April 26, 2021
Hawaii Medical Education Council
Monday, April 26, 2021
Due to COVID-19 precautions, and in observance of physical distancing, this meeting will be held in-person at the
John A. Burns, School of Medicine,
651 Ilalo Street, Honolulu, Hawaii 96813
Room #MEB 202
and via Zoom
If you need an auxiliary aid/service or other accommodation due to a disability, contact Crystal Costa at 808-692-0989 or via email at firstname.lastname@example.org preferably by April 23, 2021, 12:00 PM. Requests received after that may not be guaranteed accommodation. Upon request, this notice is available in alternate formats such as large print, Braille, or electronic copy.
- Review & Approval of January 25, 2021 Minutes –Dr. Hedges (distributed via email to members on 04/23/21)
- Report from HMEC Chair – Dr. Hedges a. Announcements/Discussion (10 minutes) i. Membership updates ii. Graduate Medical Education updates – Lee Buenconsejo-Lum 1. Resident Physician Shortage Reduction Act of 2021 2. GME Program Prioritization Process/Potential Expansions b. Update on Legislative Strategies – Jerris Hedges and Cynthia Nakamura (10 minutes)
- Physician Workforce Data Updates & Synergies – Aimee Grace & Kelley Withy (10 minutes) a. Preceptor Tax Credit Update b. Physician Workforce c. Federal Appropriations Update
- HMEC Recommendations confirmed to the 2021 Legislature – Lee Buenconsejo-Lum (5 minutes)
RECOMMENDATION #1 UH/HMEC recommends that the 2021 State Legislature and State Executive Branch continue to support and provide a State financial match to the Hawaii State Loan Repayment Program. Ideally, this match would be provided as a supplement to the annual Department of Health (DOH) budget with the explicit instruction for the DOH to annually transfer those funds to JABSOM as long as JABSOM oversees the health professional loan repayment program for Hawai‘i – including coordination of the National Loan Repayment Program Federal match for Hawai‘i.
RECOMMENDATION #2 UH/HMEC recommends that the 2021 State Legislature and State Executive Branch provide funding to support the JABSOM faculty and staff, as well as both the medical student and residency curricula. The curricula needs support in order to maintain existing medical student and resident rotations on the neighbor islands, and to maintain currently existing innovative programs which serve to meet the needs of underserved communities.
RECOMMENDATION #3 UH/HMEC recommends that the State Department of Human Services and other stakeholders develop a working group to explore the mechanisms and develop a plan to obtain future Federal Medicaid GME funding since many of the residency programs provide inpatient and ambulatory care for Medicaid populations.
5. Additional Items – Next HMEC Meeting – Monday, July 26, 2021 @ 7:30am via Zoom and in-person
Hawai‘i Medical Education Council (HMEC) Meeting April 26, 2021 Time: 7:30-8:30 a.m. John A. Burns School of Medicine, via Zoom due to COVID-19
Members Present: Mary Ann Antonelli (representing the federal healthcare sector), Nicole Apoliona (representing the health professions community), Lee Buenconsejo-Lum (Associate Dean for Academic Affairs, Designated Institutional Official (DIO) for Graduate Medical Education, JABSOM), Leslie Chun (representing a hospital conducting ACGME programs), Katherine Finn Davis (for Mary Boland, representing the School of Nursing), Jami Fukui (for Randall Holcombe, representing the UH Cancer Center), Jerris Hedges (Chair, JABSOM Dean), Allen ”Chip” Hixon (representing the health professions community), Robert Hong (representing the health professions community), Lorrin Kim (for Elizabeth Char, representing the Department of Health), Lisa Rantz (representing a person of the general public), Kenneth Robbins (representing a hospital conducting ACGME programs), Linda Rosen (representing the health professions community), and Todd Seto (representing a hospital conducting ACGME programs).
Members Absent: Judy Kovell (representing a hospital conducting ACGME programs).
Others in Attendance: Chip Ellis (CFO, University Health Partners of Hawai‘i), Aimee Grace (Director of UH System Office of Strategic Health Initiatives), Marlene Keawe (COO, Hawai‘i Residency Programs, Inc.), Cynthia Nakamaura (Government Affairs and Legislative Consultant), Holly Olson (Deputy DIO, JABSOM), Larry Shapiro (CEO, University Health Partners), Susan Steinemann (Assistant DIO, JABSOM) and Kelley Withy (Director, AHEC).
