April 29, 2019
Hawaii Medical Education Council
Monday, April 29, 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, April 29, 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 January 28, 2019 Minutes –Dr. Hedges (distributed via email to members on 4/26/19)
- Report from HMEC Chair – Dr. Hedges
- Announcements (5 minutes)
- Update on Legislative Strategies – Cynthia Nakamura (10 minutes)
- Report on the Community Health Needs Assessment – Andrew Aoki, Islander Institute (35 minutes)
- Physician Workforce Data Updates
- UHealthy Hawaii & Physician Workforce synergies Update – Aimee Grace & Kelley Withy (30 minutes)
- Quantifying promoters and barriers to recruitment/retention
- UHealthy Hawaii & Physician Workforce synergies Update – Aimee Grace & Kelley Withy (30 minutes)
- 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, July 29, 2019 @ 7:30am in MEB 202
Hawaii Medical Education Council (HMEC) Meeting
April 29, 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), Dean Jerris Hedges (Chair, JABSOM), Allen ”Chip” Hixon (representing the health professions community), Lorrin Kim (for Bruce Anderson, representing the Department of Health), 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
Members Absent: William Dubbs (representing federal healthcare sector), Joseph Sterbis (representing hospital conducting ACGME programs), and Sharon Vitousek (representing health professions community).
Others in Attendance: Andrew Aoki (Islander Institute), Patricia Blanchette (Associate Dean of Clinical Affairs, JABSOM), Chip Ellis (UHP of Hawaii), Aimee Grace via zoom (UH Director of Health Science Policy), Cynthia Nakamura (Government Affairs and Legislative Consultant), Holly Olson (JABSOM), Richard Philpott (Hawaii Residency Programs, CEO), Sydney Tatsuno via zoom (Hui Kahu Malama), and Kelley Withy (Director, 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 1/28/19, was reviewed and approved as is. Motion to approve came from K. Robbins and second by L. Rantz. Motion to approve carried unanimously. No opposed and no abstentions.||NA.|
|2. Chair Report||a. Announcements:||FYI/Update.|
|Dean J. Hedges||Kaiser has committed to increasing faculty availability for UME teaching and will be providing scholarships that will assist in expanding the JABSOM student class size. A special “Thank You” to Hawaii Pacific Health, Kamehameha Schools Bishop Estates and two private donors for their contributions of new scholarships.|
|b. Legislative strategies update for 2019 - Cynthia Nakamura:|
|- SB 1404, the bill to renew the loan repayment funding for state funds to match the federal grant funds, was only authorized for 1 year of appropriations for $150,000 compared to the initial $250-$280K request. The new budgeting system, which now requires both chambers of the legislature to review each agency’s budget separately, could have adversely affected the amounts awarded. This could be an opportunity to continue working with the Department of Health (DOH) to potentially include needed funding in the DOH budget next year, eliminating the need for us to go through the appropriations process again for the remaining amount. DOH was acknowledged and thanked for their continued support and partnership in demonstrating to the legislature their combined efforts with JABSOM. The recent telehealth bill and the loan repayment bill are examples of joint efforts with DOH that streamline future funding from the legislature. Discussions continue with Representative Sylvia Luke and Senator Rosalyn Baker regarding the potential to make loan repayment a permanent part of the DOH budget. In the meantime, JABSOM will work on a presentation that will illustrate those students that have requested and obtained loan repayment.||Cynthia to provide ongoing updates.
Dr. Withy to present data on loan repayment applicants at our next meeting.
