April 27, 2020

MEETING ANNOUNCEMENT

                                    Hawaii Medical Education Council                                                                                     Monday, April 27, 2020                                                     7:30-9:00 am

Due to COVID-19 precautions, and in observance of social distancing, this meeting will be held via Zoom 

Please contact Crystal Costa via costaca@hawaii.edu or                         (808) 692-0989 for Zoom meeting access. 

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 costaca@hawaii.edu preferably by APril 24, 2020, 12:00 PM.  Responses received after that may not be guaranteed though we will try our best. Upon request, this notice is available in alternate formats such as large print, Braille, or electronic copy.

AGENDA

Hawai‘i Medical Education Council (HMEC)

University of Hawai‘i, John A. Burns School of Medicine

Date: Monday, April 27, 2020, 7:30 a.m. – 9:00 a.m.

Via Zoom – Due to COVID-19 precautions

  1. Review & Approval of January 27, 2020 Minutes –Dr. Hedges (distributed via email to members on 4/25/20)
  2. Report from HMEC Chair – Dr.Hedges                                                                     a. Announcements/Discussion (15 minutes)                                                        i. Impacts and adjustments due to COVID-19                                              ii. Graduate Medical Education updates – Lee           Buenconsejo-Lum                                                                                                                  b. Update on Legislative Strategies – Jerris Hedges and Cynthia Nakamura (15 minutes)
  3. Physician Workforce Data Updates & Synergies – Aimee Grace & Kelley Withy (40 minutes)                                                                                              a.  Preceptor Tax Credit Update                                                                            b. Physician Workforce                                                                                              c. Physician Recruiter                                                                                                  d. Synergies
  4. HMEC Recommendations as proposed to the 2020 Legislature – Lee Buenconsejo-Lum (2 minutes)

 

RECOMMENDATION #1                                                                                      UH/HMEC recommends that the 2020 State Legislature and State Executive Branch continue to support and provide a State match to continue the Hawaii State Loan Repayment Program.  Ideally, this match could 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 program for Hawaii – including coordination of the National Loan Repayment Program Federal match. 

RECOMMENDATION #2                                                                                    UH/HMEC recommends that the 2020 State Legislature and State Executive Branch support the expansion of JABSOM faculty and staff to provide satellite educational programs for year-round undergraduate medical education on Hawaii and Maui Islands which will allow expansion of the medical school class size with more neighbor island medical education, and will allow exploration of residency training expansion to these islands. 

RECOMMENDATION #3                                                                                        UH/HMEC recommends that the 2020 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.

5.  Additional Items                                                                                                                   a.  Announcements – Next HMEC Meeting – Monday, July 20, 2020 @ 7:30am in MEB 202                                                                                          6. Adjournment 

Minutes 

                       Hawaii Medical Education Council (HMEC) Meeting                                                   April 27, 2020  Time:  7:30-9:00 a.m.                                      John A. Burns School of Medicine, via Zoom due to COVID-19

Members Present:  Mary Ann Antonelli (for Kathryn Ryder, representing federal healthcare sector), Lee Buenconsejo-Lum, (Associate Dean for Academic Affairs, Designated Institutional Official (DIO) for Graduate Medical Education, JABSOM), 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), Jerris Hedges (Chair, JABSOM Dean), Allen ”Chip” Hixon (representing the health professions community), Lorrin Kim (for Bruce Anderson, representing the Department of Health), 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: Kathryn Ryder (representing federal healthcare sector) and Sharon Vitousek via Zoom (representing health professions community).

Others in Attendance: Patricia Blanchette (Interim Associate Dean for Clinical Affairs, JABSOM), Thomas Cook (AHEC, Physician Recruiter), Chip Ellis (CFO, University Health Partners), Aimee Grace (UH Director of Health Science Policy), Marlene Keawe (COO, Hawaii Residency Programs, Inc.), Cynthia Nakamura (Government Affairs and Legislative Consultant), Holly Olson (Deputy DIO, JABOSM), Susan Steinemann (Assistant DIO, JABOSM) and Kelley Withy (Director, AHEC).  