HMEC Administrator: Lee Buenconsejo-Lum Recorder: Crystal Costa
|1. Review of|
|Minutes from our last meeting, held on 1/25/21, were reviewed and approved, including edits from Dr. Aimee Grace. The motion for approval came from Dr. Robbins and seconded by Dr. Seto. Approval was unanimous. No members opposed or abstained. Voting was done via Zoom using the “thumbs up” icons. Links to websites and resources will continue to be embedded into the meeting minutes for everyone’s|
|2. Chair Report -|
Dean J. Hedges &
|a. Announcements (Jerris Hedges):|
Dean Hedges reminded all attendees of the Council’s focus in addressing the physician workforce for the state of Hawaii. New members recently approved by the Governor and Senate were announced (listed below). Dr. Kenneth Robbins was thanked for his service for his term ending in June 2021. All Council member’s names were announced for attendance monitoring, to ensure a quorum for voting, and for accurate record keeping. Dialogue from all attendees in this public forum remains encouraged and all were reminded to please announce their names when speaking for those on Zoom.
1. Dr. Mary Ann Antonelli, to be representing the federal healthcare sector, replaced Dr. Kathryn Ryder.
2. Dr. Nicole Apoliona, representing the health professions community, replaced Dr. Sharon Vitousek.
3. Dr. Leslie Chun, representing a hospital conducting ACGME programs, replaced Dr. Kenneth Robbins.
4. Dr. Robert Hong, representing the health professions community, replacing Dr. Allen Hixon.
Medical Student and Graduate Medical Education Updates (Dr. Lee Buenconsejo-Lum)
Programs are planning for modified graduations and orientations to adhere to COVID-19 restrictions. Hybrid (mix of in-person and Zoom) academic half-days in the residency programs continue, but some programs remain fully on Zoom which is having some negative
impacts. All but 1 medical student has been fully vaccinated and we will be at 100% soon. N95 masks, fit testing and PPE continues; there have been some challenges with getting certain types of smaller masks, but we should have sufficient for most rotations. Geriatrics rotations in the long-term care facilities requires regular testing and more N-95s. Well- being and safety of trainees and faculty continuing to be a top priority.
The medical student problem-based learning portion of the curriculum has just started to be fully in person. Students gathered for the first time since they started school last July 2020. Match Day for students was held in person but with no guests; the event was live streamed for family and friends. Commencement for the undergraduate Medical Technology students and graduate (Masters and PhD) students will be in person, with limited Guests. Convocation for the medical students will be later that day (May 15, 2021). Special events continue to include videos from loved ones and are live-streamed. The current plans for July 2021 and the Fall include predominately in-person teaching with Zoom
available if circumstances warrant more physical distancing.
|Match Day 2021 included 68 student placements with a higher number staying in Hawaii this year. For Family Medicine, 5 are from JABSOM and the remaining 2 have Hawaii ties and strong commitments to serving the Hawaii community. Full details regarding the event and where students matched to can be viewed on the JABSOM website (live link|
included). JABSOM students matched into the following specialties: Internal Medicine: 21, Family Medicine: 9, Pediatrics: 4, Psychiatry: 4,
General Surgery: 5, Obstetrics-Gynecology: 4, Emergency Medicine: 2,
Anesthesiology: 6, Dermatology: 1, Neurology: 2, Neurosurgery: 2,
Ophthalmology: 1, Pathology: 3, Radiology: 3, and Radiology-
GME Program Prioritization Process/Potential Expansions (Dr. Lee Buenconsejo-Lum)
As discussed at the January HMEC meeting, programs have been asked to consider and provide any anticipated changes to their program complement over the next 5 years. To help identify priorities, programs hopes or plans for expansion (or new programs) include impacts on: 1) mission critical needs, 2) healthcare delivery and quality, 3) program quality and innovation, 4) recruitment and retention, 5) research and/or scholarship, and 6) financial sustainability and any related resources.
Reports are due on May 14, 2021 and the DIO will be discussing further with the GME Advisory Council on May 24, 2021, then with the Hawaii Residency Programs, Inc. Board of Directors on July 14, 2021. Any expansion will need to include considerations and impacts on existing programs with the aim to reinstate recent reductions in the psychiatry residency and child and adolescent psychiatry fellowship programs.
Family Medicine which recently expanded to 7 residents per year, would need to further expand (rural training track model) to better meet Hawai‘i’s primary care workforce needs. Surgery also desires to move to 5 categorical resident per year and expand training in rural areas to address surgical workforce needs on the neighbor islands. Psychiatry continues to be a big need throughout the State, as are many surgical specialties. Currently, there is interest in creating new GME programs in Anesthesia, Gastroenterology, Pulmonology Critical Care, Medical Oncology, and Neurology. Any expansion or new program would also need to include resources for space/sites and compensated faculty supervisors to ensure high quality. Travel and lodging support for neighbor island rotations are available for medical students and residents/fellows through the general AHEC fund and through the VA, but it is insufficient for current needs since the medical school class size has increased. In order to receive VA support, rotations must occur in the VA community-based outpatient clinics. COVID-19 has also negatively impacted availability of housing and transportation on the neighbor islands.
