January 22, 2018

MEETING ANNOUNCEMENT 

Hawaii Medical Education Council
Monday, January 22, 2018
7:30-9:00 am

John A. Burns School of Medicine
Kaka`ako Campus
651 Ilalo Street, Medical Education Building
Room 202

Parking Reserved in LOT B for RSVP’s

AGENDA

Hawai‘i Medical Education Council (HMEC)
University of Hawai‘i, John A. Burns School of Medicine
Date: Monday, January 22, 2018, 7:30 a.m. – 9:00 a.m.
Location: 651 Ilalo Street, Kaka‘ako Campus, Medical Education Building, Room 202
Honolulu, Hawaii 96813

1. Review & Approval of October 13, 2017 Minutes – Dr. Hedges

2. Report from HMEC Chair – Dr. Hedges

3. Legislative Strategies – Dr. Jerris Hedges & Cynthia Nakamura

4. Physician Workforce & related discussions

a. Data / maps update – Dr. Kelley Withy

i. Population distribution on the different islands so we can better understand these numbers and help identify shortages.
ii. How many providers per population, by specialty (keep it at X per 100,000 for specialists)
iii. Determine a threshold so we can act proactively.
iv. Can we track physician ages?

b. Develop a framework and set goals (by specialty, by island), then prioritize which specialties to focus recruitment and retention efforts
c. Determine a shared definition for workforce similarly to how the Chamber of Commerce is discussing the definition of the medical home.
d. Working group to discuss how DOH, DHS and other agencies can capitalize on resources to get the right services to areas of need

5. GME Task Forces Update – Dr. Lee Buenconsejo-Lum

6. Follow-up to final 2017 HMEC report

RECOMMENDATION #1
UH JABSOM/HMEC recommends that UH JABSOM and the legislature work with vital stakeholders to identify options for funding GME and the return on investment to the state of Hawai‘i in funding GME.

RECOMMENDATION #2
UH JABSOM/HMEC recommends that the 2018 State Legislature assess the advisability and feasibility of an annual GME Appropriation to fund HMEC designated residency/fellowship programs with a particular emphasis on primary care.

RECOMMENDATION #3
UH/HMEC recommends that the 2018 State Legislature and State Executive Branch support the State Department of Human Services and UH JABSOM to work together to develop a State Medicaid GME Matching program to augment GME funding.

RECOMMENDATION #4
UH/HMEC recommends that the 2018 State Legislature, UH JABSOM, the Hawai‘i Medical Association and other stakeholders explore potential remedies or reforms to protect residents and fellows from being named in malpractice suits while they are in a formal training program and providing care under the supervision of a fully licensed attending physician.

7. Announcements:  Next HMEC Meeting – Monday, April 23, 2018 @ 7:30am in MEB 202

8. Adjournment

MINUTES

Hawaii Medical Education Council (HMEC) Meeting
January 22, 2018 Time: 7:30-9:00 a.m.
John A. Burns School of Medicine , Room MEB 202
651 Ilalo Street, Medical Education Building, Honolulu, Hawaii 96813

Members Present: Mary Ann Antonelli (for William Dubb, representing federal healthcare sector), Katherine Finn Davis (for Mary Boland, representing the School of Nursing), Christopher Flanders (representing health professions community), Jami Fukui (for Randall Holcombe, representing the UH Cancer Center Director), Dean Jerris Hedges (Chair, JABSOM), Allen ”Chip” Hixon (representing the health professions community), Mark Mugiishi (representing health professions community), J. Alan Otsuki (Associate Dean for Academic Affairs, JABSOM), Virginia Pressler (department of health, director), Kenneth Robbins (representing hospital conducting ACGME programs), and Sharon Vitousek (representing health professions community).

Members Absent: William Dubbs (representing federal healthcare sector), Lisa Rantz (representing person of the general public community), and Paula Yoshioka (representing hospital conducting ACGME programs).

Others in Attendance: Cynthia Nakamura, Holly Olson, Richard Philpott, Linda Rosen (HHSC), and Kelley Withy (Director, JABSOM Area Health Education Center).

HMEC Administrator: Lee Buenconsejo-Lum, UH JABSOM Designated Institutional Official (DIO) for Graduate Medical Education Recorder: Crystal Costa

