January 28, 2019
Hawaii Medical Education Council
Monday, January 28, 2019
John A. Burns School of Medicine
651 Ilalo Street, Medical Education Building
Parking Reserved in LOT B for RSVP’s
Hawai‘i Medical Education Council (HMEC)
University of Hawai‘i, John A. Burns School of Medicine
Date: Monday, January 28, 2019, 7:30 a.m. – 9:00 a.m.
Location: 651 Ilalo Street, Kaka‘ako Campus, Medical Education Building, Room 202
Honolulu, Hawaii 96813
- Review & Approval of October 22, 2018 Minutes – Dr. Otsuki on behalf of Dr. Hedges (to be distributed via email to members)
- Report from HMEC Chair – Dr. Otsuki on behalf of Dr. Hedges
- Update on Legislative Strategies (with Cynthia Nakamura)
- Update on UHealthy Hawaii – Dr. Aimee Grace
- Physician Workforce Data Updates – Dr. Kelley Withy
- Data / Maps
- Healthcare Preceptor Tax Credits law – (Kelley Withy & Laura Reichhardt)
- Next Steps – Dr. Lee Buenconsejo-Lum
- HMEC Subcommittee Update
- Models to consider for supporting GME programs and/or expansion
- Follow-up to final 2018 HMEC report and recommendations to the 2019 Legislature
UH JABSOM/HMEC recommends that the 2019 State Legislature assess the advisability and feasibility of an annual and recurring GME Appropriation to support HMEC-designated residency/fellowship programs with a particular emphasis on primary care.
UH/HMEC recommends that the 2019 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-focused Matching program to augment GME faculty and resident/fellow funding.
UH/HMEC recommends that the 2019 State Department of Human Services and other stakeholders explore the mechanisms to obtain Federal Medicaid GME funding since many of the residency programs provide inpatient and ambulatory care for Medicaid populations.
- Additional Items
- Announcements – Next HMEC Meeting – Monday, April 29, 2019 @ 7:30am in MEB 202
Hawaii Medical Education Council (HMEC) Meeting
January 28, 2019, 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 (VA), Katherine Finn Davis via zoom (for Mary Boland, representing the School of Nursing), Christopher Flanders (representing health professions community), Jami Fukui (for Randall Holcombe, representing the UH Cancer Center), Allen ”Chip” Hixon (representing the health professions community), J. Alan Otsuki (Associate Dean for Academic Affairs, JABSOM), Lisa Rantz (representing person of the general public community), Kenneth Robbins (representing hospital conducting ACGME programs), Todd Seto (representing hospital conducting ACGME programs), and Joseph Sterbis (representing hospital conducting ACGME programs).
Members Absent: William Dubbs (representing federal healthcare sector), Dean Jerris Hedges (Chair, JABSOM), Lorrin Kim (for Bruce Anderson, representing the Department of Health), and Sharon Vitousek (representing health professions community).
Others in Attendance: Patricia Blanchette (Associate Dean of Clinical Affairs, JABSOM), Chip Ellis (UHP of Hawaii), Aimee Grace via zoom (UH Director of Health Science Policy), Marlene Keawe (Hawaii Residency Programs, COO), Cynthia Nakamura (Government Affairs and Legislative Consultant), Holly Olson (JABSOM), Linda Rosen via zoom (Hawaii Health Systems Corporation), Sydney Tatsuno via zoom (Hui Kahu Malama), and Kelley Withy (AHEC).