HMEC Administrator:  Lee Buenconsejo-Lum Recorder: Crystal Costa

TOPICDISCUSSION / CONCLUSIONS / ACTIONS / DECISIONSTASKS
1. Review of MinutesMinutes from our last meeting, held on 1/27/20, were reviewed and approved. Motion to approve came from Dr. Hixon and second by Dr. Shapiro. Motion to approve carried unanimously. No opposed and no abstentions.NA.
2. Chair Report Dean J. Hedges & Legislative Strategies Update by Cynthia Nakamuraa. Announcements (Dean Hedges):
COVID-19 Impacts on medical students and GME:
While tackling the impacts and adjustments caused by COVID-19, JABSOM and the hospitals continue to explore ways to keep teaching and services available. Telehealth services are being utilized and non-urgent visits have been postponed. Plans are underway to address resuming medical student rotations at hospitals (QMC 5/1) and finding creative ways to keep residents busy and learning while volume is low. Time has been used for online learning, simulations, case-based discussions, limited telemedicine and demonstrations to keep learning productive. PPE will need to be managed and available for all trainees.
USMLE testing limitations due to Prometric closures have affected the timeline for taking & passing licensure exams for students (and residents) causing increased anxiety about incomplete applications to residency. To date, 97% of medical schools are not considering early graduation, JABSOM included. Many of the ACGME accreditation activities across the country have ceased. Programs are being asked to promote flexibility in curriculum and PDs have been granted the authority to determine if individuals are ready for independent practice regardless if all procedural or clinic visit requirements are met. Adequate resources (PPE), supervision, and duty hour adherence are expected to be met and maintained, regardless of COVID impact on the training program. Many sites have been utilizing telehealth. JABSOM is actively participating in surge planning, redistributing residents/fellow based on service, and converting to online or alternate learning activities as possible. Oversight will be maintained and continued throughout pandemic. HRP is doing detailed tracking to help monitor if resident’s rotations/sites are shifted to help with annual CMS reporting.
Next Steps include plans to adjust and accommodate travel quarantine and curriculum changes. Changes during orientation would include boot camps with the use of simulation in a more concentrated period of time. Scheduling challenges are expected due to physical distancing requirements. All activities will need adjusting to accommodate class sizes following physical distancing requirements. Biggest challenges will include recruitment for the next class of residents, lack of testing capacity and impacts on away rotations (SubIs). Residencies and Fellowships are being encouraged to provide virtual interviews while nationally there is a strong push to delay the Match and adjust the timeline for medical school Dean’s letters. Updates expected over the coming weeks.
Opportunity to build resiliency and leadership in learners amidst the crisis.
b. Legislative strategies update for 2019 (Cynthia Nakamura):
The legislature is currently in recess due to COVID-19 and no hearings on bills are being scheduled until further notice. Funding of $1.4 million for the expansion of medical education and training to Maui is part of the University’s overall budget. Response from legislators on the request and proposal has been supportive and positive. However, whether the requested funding is approved will depend on the State’s and UH’s economic outlook in light of COVID-19.
LOAN REPAYMENT		NA.
Informational only. Ongoing updates.
TOPICDISCUSSION / CONCLUSIONS / ACTIONS / DECISIONSTASKS
HB 2254 and SB 2983 both seek $500,000 in funding to match the federal grant dollars JABSOM receives for the health care provider loan repayment program. Both bills crossed over to the opposite chambers. SB 2983 was heard by the Health and Lower and Higher Education Committees and passed. HB 2254 had not been scheduled for hearing before the legislature went into recess due to COVID.
PRECEPTOR TAX CREDIT
SB 31 requests an amendment to the definitions of “primary care providers” and “volunteer based supervised clinical training rotation”. In implementing the program, it was found that it was necessary to broaden the array of specialties that help to train future primary care providers. Also, the bill clarifies the definition of “compensation” so that if a preceptor is paid with state funds he or she would not be eligible to claim the tax credit. The bill crossed over and received its first hearing and passed by House Health Committee. SB 31 needs to be heard in the Consumer Protection and Finance Committees. As the bill does not seek an appropriation, it may be possible that the legislature will pass it.