TOPICDISCUSSION / CONCLUSIONS / ACTIONS / DECISIONSTASKS
1.    Review of Minutes Minutes were reviewed and approved as is from last meeting on 10/13/17. Motion to approve came from V. Pressler and second by S. Vitousek. Motion to approve carried unanimously. No opposed and one abstention from C. Flanders who did not attend the 10/13/17 meeting.NA.
2.    Chair ReportAnnouncements:NA.
Dean J. Hedges1.       Dean Hedges announced that we were entering the legislative session with what seems to be a strong economy for the state of Hawai`i which helps planning for future long-term strategies and investments.
2.       We seem to have a clear pattern and projected vision from the Governor and other key legislators to continue the health missions.
3.       We would like to keep up the momentum to see what we can do differently to help while focusing on increasing retention and recruitment rates/efforts.
4.       Introduced Dr. J. Alan Otsuki, as JABSOM’s new Associate Dean for Academic Affairs, replacing Dr. P. Blanchette who was serving as the interim Associate Dean for Academic Affairs at JABSOM. She will continue at JABSOM and participate with HMEC as the JABSOM Associate Dean for Clinical Affairs.
3. Legislative Strategies Current legislative update is as follows:Ongoing discussions.
1.       2018 session started Wednesday, 1/17/18 with Scott Saiki as the new speaker of the house. He is generally in favor of the medical school and our efforts. 
Dean J. Hedges2.       House of Representatives new chair for Health and Human Services committee is Representative John Mizuno. Senator Ros Baker continues as the chair of the Senate Commerce, Consumer Protection and Health committee. Both legislators are and have been supporters of our medical school efforts and we look forward to continued favorable working relationships with them.  
& Cynthia Nakamura3.       Legislative initiatives include:
a.       Preceptor tax credit bill that would provide a $1000 tax credit to preceptors for every student they teach. Currently these bills (introduced by John Mizuno for HB #1967, and Senator Ros Baker for SB #2298), cover volunteer preceptors for 4 professions that have accredited training programs in Hawaii [APRN (nursing), Dental Hygienists, Medical Students/Residents (doctors), and Pharmacy]. There is also a recommendation to expand these bills to include social workers. Dr. Flanders also recommended adding Physician Assistants to the bill. A task force is proposed to draft verbiage and details that might favor those preceptors practicing in neighbor islands and rural Oahu, targeting the highest areas in need. Three states have successfully implemented similar tax credits.
b.       The Family Medicine (FM) program is working on securing $1M in state funding to assist in the relocation of the Family Medicine clinic in Mililani to the Pali Momi Pavilion (same location as the UHP OB clinic). An application for a grant in aid was submitted. Representative Yamane additionally recommended and drafted a bill to help secure funding that could flow through the DOH. FM anticipates that some patients would relocate with the clinic and some may remain in Mililani. Dr. Hixon noted that there are still options to explore for the current Mililani clinic before discussing its possible closure. He noted the value of a primary care clinic in Central Oahu. If economically feasible, he would like to see both locations remain open to meet the needs of the local patients. The FM program plans on addressing the affected communities at future neighborhood board meetings. Currently, the project is a joint venture (public and private) with Hawaii Pacific Health that has remained supportive and a strong ally for the Family Medicine program.
c.        Dean Hedges informed the HMEC of a wound care program being developed that would include using the Hyperbaric Treatment Center (HTC). Loss of HTC services came suddenly last October due primarily to a lack of physician availability to support 24/7 service. JABSOM has been refocusing efforts on the HTC to create a more fiscally sustainable out-patient business model. A legislative request for transition money (via grant-in-aid) would help to provide better access to wound care and diving injuries while providing training for providers and potentially requiring dive shops to purchase insurance that would cover customer injuries. Presently, excepting Kaiser, only QMC has the capacity to offer chronic wound treatment to patients, but their focus is on following those who receive/received inpatient services. Time will be needed to market this strategy, generate funding to sustain this operation and develop/increase the workforce to provide these HTC-related services.
d.       Opioids are a hot topic this year. Dr. Pressler and the DOH have posted training and monitoring requirements on their website regarding opioid education, usage, and addiction. JABSOM is currently assembling an inventory of topics and curricula used in education of students, residents/fellows and faculty. The inventory will be used to illustrate how JABSOM is addressing this issue and identify additional opportunities or needed resources that should be incorporated into the various curricula.
e.       Dean Hedges informed the HMEC that we may see future legislation introduced to minimize residents/fellows being named in lawsuits, while in their capacity as a trainee. Richard Philpott (Hawaii Residency Programs) will continue to work with advocates to explore the feasibility of a legislative solution to address this growing problem, and will provide periodic updates. The council should be aware of this issue and potential negative impacts related to physician recruitment and retention.
The physician licensing survey has been released and data is currently being collected. Data and numbers will be provided at our next meeting in April. Dr. Withy to provide regular updates.
4. Physician Workforcea.       Council reviewed maps provided by Dr. Withy depicting the primary care provider supply by region per 10,000 people, and the general surgery specialty and infectious disease specialty by island per 100,000 people.
b.       Survey data indicates that where the physician practices is not necessarily where they live.
Kelley Withyc.        Maps indicated that Kauai is the only island thus far that has increased their providers over the last year.
