Lives. 6

Diligent Persistence… Dedicated Staff… • Work closely with NE DHHS, Office of Rural Health • Surveys - professionals & facilities • Licensure comparisons (continuous) • Returned mail notifications • Articles/advertisements • Telephone verifications • “Good Will” notifications • Internet research Helping People Live Better Lives. 7

Physicians (MD/DO/TEP) Licensed in NE August 2018 60% 50% 49% 42% 40% 30% 20% 10% 3% 4% 1% 0% Column 1 Practice in NE Retired/Inactive/New Field Helping People Live Better Lives. 8

Quality data does not just happen… It is the result of dedicated resources & staff and we all contribute Helping People Live Better Lives. 9

Nebraska State Shortage Area Process • Every 3 years - State Office of Rural Health gets latest information from HPTS • FTEs are stripped of ER time and other specialty work and normalized to a 40 hour week • High needs indicators included • Maps are created and made available for public comment Helping People Live Better Lives. 10

Example of Information shared with Critical Access Hospital Administrators Helping People Live Better Lives. 11

Nebraska State Shortage Areas All incentive programs require practice in a shortage area, but shortage areas are different for each specialty (and for state and federal programs) Rural Health Advisory Commission designates state shortage areas in Nebraska and selects state Loan Repayment recipients Available Online: http: //dhhs. ne. gov/Pages/Rural-Health-Eligible. Disciplines-and-Shortage-Areas. aspx Helping People Live Better Lives. 12

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STATE of NEBRASKA Loan Repayment Programs Helping People Live Better Lives. 14

Loan Repayment Programs For eligible licensed health professionals (do not have to be a Nebraska resident or graduate of a Nebraska college) Helping People Live Better Lives. 15

Student Loan Debt by Profession Average Range Dentists $270, 395. 00 $103, 730 -$464, 822 MD/DO $216, 951. 00 $63, 915 -$461, 038 PA $97, 043. 00 $34, 542 -$197, 443 LMHP $93, 098. 00 $11, 000 -$208, 000 Pharmacists $126, 994. 00 $59, 974 -$195, 903 Helping People Live Better Lives. 16

State Managed Loan Repayment Programs Requirements • Providers must have an employer and local match lined up • Local entity (employer or a community foundation) must agree to provide local match and verify practice • Local entity fills out the second half of the application • Loan requirements • must be Government or Commercial educational loans • only educational loans to student in student’s name are eligible • loans to parents, consumer loans (ex: credit card), mortgage loans, and private loans are not eligible Helping People Live Better Lives. 17

State Managed Loan Repayment Programs Other Requirements • 2 -4 year practice obligation in a designated shortage area • Must be licensed to participate, but can apply up to 18 months in advance of being fully licensed (waiting list) • Must be a US Citizen/National (or legal resident for the state program) • Cannot participate in multiple programs simultaneously Helping People Live Better Lives. 18

State Managed Loan Repayment Programs Benefits • Maximum of $100, 000 - $200, 000 over 2 -4 years for physicians, dentists, and psychologists • Maximum of $50, 000 - $100, 000 over 2 -4 years for all other eligible professions • Loan repayment no longer taxable income (effective January 1, 2009 as per P. L. 111 -148, 3/23/10) Helping People Live Better Lives. 19

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Federal Shortage Areas are designated using the federal criteria which is more challenging to meet than Nebraska state shortage area criteria which is based on the ratio of provider to population ratios to eliminate health care provider access at the county level. Helping People Live Better Lives. 27

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What are we doing to assist rural and underserved communities in Nebraska • We work with health care providers and communities to match the resources we are given to maximize the effects of each loan repayment program. • We work with training programs, Area Health Education Centers, Rural Health Advisory Commission and others to aid the pipeline of health care providers to underserved areas. Helping People Live Better Lives. 31

Recruitment and Retention • We can assist by approving positions openings on the Rural Recruitment and Retention Network (www. 3 rnet. org) • We survey and monitor the retention of obligated healthcare providers through HPTS and Retention Management System. Helping People Live Better Lives. 32

Where to Look for a JOB These recruitment web sites are focused on serving the underserved and many times will provide assistance with student loans. • National Rural Recruitment and Retention Network https: //www. 3 rnet. org/ • National Health Service Corps – NHSC Connector https: //connector. hrsa. gov/connector/ Helping People Live Better Lives. 33

Healthcare Professional Data Rural Nebraska • 2016 vs 2017 MDs - Rural Nebraska 2016 - 992 2017 - 987 Net Change - decrease of 5 The decrease of 5 is actually made up of: - 87 + 82 MDs no longer identified as practicing in Rural NE MDs identified as newly practicing in Rural NE 169 Actual Change Helping People Live Better Lives. 34

Healthcare Professional Data 2016 vs 2017 MDs - Rural Nebraska - 87 MDs not longer identified as practicing in Rural NE 26% retired, 5% deceased, 6% license inactive, 9% move to Urban NE, 28% left NE, 26% unknown can also identify – Age brackets, specialties, education location + 82 MDs identified as newly practicing in Rural NE Age brackets, specialties, education location Helping People Live Better Lives. 35

100% Percentage antcipating remaining 90% NHSC Loan Repay (n=638) 80% 70% 60% NHSC Scholar (N=56) 50% 40% 30% Nebraska LRP (n=39) 20% 10% Nebraska Student Loan Prog (n=14) 0% 0 1 2 3 4 5 6 7 8 9 10 Years after service term Helping People Live Better Lives. 36

Multi-State Retention Collaborative and Data Management System 2013 - 2019 Helping People Live Better Lives. 37

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Questions? Contact: Tom Rauner or Rachael Wolfe 402 -471 -2337 Thomas. Rauner@Nebraska. gov or Rachael. Wolfe@Nebraska. gov Helping People Live Better Lives. 39