January 25, 2021

MEETING
ANNOUNCEMENT

Hawaii Medical Education Council
Monday, January 25, 2021
7:30-8:30 am

Due to COVID-19 precautions, and in
observance of physical 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 January 25, 2020, 7:00 AM. 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, January 25, 2021, 7:30 a.m. – 8:30 a.m.
Via Zoom – Due to COVID-19 precautions

1. Review & Approval of October 26, 2020 Minutes –Dr. Hedges (distributed via email to members on 01/22/21)

2. Report from HMEC Chair – Dr. Hedges
a. Announcements/Discussion (10 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 (20 minutes)
a. Preceptor Tax Credit Update
b. Physician Workforce
c. Federal Appropriations Update

4. 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
a. Announcements – Next HMEC Meeting – Monday, April 26, 2021 @ 7:30am location TBD

6. Adjournment

Minutes

Hawai‘i Medical Education Council (HMEC) Meeting
January 25, 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 (for Kathryn Ryder, 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), 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), Lorrin Kim (for Libby 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 Joseph Sterbis (representing a hospital conducting ACGME programs).
Members Absent: Todd Seto (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), Robert Hong
(Professor, UH Department of Medicine), 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

TOPICDISCUSSION / CONCLUSIONS / ACTIONS / DECISIONSTASKS 
1. Review of MinutesMinutes from our last meeting, held on 10/26/20, were reviewed and approved. Dr. Sterbis made the motion for approval, which was seconded by Dr. Robbins. Approval was unanimous. No members opposed or abstained.NA.
2. Chair Report - Dean J. Hedges & Legislative Strategies Update
– Cynthia Nakamura
a. Announcements (Jerris Hedges):
Dean Hedges reminded the Council about the 2021 HMEC annual report to the Hawai‘i legislature which includes progress and recommendations made by the Council. Membership changes are included in the annual reports and will be updated next year to reflect our newest members. Thank you to Drs. Sharon Vitousek, Kathryn Ryder, and Allen Hixon for their service and we welcome our newest members, Drs. Nicole Apoliona and Leslie Chun. Annual reports can be found on the UH Manoa legislative reports website.
Links have been embedded into the meeting minutes for convenience.
Impacts and adjustment due to COVID-19
Dr. Buenconsejo-Lum, Associate Dean for Academic Affairs, GME Director and Designated Institutional Official, along with Dr. Jill Omori, Director of the Office of Medical Education, have been working to get all students, residents/fellows vaccinated. Updates will be provided at our next meeting with the aim to have everyone vaccinated before June. Graduation celebrations, convocations, annual events and other end of year activities will be held virtually to accommodate physical distancing. Teams have been working tirelessly to convert all events and enable video broadcasting.
Update on Legislative Strategies
The 2021 legislative session opened on January 20, 2021. The priority for the legislature this session is finding funds to make up the budget shortfall. We have been informed that all the special funds will be examined which may include the physician workforce assessment and the tobacco settlement special fund. The bill introduction deadline is on Wednesday, 1/27/2021.
There have been some changes in committee chairs in both the House and Senate.
HOUSE
For the Committee on Health, Human Services & Homelessness Representative Ryan Yamane is the new chair. The Committee on Higher Education and Technology is now chaired by Representative Gregg Takayama and the Committee on Consumer Protection & Commerce is now chaired by Representative Aaron Johanson. Representative Sylvia Luke still chairs the Finance Committee.
SENATE
The Committee on Commerce, Consumer Protection and Health has been separated into two committees: The Committee on Commerce and Consumer Protection, which is chaired by Senator Roz Baker and the Committee on Health, which is chaired by Senator Jarrett Keohokalole. The Committee on Higher Education continues under Senator Donna Mercado Kim and the Ways and Means Committee is still chaired by Senator Donovan Dela Cruz.
Bills of note (to date)
NA.
Informational only. Ongoing updates.
TOPICDISCUSSION / CONCLUSIONS / ACTIONS / DECISIONSTASKS
HB 313 and SB 613 relating to the Physician Workforce Assessment amend the purpose of the assessment to enable JABSOM to use some of the funds for loan repayment for physicians participating in the healthcare provider loan repayment program administered by JABSOM and to provide scholarships for JABSOM students. The bills also remove the spending ceiling for flexibility.
HB 306 and SB 976 relating to the Preceptor tax credit modifies 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.
SB 138 increases the tobacco tax and directs 1.67 cents per cigarette into a special account to repay medical school loans of graduates of the John A. Burns school of medicine, who practice in primary care in the medically underserved population areas of this State.