GME legislation that was passed in December 2020 includes 1,000 new Medicare-supported GME positions (over 5 years) which gives priority to rural programs. The current definitions of rural makes Hawai‘i ineligible for any priority categories. A task force comprised of HMEC members
and others is working with the Federal government and others to
|explore options to change definitions, language, criteria, or statute to help Hawai‘i become less disadvantaged in eligibility for almost all Federal funding (HRSA, CMS).|
Update on Legislative Strategies (Cynthia Nakamura)
The Legislature was in their last week of the 2021 legislative session with the house and senate having until April 29, 2021 to vote on surviving bills before they can be transmitted to the Governor. In terms of the state budget, JABSOM was able to retain its line item and funding
BILLS THAT PASSED:
HB 313 allows JABSOM to use money in the physician workforce assessment fund to provide loan repayment to physicians participating in the healthcare provider loan repayment program and scholarships to qualifying JABSOM students. This bill was crucial to provide state matching funds for the federally-funded healthcare provider loan repayment program. Another important aspect of the bill was to preserve the money in the workforce assessment fund and prevent it from being swept by the legislature in their search for funds to balance the budget. HB 313 has been passed by the House and must be passed by the Senate, and then it can be transmitted to the Governor.
HB 1296 would have eliminated the Tobacco Settlement Trust Fund, the Tobacco Enforcement Special Fund, and the Tobacco Prevention and Control Special Fund, and transfer all unencumbered money into the state general fund. This bill would have severely impacted the University’s ability to pay the debt service on the bonds used for the construction of the medical school. In the final version of the bill, only the Tobacco Prevention and Control Special Fund was
eliminated. JABSOM’s allocation from the Tobacco Settlement Fund remains intact.
HB 1298 would have swept the money in a number of special funds maintained by various state agencies, including the Tobacco Settlement Special Fund and Trauma Fund. The end result was that both the Tobacco Settlement Special Fund and Trauma Fund remained intact; however, $5M was swept from the Trauma Fund to the general fund.
HB 1299 would have repealed a number of special funds, including the Physician Workforce Assessment, and transferred the money from those funds into the general fund. In the final version as passed by the House and Senate, the Physician Workforce Assessment Special Fund was spared. With the authorization provided in HB 313, JABSOM will be able to use excess funds from the workforce assessment to provide loan repayment to physicians who participate in JABSOM’s loan repayment program as well as scholarships to JABSOM students.
SB 589 sought to establish an organized cancer research center within JABSOM and required the director to report to both the UH Provost and Dean of the Medical School. In the final version of the bill, the cancer center remained a separate entity from JABSOM, but the cancer center
|must be administratively affiliated with JABSOM as a cost saving measure.|
SB 628 authorizes the transition of Leahi Hospital from HHSC to the Dept. of Health. The bill also authorizes the DOH to provide long term care and substance abuse treatment at Leahi and Maluhia, and requires the DOH to consult with UH regarding the programs at both facilities.
SB 970 establishes a physician-patient relationship via a telehealth interaction when the physician is licensed in Hawaii. The bill was passed by both chambers and has been transmitted to the Governor for approval.
BILLS THAT DID NOT PASS:
HB 306 and SB 976 relating to the Preceptor tax credit sought to modify the definition of preceptor to include preceptors from specialty practices that support primary care; and clarify the definition of “volunteer-based supervised clinical training rotation” to specify that the clinical training preceptors provide is uncompensated by clinical salary or state funds. Although both bills were heard initially, they were not heard in the final weeks of the session because the bills dealt with a tax credit which could potentially violate the Recovery Act
funding. However, the preceptor tax credit law as passed a few years ago remains in effect, and qualifying providers may continue to apply for the tax credit.
HB 540 would have provided civil and criminal immunity to a healthcare provider who acts in good faith during a state or county state of emergency and who adheres to crisis standards of care.
SB 138 would have increased the tobacco tax and directed 1.67 cents per cigarette into a special account to repay medical school loans of graduates of the JABSOM, who practice in primary care in the medically underserved population areas of this State. This was another measure that was not heard because of potential impact on Recovery Act funding.
SB 1024 sought to establish a cannabinoid medicine program at the University to be administered by JABSOM. JABSOM opposed the measure as it duplicates many of the programs JABSOM already has in place.
SB 1258 would have allowed telephonic communication for telehealth purposes.
Workforce Data Updates & Synergies
Dr. Kelley Withy
+ Dr. Aimee Grace
|Preceptor Tax Credit (Dr. Kelley Withy)|
Preceptor tax credit is ongoing for those who train Hawai‘i physician, nursing and pharmacy students. This program continues to emphasize primary care and hopes to include more preceptors in coming years. Working to adjust certain requirements that were too restrictive or potentially viewed as “compensation” and expand the definitions to reduce barriers. Hoping to fast track this for the next session as this was widely supported in 2021.