`IMI HO`ŌLA FUNDING
SB 2392 requests funding to support stipends for students enrolled in the `Imi Ho`ōla program. The bill crossed over and was heard and passed by the House Committee on Lower and Higher Education. It needs to be heard by the Finance Committee.
WIND TURBINE STUDY
HB 2188 establishes new boundaries for the location of wind turbines in relation to residential districts, and tasks JABSOM with conducting a study to determine the effect noise from the turbines has on people. Funding in the amount of $101,000 has been requested. The bill crossed over and was passed by the senate committee on Energy, Economic Development and Tourism. It still needs to be heard in the Ways and Means Committee.
3. Physician
Workforce Data Updates & Synergies
Dr. Kelley Withy + Dr. Aimee Grace		Workforce updates (Dr. Kelley Withy)
The Hawaii Island has the largest number of physicians age 65+ at 33.7%, followed by Maui/Maui County at 29% with Oahu having the lowest rate at 23.4%. Numbers for Lanai will be verified. Challenges remain when reviewing numbers for physicians that work on multiple islands. New workforce data is due in July and includes asking for the primary source of payment model, with telehealth services and employment data expected to have significant changes due to COVID.
Current efforts include helping the state determine what practices have/will be closing to determine what surge capacity will be available. To date, 26 practices have closed and 3 more shifting to part time. Support needed to help these practices includes information and advice on how to apply for federal loans with a loan officer to provide assistance. AHEC continues to reach out for practice support to help keep practices open. A COVID info page has been created on the AHEC site with feedback welcome on the design and content.
Physician Recruiter
Thomas Cook has been hired as the new recruited to help link physicians with programs and available positions, and acting as a resource throughout the state.
Updates from Loan Repayment Program and Preceptor Tax Credit		Ongoing updates to be provided by Dr. Withy and Dr. Grace.
TOPICDISCUSSION / CONCLUSIONS / ACTIONS / DECISIONSTASKS
Gave out $367K to 197 preceptors for 2019. Changes requested in legislature to expand to include specialties that support the development of primary care workforce.
Synergies (Dr. Aimee Grace)
The statewide surge planning group created for COVID includes key partners from Healthcare Association of Hawaii, Department of Health, Hawaii State Center for Nursing, Area Health Education Center, University of Hawaii, Hawaii Medical Association, and Dr. Rupal Gohil (HIEMA S ESF-8 liaison). The provider surge planning group is tasked to discuss the key professions needed in a true surge (physicians, nurses, respiratory therapists, pharmacists, radiologic technologists, surgical technicians, EMTs, others) and are calling for volunteers to serve in the DOH Medical Reserve Corps and volunteers from grassroots organizations. They are working to identify policy barriers to grow workforce. To date, there are 223 new volunteers and 79 (19 new) physicians. Working closely with the DOH to address
key staffing needs.
4. HMEC Recommendations to 2020 Legislature
L. Buenconsejo- Lum		2020 Submitted Recommendations as submitted to the Hawaii State Legislature
RECOMMENDATION #1
UH/HMEC recommends that the 2020 State Legislature and State Executive Branch continue to support and provide a State match to continue the Hawaii State Loan Repayment Program. Ideally, this match could 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 program for Hawaii - including coordination of the National Loan Repayment Program Federal match.
RECOMMENDATION #2
UH/HMEC recommends that the 2020 State Legislature and State Executive Branch support the expansion of JABSOM faculty and staff to provide satellite educational programs for year-round undergraduate medical education on Hawaii and Maui Islands which will allow expansion of the medical school class size with more neighbor island medical education, and will allow exploration of residency training expansion to these islands.
RECOMMENDATION #3
UH/HMEC recommends that the 2020 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.
5. Additional Items All members present for duration of meeting.
 Next HMEC meeting: Monday, July 20, 2020 at 7:30 am, location TBD and likely via Zoom due to COVID-19.
6. Adjournment Meeting adjourned by Lee Buenconsejo-Lum at 8:38 am.
Minutes Approved:                                                                             (Recorders Initials & Date)