A special “Thank You” to Lorrin Kim and the Department of Health for their continued support with JABSOM initiatives.
To note, SB 846, relating to medical residency programs, was introduced by Senator Favela, which would appropriate funds to support and expand residency programs in state teaching hospitals. This request would include matching funds from private funding sources. This was a surprise coming outside of JABSOM and is seen as a good sign that communities are talking about the medical school and training programs. The pandemic has increased and raised awareness about the important work JABSOM does in training and providing future physicians for the state.
Graduate Medical Education Updates (Dr. Lee Buenconsejo-Lum)
Dr. Buenconsejo-Lum reviewed the 2021 HMEC annual report to the legislature with the Council while discussing the Governor’s 15% proposed reductions to the UH budget, including JABSOM. At this time, it is undetermined if the legislature will propose the reduction or consider the flat budget option, or perhaps decide on something in between. JABSOM is preparing for the 15% reduction just in case which would be an estimated $3M.
The Family Medicine Residency Program was approved for a permanent increase from 18 residents to 21 residents while the Child and Adolescent Psychiatry Fellowship Program was reduced by 1 fellow from 3 to 2 (which is the minimum approved to keep the program open) despite the high and growing need for child psychiatrists. Budget reductions and limited resources were not feasible to keep the program sustained at 3.
The GME Provisions Enacted in December 2020 document from the Association of American Medical Colleges (AAMC), is a follow up to the Consolidation Appropriations Act 2021 and makes 3 important changes:
1. Provides 1,000 new Medicare-supported GME positions – the first increase in Medicare-supported GME in nearly 25 years;
2. Revises the Rural Training Track programs to encourage rural and urban hospitals to work together to train residents in rural areas; and
3. Adjusts artificially low Medicare caps and per resident amounts that were a barrier to some hospitals training more residents.
JABSOM will be monitoring changes and events happening in legislation very closely and will be looking to clarify the designation and definition of “rural” for medicine and training purposes. Dr. Aimee Grace is currently part of the AAMC Government Relations
TOPICDISCUSSION / CONCLUSIONS / ACTIONS / DECISIONSTASKS
Representative group and will be working with the congressional delegation to explore designations that could apply to Hawai‘i’s geographic designation other than “rural”. Currently Halawa Prison and the Maui Correctional Center are under consideration for a designation as a Health Professional Shortage Area (HPSA) which could help with expanding considerations for GME programs, in addition to supporting the Psychiatry programs which have faced recent reductions. A working group will be convened to address the CMS designation approach and will include Drs. Grace, Hixon and Withy. Any interested parties in joining this working group may contact Dr. Buenconsejo-Lum via email at lbuencon@hawaii.edu.
New CMS GME Position Opportunities
JABSOM is conducting a needs based assessment for GME positions in all current programs (19) and potential new programs. The ODIO will be updating the criteria in the “Starting and Expanding Program Guidelines” document. Programs will be asked to consider and provide any anticipated changes to their program complement over the next 5 years. Currently the Cardiovascular Disease Fellowship Program and the General Surgery Residency Programs have requested changes and will be sharing their proposals with the GME Advisory Council in February 2021. JABSOM continues to strategically think of ways to expand while balancing considerations
and impacts to the budget, community and state healthcare needs.
4. Physician
Workforce Data Updates & Synergies
Dr. Kelley Withy + Dr. Aimee Grace
Preceptor Tax Credit (Dr. Kelley Withy)
This program continues to emphasize primary care and a 187 preceptors will be receiving $368K in tax credits (in total) for 2020. Although unable to fund provider specialists in 2020, suggestions have gone to the legislature to adjust the verbiage for 2021. In 2020, the reported numbers were roughly the same and a bit higher than previous years despite impacts from COVID-19. The cap for this credit is at $1M and currently about 1/3 has been spent.
Physician Workforce (Dr. Kelley Withy)
The physician workforce presentations can be accessed through the Hawai‘i Area Health Education Center (AHEC) website and the annual report to the legislature can be found on the UH 2021 Legislative Reports website. Questions and inquiries can be sent directly to AHEC via ahec@Hawai‘i.edu.
The current physician shortage for Hawai‘i is 710, however, when you factor in the geographic and specialty specific needs by island, the shortage increases to 1008 physician FTE. There has been a challenge with the reporting numbers for hospitalists that were previously included in other-currently obtained statistics and data will continue to be reviewed to provide the most accurate numbers.