d.       A minimum threshold needs to be established so we can identify areas that need to be targeted. The current data does not separate visitors/tourists from general population.
e. 2015 data from Medicare, HMSA, Kaiser and Aloha Care are now ready for Dr. Withy and team to review per island. Currently, the recommended panel size is 2,000 patients per physician, but the size may vary depending if care is delivered by a health care team or by solo physician providers. Dr. Withy and team will take a deeper dive with the numbers to try and identify the number of patients per physician. Dr. Withy confirmed that the VA physicians are included in these numbers but not TAMC.
Next steps would be to:
a.       Translate data and shortages to outcomes.
b.       Identify physician shortages by island and specialty so that residencies and fellowships could consider targeting clinical experiences in these locations of need.
c.        Collect payer data from the DHS.
d.       Develop a working group on Telehealth/Telemedicine.
5. GME Strategic Planning Report Dr. Buenconsejo-Lum reviewed progress made by 6 GME Task Forces that were identified at the GME Strategic Planning meeting last July.
1.       Neighbor Island:
L. Buenconsejo-Lum a.       Working with HHSC and continuing to build telemedicine opportunities as part of the State’s telehealth strategic plan.
b.       Continuing discussions with the VA to maximize residents/fellows working in VA clinics and in potential future VA programs that may develop as the VA diversifies ways to provide care to veterans.
2.       Preventive Medicine/Population Health/Behavioral Health:
a.       ACGME has a new requirement that the major training sites share population health data (patient safety and quality reports) with GME programs at least annually.
b.       We will be asking programs to identify which types of information are most relevant to their GME program such that the programs can work in conjunction with health systems on patient safety or quality improvement priorities. For some programs, this includes payment transformation efforts.
c.        We continue to expand existing curricular experiences to better incorporate inter-professional education (IPE) in the clinical settings, including training on any new protocols derived from patient safety or quality issues.
3.       Burnout Prevention/Promoting Well-Being:
a.       The Cardiology Fellowship at Queen’s is instituting Schwartz Rounds (national model) that allows a large inter-professional group to have a structured discussion and debrief on difficult cases, with a focus on the health providers’ personal reflections/psychosocial impact. This format helps to reinforce humanism in medicine across the numerous health professions involved in the care of very complex patients.
b.       A baseline survey will be conducted to assess well-being and the clinical learning environment across all GME programs. Some of the well-being questions will be similar to surveys of graduating medical students so that results can be analyzed across the continuum of medical student and GME.
c.        An overall goal is for training programs to be included in their health system’s well-being initiatives, as well as preparing them to be comfortable practicing in the emerging health care delivery models.
4.       Loss of TY program: Program will no longer be active after this academic year.
5.       Resources:
a.       Focusing on strengthening and growing the faculty practice plans; bridging junior faculty positions post-residency; and expanding certain specialties to help with neighbor island health needs and potentially serve as future training sites for residency rotations.
b.       Continue working with the VA (as above).
c.        Continue discussions with HHSC for neighbor island rotations and, for high malpractice risk specialties, explore options to mitigate the risks of large claims (involving residents) financially impacting the Oahu HRP hospitals (QHS, HPH, and Kuakini).
d.       Explore the possibility of payment transformation efforts and dollars to help offset some GME expenses if residents are actively involved in panel management.
e.       Legislative preceptor tax credit bill, possible future bills to prevent GME trainees from being named in lawsuits, indemnifying care provided by GME trainees (working under credentialed faculty).
6.       Retention:
a.       Working with the Hawaii Physicians Recruiters Group on some educational programs that may help residents make decisions about future practice options.
b.       Continue to work on a more robust transition-to-practice curriculum.
c.        Explore the possibility of a “Doctor’s Club” or similar social networking for young physicians/residents, in conjunction with efforts spearheaded by the Hawaii Medical Association, AHEC, and commercial sponsors.
6. HMEC ReportRecap of 2018 HMEC recommendations to legislature:Lee will continue to seek input from HMEC members and provide updates at future meetings.
1.       RECOMMENDATION #1: UH JABSOM/HMEC recommends that UH JABSOM and the legislature work with vital stakeholders to identify options for funding GME and the return on investment to the state of Hawai‘i in funding GME.
L. Buenconsejo-Lum2.       RECOMMENDATION #2: UH JABSOM/HMEC recommends that the 2018 State Legislature assess the advisability and feasibility of an annual GME Appropriation to fund HMEC designated residency/fellowship programs with a particular emphasis on primary care.
3.       RECOMMENDATION #3: UH/HMEC recommends that the 2018 State Legislature and State Executive Branch support the State Department of Human Services and UH JABSOM to work together to develop a State Medicaid GME Matching program to augment GME funding.
4.       RECOMMENDATION #4: UH/HMEC recommends that the 2018 State Legislature, UH JABSOM, the Hawai‘i Medical Association and other stakeholders explore potential remedies or reforms to protect residents and fellows from being named in malpractice suits while they are in a formal training program and providing care under the supervision of a fully licensed attending physician.
7. Announcements·         Next HMEC meeting: Monday, April 23, 2018 at 7:30 am, JABSOM MEB 202.
8. Adjournment·         Meeting adjourned by Lee Buenconsejo-Lum at 9:00 am.