July 30, 2018

ANNOUNCEMENT

MEETING ANNOUNCEMENT

Hawaii Medical Education Council
Monday, July 30, 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, July 30, 2018, 7:30 a.m. – 9:00 a.m.
Location: 651 Ilalo Street, Kaka‘ako Campus, Medical Education Building, Room 202
Honolulu, Hawaii 96813

AGENDA

1. Review & Approval of April 23, 2018 Minutes – Dr. Hedges (also distributed via email to members)

2. Report from HMEC Chair – Dr. Hedges

a. Announcements

b. Introduction of Bruce Anderson, new DOH Director

c. Legislative Strategies (with Cynthia Nakamura)

3. Community Health Needs Assessment (CHNA) – Islander Institute (Josh Levinson, et al) [30 min]

4. Physician Workforce Data Updates – Dr. Kelley Withy

a. Data / Maps

b. Preceptor Tax Credit law

5. Next Steps – Dr. Lee Buenconsejo-Lum

a. HMEC Subcommittee Update

b. Models to consider for supporting GME programs and/or expansion

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, October 22, 2018 @ 7:30am in MEB 202

8. Adjournment

MINUTES

Hawaii Medical Education Council (HMEC) Meeting

July 30, 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: Katherine Finn Davis (for Mary Boland, representing the School of Nursing), William Dubbs (representing federal healthcare sector), 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), Lisa Rantz (representing person of the general public community), Kenneth Robbins (representing hospital conducting ACGME programs), Todd Seto (representing hospital conducting ACGME programs, and Sharon Vitousek (representing health professions community) – via phone.

Members Absent: Bruce Anderson (Department of Health, Director).

Others in Attendance: Mary Ann Antonelli (VA), Patricia Blanchette (JABSOM), Chip Ellis (UHP of Hawaii), Marlene Keawe (HRP), Curtis Lee – via phone, Josh Levinson (presenter), Alika Ke-Paloma (guest from Senate Ways and Means), Judy Mohr Peterson (Med QUEST), Cynthia Nakamura (presenter), Holly Olson (JABSOM), Linda Rosen (HHSC Director), Sydney Tatsuno, and Kelley Withy (AHEC).

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

TOPIC TASKS

1.    Review of Minutes Minutes from our last meeting, held on 4/23/18, were reviewed ahead of time via email sent on 7/27/18. Motion to approve came from A. Hixon and second by W. Dubbs. Motion to approve carried unanimously. No opposed and no abstentions. NA.

2.    Chair Report Dean J. Hedges Announcements/Introductions: Dean Hedges introduced Alika Ke-Paloma as a guest from the Senate Committee on Ways and Means who was visiting with JABSOM to learn more about the medical school and its initiatives, followed by quick introductions around the room. FYI/Update.

2018 Legislative outcomes by C. Nakamura is as follows:

a.       SB2298, the preceptor tax credit bill, was passed and signed on June 13th. Dr. Withy and colleagues from the affected health professions schools are working on the process for implementation.

b.       Funding for the relocation of the Family Medicine (FM) outpatient clinic has come through with $1M being appropriated through the DOH. Dr. Hixon, the Department Chair for FM, is working closely with the DOH on budgeting and plans to access funds.

c.        SB2407, relating to medical marijuana to treat opioid and substance abuse addiction, was vetoed by the Governor and did not pass. We expect to see more of these bills in the future.

d.       SB2464, passed requiring any provider that prescribes opioids and controlled substances to consult the Prescription Drug Monitoring Program (PDMP) website. Dean Hedges commented that JABSOM is committed in training their students and residents/fellows on the appropriate use of dealing with opioids and substance abuse. Further analysis will be needed to understand how this bill affects workflow.

3.    Community Health Needs Assessment (CHNA) A requirement of the Affordable Care Act (ACA) is that at least once every 3 years all 501(c)(3) nonprofit hospitals are to conduct an assessment of community health needs in their service area, with emphasis on high-risk, high-need and/or underserved populations. The Healthcare Association of Hawaii decided to consolidate the assessment process and then adapt the determination of priorities and implementation to their specific facility’s service area. The Islander Institute is endeavoring to conduct the assessment differently than others have done in the previous two rounds by identifying and defining healthy communities (i.e., what makes a community healthy, what are the conditions and characteristics, etc.) rather than only addressing negative healthcare outcomes. Their goal is to create a product that the hospitals and government agencies can use to identify strengths, challenges and conditions in communities (where we work, live and play) to better understand how to address and create/promote healthier communities. Discussed how this is an opportunity to think about the role the hospitals have in collaboration with various institutions across the state to start making an impactful difference by working together for a healthier Hawaii. FYI.