For a complete view of demographic data and details, please visit the website link above to access the presentation.
Loan Repayment Program (Dr. Kelley Withy)
Over 600 physicians have responded to the workforce survey as of early January 2021. The lack of doctors and infrastructure to support current practices has become evident with a decline in smaller, independent practices. To date, thanks to Cynthia Nakamura and Lisa Rantz, the $200K from the medical license assessment which previously was inaccessible, has been received in the fund, although legislative approval will be required for its use. Additional contributors, with the help of Dr. Withy and Lisa Rantz, include Mayors from Hawai‘i Island and Maui and plans are underway to approach the Mayors on Oahu and Kauai for support, as these counties value the programs addressing physician retention in Hawai‘i. Additional supporters that have contributed monies include:
The Barry Taniguchi Foundation, DOH, AlohaCare, University Health Alliance, and others. There has been $315K in federal monies
Ongoing updates to be provided by Dr. Withy and Dr. Grace.
TOPICDISCUSSION / CONCLUSIONS / ACTIONS / DECISIONSTASKS
awarded to Hawai‘i for match this year. This should help support the current program participants and the 13 new applications. There was also one applicant that will be using their own monies to match the federal funds as this represents a personal saving. Last year 9 applicants went unfunded for lack of matching monies.
Updates from the Consolidated Federal Appropriations Act of 2021 (Dr. Aimee Grace):
Dr. Grace shared that she has a 1.5-hour “Federal Budget and Appropriations Workshop” for those that are interested in learning more about the appropriations process.
Annual process starts with the US President, goes to the House and Senate committees (each has 12 subcommittees). There have been many opportunities to engage with Congress, which has been a great for Hawai‘i to strategically think about which bills to choose and how and which partners to approach. It has been helpful for Hawaii to have Senator Schatz and Representative Case serving on the Appropriations Committees.
The final federal bills were consolidated into an “omnibus” package at the end of December 2020. Highlights of the bills that have themes consistent with our workforce needs are listed below.
Labor Health and Human Service bill (Labor HHS bill) – The national AHEC program received a $2M increase ($43,250,000), the bill does contain specific eligible language that will need to be reviewed in detail, in regards to applicability to Hawaii and the Pacific.
Hawai‘i Careers Opportunity Program (HCOP): $15,000,000 – was almost eliminated but subsequently was level funded again.
Centers of Excellence (COE) program: $23,711,000 – level funded.
Dr. Grace and her team partnered with another state to propose a Center for Indigenous Innovation and Health Equity in the U.S. Department of Health and Human Services (HHS) Office of Minority Health. This Center was included in the final Labor-HHS bill with
$2M in funding. The Center would support efforts including research, education, services and policy development related to advancing Indigenous innovation and would include universities that work with Native Americans, Alaska Natives, Native Hawaiians, and Pacific Islanders. An example of an Indigenous innovation and solution that addresses health could be hula and its ability to decrease hypertension and increase equity. Another example would be the program with MA’O Farms and the work being done with community engagement to help decrease the risk of diabetes.
The Education for Native Hawaiians program got an extra $500,000 in the final bill; an earlier bill talked about the pathways for Native Hawaiians to post- secondary education. Next steps include considerations to build pathways encouraging students to enter pipeline programs that would lead them into the healthcare workforce.
Military Construction, Veterans Affairs and Related Agencies – UH proposed a Center for Native Hawaiian, Pacific Islander and U.S. Affiliated Pacific Islander Health. While no money was awarded, it did direct the center to conduct a feasibility study which is hopeful
TOPICDISCUSSION / CONCLUSIONS / ACTIONS / DECISIONSTASKS
to be funded next year. This bill recognized the contributions from Native Hawaiian and Pacific Islanders service with the military and would be an opportunity to increase partnerships with our VA colleagues.
Maternal Fetal Medicine (MFM) Telehealth Pilots – direct the VA to do a study on the extent to which services are provided and to partner with academic institutions that serve a high percentage of veterans.
Department of Interior/Technical Assistance – a $1M increase was provided to support health data projects in the U.S.-Affiliated Pacific Islands (USAPI).
Work still needs to be done and bills are being monitored closely.
5. HMEC Recommendations to 2021 Legislature
L. Buenconsejo- Lum
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 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.
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.
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.