HMEC Administrator: Lee Buenconsejo-Lum, UH JABSOM Designated Institutional Official (DIO) for Graduate Medical Education
Recorder: Crystal Costa
|TOPIC||DISCUSSION / CONCLUSIONS / ACTIONS / DECISIONS||TASKS|
|1. Review of Minutes||Minutes from our last meeting, held on 10/22/18, were reviewed and also sent via email on 1/28/19. Motion to approve came from A. Hixon and second by C. Flanders. Motion to approve carried unanimously. No opposed and no abstentions.||NA.|
|2. Chair Report||a. Legislative strategy update for 2019 (Cynthia Nakamura):||FYI/Update.|
|J. Alan Otsuki on behalf of Dean J. Hedges||Since last session, the Committee on Health and Human Services has been separated into two committees with Representative Mizuno, now Chair of the Health Committee, and Representative San Buenaventura, Chair of the Human Services Committee. Representative Woodson is Chairing the Lower/Higher Education Committee and Representative McKelvey is now Chairing the Energy Committee. Representatives Mizuno and Woodson remain supportive of our Medical School efforts. Senate leadership changes include: Senator Baker remains Chair of the Commerce, Consumer Protection and Health Committee, Senator Mercado Kim is now Chair of the Higher Education Committee (noting that previous Chair, Senator Kahele remains a member on the committee), and Senator Dela Cruz remains Chair of Ways and Means Committee.|
|A number of bills have been introduced on behalf of JABSOM as the priorities for this legislative session:||Cynthia to send tracking list of bills to Crystal to share with HMEC attendees and make recommended edits to bills.|
|1) HB 902 and SB 1404 were introduced asking for $350,000 in state matching funds to continue the loan repayment program which is due to currently expire on June 30, 2019. We are also exploring the possibility of having this funding made permanent as part of the DOH budget. Additional bills introduced in support of the loan repayment programs include: SB 870 introduced by Senator Kanuha in the amount of $500,000.|
|2) SB 532 and SB 902 are Peer Review bills introduced to expand the definition of “physician” in the peer review chapter to include residents and fellows so they can be afforded the same protections under the peer review statute. These bills have not yet been scheduled for hearing.|
|3) HB 669, SB 825, SB 903 and SB 904 seek limited liability in terms of malpractice exposure for our residents/fellows. These bills are not tort reform, but rather seek to improve the environment for trainees which would help to encourage them to come to our programs and remain in Hawaii to practice after training. Lawsuits (or the threats of) negatively impact the overall practice environment and our ability to grow the physician workforce. In terms of the limited liability bills, we are seeking amendments to remove “the duty of care” language in section A and adding subsection D to at the end to define supervision that is aligned with the ACGME. Additional minor recommendations were made to provide clarity in section A (to change the “their” to “the person”) and to include adding “while participating in an ACGME training program”. Note that moonlighting is not mentioned nor intended in this bill. SB 903 and SB 904 have not yet been scheduled for hearing.|
|Note other bills of interest include: SB 1400 that makes an appropriation to support and expand the residency training programs in state teaching hospitals and SB 1409 to appropriate funds to JABSOM to study the impact and feasibility of creating a teaching hospital on West Hawaii.|
|b. UHealthy Hawaii – Vision for a healthier Hawaii and Pacific:|
|Dr. Aimee Grace, UH Director of Health Science Policy, shared the workforce initiative of UHealthy Hawaii, which focuses on the UH health sciences programs to working to improve healthcare in partnerships throughout the state. Four main priorities are to: 1) ensure a robust statewide workforce, 2) improve and extend lives (through research and innovation), 3) public health - promoting healthier families and communities, and 4) advance health policies. UHealthy Hawaii is currently sharing their vision with our legislature and various community members and has not submitted a formal request for funding. They are currently preparing a budget for their initiatives, working on language for federal appropriations for Senator Schatz’s office, exploring opportunities with the VA while also pursuing community funding partners and additional investors.|
|3. Physician Workforce||a. Shortage of physicians is at 513 if you go by the overall statewide analysis or 797 if you use the geographical and specialty analyses. Currently, there are 260 job openings advertised which, even if all were filled, will still not meet the needs of the communities. The shortages are calculated using a micro simulation model based on our state population demographics and that tells us how many physicians are needed for that population (797 to meet service needs). Currently the physicians we are training will replace the ones that are retiring (if they all stay in Hawaii), but there remains a gap. Also, given changing practice patterns, it may take more than 1 FTE to replace some of the current physicians who have been caring for large numbers of patients in their communities.||Ongoing updates to be provided by Dr. Withy.|