Josh Levinson a.       Anticipated timeline for completion is targeted for the end of this calendar year and will include 1 statewide and 4 county level assessments. Information will become public once complete. Currently, the Islander Institute is in the data collection phase working with the University of Hawaii and Hawaii Public Health Institute. Assessment will also include data from about 100 key informant interviews and various focus groups from across the state.

b.       Goal is to be as transparent as possible including past interviews and taking the community and social determinants into consideration. The Islander Institute encourages any recommended data sources to be emailed to Josh@islanderinstitute.com.

c.        Additional areas to explore, specifically in the rural settings, are the relationship between the provider and the community and access to care, in addition to the need to better support the local schools and economy. This could potentially be something to explore as a larger investment to promote physicians to stay, live and practice in their communities.

d.       The CHNA will provide an assessment (not a plan) on how to create platforms for lending institutions, health plans, and others, to collectively address the needs of the community.

e.       As the demographics change where millennials are currently the largest consumer group, the traditional delivery models of providing and accessing healthcare is changing. Will need to pay special attention to the various age groups to better understand the concerns of the community.

4. Physician Workforce Update on data and maps regarding primary care, behavioral health, chronic disease, and surgical specialists. Crystal to forward flyer to members via email.

Kelley Withy a.       Maps depicted by county with numbers done by Full Time Equivalent (FTEs) in their respective zip codes.

b.       Next step is to get numbers aggregated by island to get an idea of where physicians are needed to prevent patients from having to fly to neighbor islands for care. Telehealth network is currently being developed to help address this. Ongoing updates to be provided by Dr. Withy.

c.        Additional review of surgical specialty numbers needed to help clarify specific needs.

d.       Data maps requested that 1) show only physicians ages 65+ and 2) overlay of diseases prevalent in specific areas.

Healthcare Preceptor Tax Credits Law (Act 43 (18)):

a.       Flyer distributed for new preceptor tax credit law that describes what this law entails.

b.       “Preceptor” means a physician or osteopathic physician, APRN or pharmacist who maintains a professional primary care practice in this State. “Primary care” means the principal point of continuing care for patients provided by a healthcare provider, including health promotion, disease prevention, health maintenance, counseling, patient education, diagnosis and treatment of acute and chronic illnesses, and coordination of other specialist care that the patient may need. ”

c.        Qualification for H1B holders will need to be discussed with their tax preparers.

d.       Additional details continue to be reviewed and developed.

5. Next Steps HMEC subcommittee report: Ongoing updates to be provided by Dr. Buenconsejo-Lum.

L. Buenconsejo-Lum Potential opportunities to explore for legislation include: 1) extending the current loan repayment program and 2) work with HRSA and the federal government to help broaden definitions for rural settings to include all islands of the state of Hawaii. Senator Brian Schatz and Representative Tulsi Gabbard both have assistants visiting JABSOM this summer to learn about the medical school initiatives.

Models to consider for supporting GME programs and/or expansion:

On the local level, we are considering asking the legislature for supplemental funding for an overall standing budget line item which would not be limited to the 2 year state legislative budget. This standing budget line item would be used for GME-related expenses (i.e. faculty, rotations, administrative fees, etc.) and not FTEs for residency/fellow positions as positions require salary commitments for the duration of the training program. This standing state budget line-item would help reduce the financial burden on our hospital partners while we continue to explore additional funding opportunities with CMS and other payers to augment the current payment models.

7. HMEC Report Recap of 2018 HMEC recommendations to legislature: Lee will continue to seek input from HMEC members and provide updates at future meetings.

L. Buenconsejo-Lum 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.

2.       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.

8. Announcements ·         Next HMEC meeting: Monday, October 22, 2018 at 7:30 am, JABSOM MEB 202.

9. Adjournment ·         Meeting adjourned by Lee Buenconsejo-Lum at 9:00 am.

Events Calendar

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28

9

9

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15

30

July 30, 2018

ANNOUNCEMENT

AGENDA

MINUTES

	TOPIC	TASKS
1. Review of Minutes	Minutes from our last meeting, held on 4/23/18, were reviewed ahead of time via email sent on 7/27/18. Motion to approve came from A. Hixon and second by W. Dubbs. Motion to approve carried unanimously. No opposed and no abstentions.	NA.
2. Chair Report Dean J. Hedges	Announcements/Introductions: Dean Hedges introduced Alika Ke-Paloma as a guest from the Senate Committee on Ways and Means who was visiting with JABSOM to learn more about the medical school and its initiatives, followed by quick introductions around the room.	FYI/Update.