TOPICDISCUSSION / CONCLUSIONS / ACTIONS / DECISIONSTASKS
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.
Discussion: Work will begin after the appropriations process is complete. This working group will help to strategically configure GME possibilities and open to anyone who would like to participate.
Interested participants are welcome to join the working group for recommendation #3.
6. Additional Items All participants present for the duration of the meeting.
 Next HMEC meeting: Monday, April 26, 2021, at 7:30 am, location TBD and via Zoom.
7. Adjournment Meeting adjourned by Dean Hedges at 8:32 am.
Minutes Approved:                                                                             (Recorders Initials & Date)
TOPICDISCUSSION / CONCLUSIONS / ACTIONS / DECISIONSTASKS 
1. Review of MinutesMinutes from our last meeting, held on 10/26/20, were reviewed and approved. Dr. Sterbis made the motion for approval, which was seconded by Dr. Robbins. Approval was unanimous. No members opposed or abstained.NA.
2. Chair Report - Dean J. Hedges & Legislative Strategies Update
– Cynthia Nakamura
a. Announcements (Jerris Hedges):
Dean Hedges reminded the Council about the 2021 HMEC annual report to the Hawai‘i legislature which includes progress and recommendations made by the Council. Membership changes are included in the annual reports and will be updated next year to reflect our newest members. Thank you to Drs. Sharon Vitousek, Kathryn Ryder, and Allen Hixon for their service and we welcome our newest members, Drs. Nicole Apoliona and Leslie Chun. Annual reports can be found on the UH Manoa legislative reports website.
Links have been embedded into the meeting minutes for convenience.
Impacts and adjustment due to COVID-19
Dr. Buenconsejo-Lum, Associate Dean for Academic Affairs, GME Director and Designated Institutional Official, along with Dr. Jill Omori, Director of the Office of Medical Education, have been working to get all students, residents/fellows vaccinated. Updates will be provided at our next meeting with the aim to have everyone vaccinated before June. Graduation celebrations, convocations, annual events and other end of year activities will be held virtually to accommodate physical distancing. Teams have been working tirelessly to convert all events and enable video broadcasting.
Update on Legislative Strategies
The 2021 legislative session opened on January 20, 2021. The priority for the legislature this session is finding funds to make up the budget shortfall. We have been informed that all the special funds will be examined which may include the physician workforce assessment and the tobacco settlement special fund. The bill introduction deadline is on Wednesday, 1/27/2021.
There have been some changes in committee chairs in both the House and Senate.
HOUSE
For the Committee on Health, Human Services & Homelessness Representative Ryan Yamane is the new chair. The Committee on Higher Education and Technology is now chaired by Representative Gregg Takayama and the Committee on Consumer Protection & Commerce is now chaired by Representative Aaron Johanson. Representative Sylvia Luke still chairs the Finance Committee.
SENATE
The Committee on Commerce, Consumer Protection and Health has been separated into two committees: The Committee on Commerce and Consumer Protection, which is chaired by Senator Roz Baker and the Committee on Health, which is chaired by Senator Jarrett Keohokalole. The Committee on Higher Education continues under Senator Donna Mercado Kim and the Ways and Means Committee is still chaired by Senator Donovan Dela Cruz.
Bills of note (to date)
NA.
Informational only. Ongoing updates.
TOPICDISCUSSION / CONCLUSIONS / ACTIONS / DECISIONSTASKS
HB 313 and SB 613 relating to the Physician Workforce Assessment amend the purpose of the assessment to enable JABSOM to use some of the funds for loan repayment for physicians participating in the healthcare provider loan repayment program administered by JABSOM and to provide scholarships for JABSOM students. The bills also remove the spending ceiling for flexibility.
HB 306 and SB 976 relating to the Preceptor tax credit modifies 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.
SB 138 increases the tobacco tax and directs 1.67 cents per cigarette into a special account to repay medical school loans of graduates of the John A. Burns school of medicine, who practice in primary care in the medically underserved population areas of this State.
A special “Thank You” to Lorrin Kim and the Department of Health for their continued support with JABSOM initiatives.
To note, SB 846, relating to medical residency programs, was introduced by Senator Favela, which would appropriate funds to support and expand residency programs in state teaching hospitals. This request would include matching funds from private funding sources. This was a surprise coming outside of JABSOM and is seen as a good sign that communities are talking about the medical school and training programs. The pandemic has increased and raised awareness about the important work JABSOM does in training and providing future physicians for the state.
Graduate Medical Education Updates (Dr. Lee Buenconsejo-Lum)