|Kelley Withy||b. Preceptor Tax Credit is applicable for those teaching primary care anywhere in Hawaii to students of JABSOM, Pharmacy, Nursing and AT Still schools. There is an online sign up (reviewed website). Physicians must attest that teaching is in primary care, voluntary, uncompensated, and declare how they want their tax statements processed when they sign up. The schools must enter the educational experience, the preceptors, and number of hours of teaching. At the end of the year, the physician can claim up to a maximum $5000 in tax credit on their taxes ($1000 for every 80 hours of time spent teaching). Note this is not a deduction, but rather a credit off the amount a person may owe on their taxes. For more information or any interested preceptors, please visit the website at: http://preceptortaxcredit.hawaii.edu/|
|4. Next Steps||HMEC subcommittee report:||Ongoing updates by Dr. Buenconsejo-Lum.|
|L. Buenconsejo-Lum||Continued work is needed in building collaborative partnerships statewide.|
|Models to consider for supporting GME programs and/or expansion:|
|Proposal to create a subcommittee on Research (or combine with mapping subcommittee) to help monitor the impact of changes in practice patterns and physician workforce and see if there are any correlations to changes in reimbursement / payment transformation.|
|5. HMEC Report||Follow-up to final 2018 HMEC report and recommendations for 2019 Legislature:||Lee will continue to seek input from HMEC members and provide updates at future meetings.|
|· Peer Review Bill SB532, though not scheduled yet, a hearing is anticipated before 2/15/19. In an effort to protect the necessary educational activities under the Peer Review statute, JABSOM is proposing additional definition to section D (4) regarding covered “health care entity” to be: (4) graduate medical education programs and healthcare training programs as defined in HRS 304A-1701 that conduct educational discussions and activities as required by its nationally-recognized accrediting body and for the purposes of learning to improve patient care, patient safety and furthering quality health care as may be determined under rules or guidelines which may be adopted under section 671D-13;|
|i. §671D-13 Guidelines of the director. The director, in consultation with the director of the department of health, may adopt pursuant to chapter 91, such rules and voluntary guidelines as may assist the professional review bodies in meeting the standards described in section 671D-11(a). [L 1989, c 354, pt of §3 and c 363, pt of §3]|
|RECOMMENDATION #1 - UH JABSOM/HMEC recommends that the 2019 State Legislature assess the advisability and feasibility of an annual and recurring GME Appropriation to support HMEC-designated residency/fellowship programs with a particular emphasis on primary care.|
|• HB609 introduced by Representative Ward, was referred to 3 committees for review. This bill which appropriates monies to the GME program for residency programs in Hawaii, provided that the funds are matched dollar-for-dollar by private sector medical hospitals and institution, has been heard but has not been assigned a hearing yet. This would appropriate money to JABSOM through the DOH. Current plan is to investigate other factors driving costs to see if those factors/costs can be reduced to allow more funding to be appropriated for educational commitments (SB1400). A noted challenge is that these bills, if successful, would only be for 1-2 year legislative commitments. This might help with planning, but would be problematic for ensuring continuity of GME funding.|
|RECOMMENDATION #2 - UH/HMEC recommends that the 2019 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-focused Matching program to augment GME faculty and resident/fellow funding.|
|· Reviewed HB1444 proposed activities which includes this HMEC recommendation (#2) though there is no current bill referral scheduled. The HMEC also reviewed the list of participants outlined in this bill for collaborative efforts noting the timeline is very specific with no appropriations tied to the bill. This bill, written and introduced by Representative Belatti, establishes a Primary Care Payment Reform Collaborative task force in the DOH to examine issues related to primary care spending and data collection and to develop recommendations to the legislature. The report shall include payment reform; value-based care; workforce and recruitment; directing resources to support and expand primary care access; increasing integrated care including for women’s and behavioral health; determination of the current percentage of medical expenses in the State allocated to primary care; primary care spending mandates in other states, including an assessment of methods for establishing a minimum primary care spending percentage or dollar amount; data collection issues regarding primary care spending in the State and its potential impact on data submitted to Hawaii’s All Payer Claims Database; and potential standard definitions of “primary care “ that may be used in future legislation. If passed, the timeline for the task force to complete its work is less than 1 year (before the 2020 session).|
|RECOMMENDATION #3 - UH/HMEC recommends that the 2019 State Department of Human Services and other stakeholders explore the mechanisms to obtain Federal Medicaid GME funding since many of the residency programs provide inpatient and ambulatory care for Medicaid populations.|
|• To be explored further. Not yet started.|
|6. Announcements||· Next HMEC meeting: Monday, April 29, 2019 at 7:30 am, JABSOM MEB 202.|
|7. Adjournment||· Meeting adjourned by Lee Buenconsejo-Lum at 9:00 am.|