	2018 Legislative outcomes by C. Nakamura is as follows:
	a. SB2298, the preceptor tax credit bill, was passed and signed on June 13th. Dr. Withy and colleagues from the affected health professions schools are working on the process for implementation.
	b. Funding for the relocation of the Family Medicine (FM) outpatient clinic has come through with $1M being appropriated through the DOH. Dr. Hixon, the Department Chair for FM, is working closely with the DOH on budgeting and plans to access funds.
	c. SB2407, relating to medical marijuana to treat opioid and substance abuse addiction, was vetoed by the Governor and did not pass. We expect to see more of these bills in the future.
	d. SB2464, passed requiring any provider that prescribes opioids and controlled substances to consult the Prescription Drug Monitoring Program (PDMP) website. Dean Hedges commented that JABSOM is committed in training their students and residents/fellows on the appropriate use of dealing with opioids and substance abuse. Further analysis will be needed to understand how this bill affects workflow.
3. Community Health Needs Assessment (CHNA)	A requirement of the Affordable Care Act (ACA) is that at least once every 3 years all 501(c)(3) nonprofit hospitals are to conduct an assessment of community health needs in their service area, with emphasis on high-risk, high-need and/or underserved populations. The Healthcare Association of Hawaii decided to consolidate the assessment process and then adapt the determination of priorities and implementation to their specific facility’s service area. The Islander Institute is endeavoring to conduct the assessment differently than others have done in the previous two rounds by identifying and defining healthy communities (i.e., what makes a community healthy, what are the conditions and characteristics, etc.) rather than only addressing negative healthcare outcomes. Their goal is to create a product that the hospitals and government agencies can use to identify strengths, challenges and conditions in communities (where we work, live and play) to better understand how to address and create/promote healthier communities. Discussed how this is an opportunity to think about the role the hospitals have in collaboration with various institutions across the state to start making an impactful difference by working together for a healthier Hawaii.	FYI.
Josh Levinson	a. Anticipated timeline for completion is targeted for the end of this calendar year and will include 1 statewide and 4 county level assessments. Information will become public once complete. Currently, the Islander Institute is in the data collection phase working with the University of Hawaii and Hawaii Public Health Institute. Assessment will also include data from about 100 key informant interviews and various focus groups from across the state.
	b. Goal is to be as transparent as possible including past interviews and taking the community and social determinants into consideration. The Islander Institute encourages any recommended data sources to be emailed to Josh@islanderinstitute.com.
	c. Additional areas to explore, specifically in the rural settings, are the relationship between the provider and the community and access to care, in addition to the need to better support the local schools and economy. This could potentially be something to explore as a larger investment to promote physicians to stay, live and practice in their communities.
	d. The CHNA will provide an assessment (not a plan) on how to create platforms for lending institutions, health plans, and others, to collectively address the needs of the community.
	e. As the demographics change where millennials are currently the largest consumer group, the traditional delivery models of providing and accessing healthcare is changing. Will need to pay special attention to the various age groups to better understand the concerns of the community.
4. Physician Workforce	Update on data and maps regarding primary care, behavioral health, chronic disease, and surgical specialists.	Crystal to forward flyer to members via email.
Kelley Withy	a. Maps depicted by county with numbers done by Full Time Equivalent (FTEs) in their respective zip codes.
	b. Next step is to get numbers aggregated by island to get an idea of where physicians are needed to prevent patients from having to fly to neighbor islands for care. Telehealth network is currently being developed to help address this.	Ongoing updates to be provided by Dr. Withy.
	c. Additional review of surgical specialty numbers needed to help clarify specific needs.
	d. Data maps requested that 1) show only physicians ages 65+ and 2) overlay of diseases prevalent in specific areas.

	Healthcare Preceptor Tax Credits Law (Act 43 (18)):
	a. Flyer distributed for new preceptor tax credit law that describes what this law entails.
	b. “Preceptor” means a physician or osteopathic physician, APRN or pharmacist who maintains a professional primary care practice in this State. “Primary care” means the principal point of continuing care for patients provided by a healthcare provider, including health promotion, disease prevention, health maintenance, counseling, patient education, diagnosis and treatment of acute and chronic illnesses, and coordination of other specialist care that the patient may need. ”
	c. Qualification for H1B holders will need to be discussed with their tax preparers.
	d. Additional details continue to be reviewed and developed.
5. Next Steps	HMEC subcommittee report:	Ongoing updates to be provided by Dr. Buenconsejo-Lum.
L. Buenconsejo-Lum	Potential opportunities to explore for legislation include: 1) extending the current loan repayment program and 2) work with HRSA and the federal government to help broaden definitions for rural settings to include all islands of the state of Hawaii. Senator Brian Schatz and Representative Tulsi Gabbard both have assistants visiting JABSOM this summer to learn about the medical school initiatives.

	Models to consider for supporting GME programs and/or expansion:
	On the local level, we are considering asking the legislature for supplemental funding for an overall standing budget line item which would not be limited to the 2 year state legislative budget. This standing budget line item would be used for GME-related expenses (i.e. faculty, rotations, administrative fees, etc.) and not FTEs for residency/fellow positions as positions require salary commitments for the duration of the training program. This standing state budget line-item would help reduce the financial burden on our hospital partners while we continue to explore additional funding opportunities with CMS and other payers to augment the current payment models.
7. HMEC Report	Recap of 2018 HMEC recommendations to legislature:	Lee will continue to seek input from HMEC members and provide updates at future meetings.
L. Buenconsejo-Lum	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.
	2. 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.
8. Announcements	· Next HMEC meeting: Monday, October 22, 2018 at 7:30 am, JABSOM MEB 202.
9. Adjournment	· Meeting adjourned by Lee Buenconsejo-Lum at 9:00 am.