|- SB 1033, the bill for licensing of midwives, has passed. It will be a program in the Department of Commerce and Consumer Affairs (DCCA) with an Advisory Committee to provide oversight and advice.|
|- SB 1246, the telehealth “superbill,” will expand telehealth to increase access to care for those in need.||Andrew Aoki to meet with banks and stakeholders on Kauai in May 2019.|
|- SB 1406, a bill regarding physician assistants (PAs), clarifies that supervision of PAs may be by a group of physicians (rather than only by an isolated physician) and also established policies regarding records review.|
|- SB 804, regarding palliative care, was inspired by the medical aid in dying law to develop a culturally competent palliative care pilot with $250K awarded for each of two years. Potential to create two pilots with one designated for Oahu. Will need to confirm if both pilots are required and what the stipulations are for each. Goal for this bill is to provide palliative care education with the expectation to generate local data.|
|- HB 1456, authorizes DOH to define and establish a community paramedicine program that would provide more training to EMTs, and would also allow paramedics to use telehealth. Importantly the bill allows for payment of ambulance runs that do not result in an emergency department visit.|
|c. Report on Community Health Needs Assessment (CHNA) - Andrew Aoki, Islander Institute:|
|This 2018 assessment is required by the IRS for non-profit hospitals every 3 years. This CHNA has a holistic approach and identified 3 takeaways to address: 1) We need to understand people’s lived experiences, 2) Health is more than treating illness and prolonging life, and 3) Community health is the product of a healthcare ecosystem. This assessment led to 3 goals with a total of 11 priorities. Goals: 1) Provide the basic foundations so that people can have more control over their own health, 2) Preserve, nurture, expand and employ the healing properties of community, and 3) Improve the relationship between people and the healthcare system. Priorities that were identified include: 1) addressing financial insecurity, 2) assuring equality and justice, 3) strengthening families, 4) preparing for emergencies, 5) building a good (and secure) food system, 6) restoring environment and sense of place, 7) nurturing community identify and cohesiveness, 8) investing in teenagers and healthy starts, 9) shifting Kūpuna care away from “sick care”, 10) strengthening trust in healthcare, and 11) providing accessible, proactive support for those with high needs. For additional detail and recommendations on addressing the goals and priorities mentioned, please review the full CHNA report online at: Www.islanderinstitute.com/health.|
|Next steps include developing ways to monitor progression of the CHNA report and to keep the various sectors accountable for ongoing developments. We need to collectively continue working on breaking down barriers and silos to build the community-based organizations and partnerships to include groups such as the DOE, DOH, FQHCs and other health care centers. As social determinants are a priority that impacts community health, we need to continue to build and expand education and relationships across the state. Islander Institute (Andrew Aoki) will be meeting with banks to address the financial insecurity concerns, the Hawaii Island Rural Health Association is ready to move onto their next step and build a project with an action plan in addition to developing relationships/connections. Potential opportunity for DOE to work on developing ways of streamlining the certification for Certified Nursing Assistants for high school students so that when they graduate, they are ready to go directly into the workforce. Dr. Aimee Grace and UH System will continue to work through the UHealthy project and other similar initiatives that are synergistic with this report goals and priorities to meet the community needs.|
|3. Physician Workforce||The UHealthy Hawaii initiative was created to improve health and health care in Hawaii and the Pacific by leveraging the UH System’s health science programs and creating collaborative partnerships. Partnerships continue to be developed and have grown since establishment of the initiative. Four key priorities for this initiative include: 1. Ensure a robust statewide health workforce, 2. Discover and innovate to improve and extend lives, 3. Promote healthier families and communities, and 4. Advance health in all policies. In addressing workforce, Dr. Aimee Grace has teamed up with Dr. Kelley Withy to develop concept maps linking causes for the shortages and to develop a matrix with possible solutions to address the state’s health workforce challenges. They sought feedback from the group regarding comments on the proposed solutions and other suggestions for solutions. Discussed additional data and research needed for cost of living, loan forgiveness programs offered, debt ratios/consolidation (tied to challenges in buying a home with little or no down payment), and streamlining to expedite the onboarding processes and credentialing. This could be an opportunity to work with DOH to potentially revisit the creation of a uniform credentialing service as their telehealth bill includes convening a group to investigate credentialing. The biggest delay is on the insurance side is waiting for credentialing to be processed. It would be helpful if insurers would consider retroactive payments covering care provided from the time applications were submitted to the health insurance company. It would also be helpful if the DCCA could include “location of actual practices” in their requested information. The VA currently allows early paperwork processing for trainees that have previously rotated there to help alleviate processing delays and JABSOM is planning to work some of these requests into future legislative agenda items.||Ongoing updates to be provided by Dr. Withy and Dr. Grace.|
|Kelley Withy + Aimee Grace|
|Next steps will be to seek feedback through listening sessions, write proposals and seek funding for key priorities.|
|4. HMEC Report||No updates at this time. Deferred to next meeting.||Lee will continue to seek input from HMEC members and provide updates at future meetings.|
|L. Buenconsejo-Lum||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.|
|· Next HMEC meeting: Monday, July 29, 2019 at 7:30 am, JABSOM MEB 202.|
|· Meeting adjourned by Lee Buenconsejo-Lum at 9:00 am.|