Policy 101: What are medically underserved communities?

Hub on Provider Status

Federal provider status recognition legislation was introduced as H.R. 4190 in the last Congress by Reps. Brett Guthrie (R-KY), G.K. Butterfield (D-NC), and Todd Young (R-IN) on March 11, 2014, and is expected to be reintroduced—with a new bill number—in this Congress. The legislation would amend Title XVIII of the Social Security Act to enable patient access to, and coverage for, Medicare Part B services by all state-licensed pharmacists who practice in “medically underserved communities.” 

What are medically underserved communities? The legislation specifically references Medically Underserved Areas (MUAs), Medically Underserved Populations (MUPs), or Health Professional Shortage Areas (HPSAs), which are defined and designated by the Health Resources and Services Administration (HRSA) in the U.S. Department of Health & Human Services.

Pharmacists can find out if they practice in an MUA, MUP, or HPSA on the HRSA website.

Shortage designation: Combination of factors

The HRSA designations aren’t just about not enough physicians. Rather, they are the result of a combination of factors, according to the HRSA website.

MUAs and MUPs are areas or populations that have too few primary care providers, high infant mortality, high poverty, and/or high older adult population. In MUAs—including a whole county, a group of contiguous counties, a group of county or civil divisions, or a group of urban census tracts—residents have a shortage of personal health services. MUPs may include groups of persons within an area of residence who face economic, cultural, or linguistic barriers to health care.

HPSAs have shortages of primary medical care, dental, or mental health providers and may be geographic (a county or service area), demographic (low-income population), or institutional (comprehensive health center, federally qualified health center, or other public facility). In short, HPSAs may be urban or rural areas, population groups, or medical or other public facilities.

Medically underserved communities aren’t just very remote or rural. Many areas throughout the country, including inner-city urban areas, fall into MUAs, MUPs, and HPSAs. The areas so designated will likely increase as the shortage of primary care providers worsens as projected.

Practicing in an underserved community

El Rio Health Center—which serves the greater Tucson area and southern Arizona with 18 locations—is located in an area that HRSA designates as MUA, MUP, and HPSA (primary care, as well as mental health and dental provider shortages). 

“As health care continues to shift to outcomes-driven care, it is especially critical to have access to care for patients to hit quality outcomes, goals, and safety,” said Sandra Leal, PharmD, MPH, Vice President for Innovation at SinfoniaRx, former Medical Director of Clinical Pharmacists/Broadway Clinic at El Rio, and a longtime advocate for pharmacist provider status. 

“This legislation is critical for us because pharmacists can help fill gaps in care to improve access to care for patients,” said Leal. “This legislation will create opportunities for pharmacists to help alleviate the shortages that are currently happening in HPSA areas and MUA areas. Some of these areas are in remote rural areas where pharmacists are sometimes one of the few providers available to help patients.”

Health Partners of Western Ohio (HPWO) has four locations that are designated as primary care, mental health, and dental MUA, MUP, and HPSA, said Jenny Clark, BSPharm, HPWO Director of Pharmacy Services. “With Medicaid expansion in Ohio and patients getting insurance through the marketplace, more patients are presenting for care at a time when there are fewer primary care providers to meet their needs,” Clark said. 

“We are in medically underserved areas, so most of the time we don’t have physicians. We’re dealing with mostly nurse practitioners and physician assistants. So pharmacists are really able to integrate into the team,” said Josh Ebbing, PharmD, a clinical pharmacist at one of the clinics. “This legislation is vital to continue our incorporation into the health care team.”

“At our organization, we have people come in who have not seen a family provider in over 20 years, due to the lack of care in the community in which they live. This legislation would allow more patients the opportunity to get the care that they have been missing out on for a long time,” said Kyle Glasgow, PharmD, BCACP, a Clinical Pharmacy Manager and Residency Coordinator at another of the clinics. 

“Practicing with this community, it really allows you to form a unique bond with your patient because a lot of these patients have been failed so many other times in their lives,” Glasgow continued. “Once they do open up to you, it’s amazing how much they show you what you mean to them; how appreciative they are that they finally have a group of people who care about them. It makes it easy to go to work every day knowing the impact you can have on somebody’s life.”