For more information, please review the Preceptor Tax Credit and the Preceptor Credit Assurance Committee summaries (live links).
Physician Workforce (Dr. Kelley Withy)
The currently used model accounts for utilization patterns in Hawai‘i. With this model, the current physician workforce shortage for Hawaii is
~1000 (factoring in the geographic and specialty specific needs by island). AHEC recently paid to develop an updated Hawai‘i-specific model that would take CMS, Kaiser, and all other types of tracked utilization data collected from across the country to estimate the utilization of services by determining a micro simulation model. The model would apply to Hawaii based on population size, ethnicity, age, insurance status and health factors and provide an estimate of how many physicians from different specialties would be needed for the average U.S. county for that specialty. Hawaii would need to identify the special adjustments to make the model more accurate. Prior model adjustments included emergency medicine and ICU needs for 27/4 coverage. Additional adjustments are needed to help address the population flux (tourists, snowbirds), those leaving the islands for care on the mainland (e.g., certain cancer treatments) and spinal cord injuries (which are mainly seen with tourists). The Council recommended using data from the Laulima Data Alliance which includes emergency medicine information and patient zip codes. The Council also recommended to adjust for differing needs for 24/7 coverage, and critical access hospital needs on the different islands.
Any additional ideas or questions may be emailed to Dr. Withy at email@example.com. A copy of the physician workforce model presentation can be access here (live link). The current supply and demand numbers are available on the AHEC website: https://www.ahec.hawaii.edu/workforce-page/
Loan Repayment Program (Dr. Kelley Withy)
Although not discussed during this meeting, the most recent loan program presentation may be accessed here (live link).
Updates from the Consolidated Federal Appropriations Act of 2021 (Dr. Aimee Grace):
There are two types of appropriation processes: regular appropriations and the earmarks process, a provision that directs funds to a specific account during the allocations process, which is being brought back for use. While the earmarks process can be helpful, it is also limited to
certain types of accounts and only in the House or Representatives. The
|Ongoing updates to be provided by Dr. Withy and Dr.|
|University of Hawaii recently submitted a proposal for a rural health research center with their main goals to address rural health workforce policy and health equity. Questions they are hoping to explore include how should GME reformed, how should Medicaid rates change, addressing the definition of “rural” in Hawaii and reviewing policy issues, which have all been difficult without dedicated staff and resources.|
Dr. Grace is also closely monitoring the Title VII and Title VIII general workforce related programs that are being requested to double and ensure that UH is well represented on any GME and physician workforce related discussions. Work continues with colleagues from Alaska on designating Hawaii and Alaska as “rural states” based on their geographic locations in addition to planning strategically with Senator Brian Schatz, Chair of the Indian Affairs Committee, to leverage ways of benefitting native communities and expand support for Hawaii.
|2. HMEC Recommendati ons to 2021 Legislature|
UH/HMEC recommends that the 2021 State Legislature and State Executive Branch continue to support and provide a State financial match to the Hawai‘i State Loan Repayment Program. Ideally, this match would be provided as a supplement to the annual Department of Health (DOH) budget with the explicit instruction for the DOH to annually transfer those funds to JABSOM as long as JABSOM oversees the health professional loan repayment program for Hawai‘i - including coordination of the National Loan Repayment Program Federal match for Hawai‘i.
UH/HMEC recommends that the 2021 State Legislature and State Executive Branch provide funding to support the JABSOM faculty and staff, as well as both the medical student and residency curricula. The curricula needs support in order to maintain existing medical student and resident rotations on the neighbor islands, and to maintain currently existing innovative programs which serve to meet the needs of underserved communities.
Discussion: While there is limited funding available, this recommendation hopes to highlight the existing needs in hopes of no further budget reductions. JABSOM continues to hold any expansions for student experiences.
UH/HMEC recommends that the State Department of Human Services and other stakeholders develop a working group to explore the mechanisms and develop a plan to obtain future Federal Medicaid GME funding since many of the residency programs provide inpatient and ambulatory care for Medicaid populations.
|Discussion: Work will begin after the appropriations process is complete. This working group will help to strategically configure GME possibilities and is open to anyone who would like to participate.|
|3. Additional Items|| All participants present for the duration of the meeting.|
Next HMEC meeting: Monday, July 26, 2021, at 7:30 am, location JABSOM MEB 202 and via Zoom.
| Meeting adjourned by Dean Hedges at 8:34 am.|
|Minutes Approved: CC 7/26/21 (Recorders Initials & Date)|