Dr. Buenconsejo-Lum reviewed the 2021 HMEC annual report to the legislature with the Council while discussing the Governor’s 15% proposed reductions to the UH budget, including JABSOM. At this time, it is undetermined if the legislature will propose the reduction or consider the flat budget option, or perhaps decide on something in between. JABSOM is preparing for the 15% reduction just in case which would be an estimated $3M.
The Family Medicine Residency Program was approved for a permanent increase from 18 residents to 21 residents while the Child and Adolescent Psychiatry Fellowship Program was reduced by 1 fellow from 3 to 2 (which is the minimum approved to keep the program open) despite the high and growing need for child psychiatrists. Budget reductions and limited resources were not feasible to keep the program sustained at 3.
The GME Provisions Enacted in December 2020 document from the Association of American Medical Colleges (AAMC), is a follow up to the Consolidation Appropriations Act 2021 and makes 3 important changes:
1. Provides 1,000 new Medicare-supported GME positions – the first increase in Medicare-supported GME in nearly 25 years;
2. Revises the Rural Training Track programs to encourage rural and urban hospitals to work together to train residents in rural areas; and
3. Adjusts artificially low Medicare caps and per resident amounts that were a barrier to some hospitals training more residents.
JABSOM will be monitoring changes and events happening in legislation very closely and will be looking to clarify the designation and definition of “rural” for medicine and training purposes. Dr. Aimee Grace is currently part of the AAMC Government Relations
TOPICDISCUSSION / CONCLUSIONS / ACTIONS / DECISIONSTASKS
Representative group and will be working with the congressional delegation to explore designations that could apply to Hawai‘i’s geographic designation other than “rural”. Currently Halawa Prison and the Maui Correctional Center are under consideration for a designation as a Health Professional Shortage Area (HPSA) which could help with expanding considerations for GME programs, in addition to supporting the Psychiatry programs which have faced recent reductions. A working group will be convened to address the CMS designation approach and will include Drs. Grace, Hixon and Withy. Any interested parties in joining this working group may contact Dr. Buenconsejo-Lum via email at lbuencon@hawaii.edu.
New CMS GME Position Opportunities
JABSOM is conducting a needs based assessment for GME positions in all current programs (19) and potential new programs. The ODIO will be updating the criteria in the “Starting and Expanding Program Guidelines” document. Programs will be asked to consider and provide any anticipated changes to their program complement over the next 5 years. Currently the Cardiovascular Disease Fellowship Program and the General Surgery Residency Programs have requested changes and will be sharing their proposals with the GME Advisory Council in February 2021. JABSOM continues to strategically think of ways to expand while balancing considerations
and impacts to the budget, community and state healthcare needs.
4. Physician
Workforce Data Updates & Synergies
Dr. Kelley Withy + Dr. Aimee Grace
Preceptor Tax Credit (Dr. Kelley Withy)
This program continues to emphasize primary care and a 187 preceptors will be receiving $368K in tax credits (in total) for 2020. Although unable to fund provider specialists in 2020, suggestions have gone to the legislature to adjust the verbiage for 2021. In 2020, the reported numbers were roughly the same and a bit higher than previous years despite impacts from COVID-19. The cap for this credit is at $1M and currently about 1/3 has been spent.
Physician Workforce (Dr. Kelley Withy)
The physician workforce presentations can be accessed through the Hawai‘i Area Health Education Center (AHEC) website and the annual report to the legislature can be found on the UH 2021 Legislative Reports website. Questions and inquiries can be sent directly to AHEC via ahec@Hawai‘i.edu.
The current physician shortage for Hawai‘i is 710, however, when you factor in the geographic and specialty specific needs by island, the shortage increases to 1008 physician FTE. There has been a challenge with the reporting numbers for hospitalists that were previously included in other-currently obtained statistics and data will continue to be reviewed to provide the most accurate numbers.
For a complete view of demographic data and details, please visit the website link above to access the presentation.
Loan Repayment Program (Dr. Kelley Withy)
Over 600 physicians have responded to the workforce survey as of early January 2021. The lack of doctors and infrastructure to support current practices has become evident with a decline in smaller, independent practices. To date, thanks to Cynthia Nakamura and Lisa Rantz, the $200K from the medical license assessment which previously was inaccessible, has been received in the fund, although legislative approval will be required for its use. Additional contributors, with the help of Dr. Withy and Lisa Rantz, include Mayors from Hawai‘i Island and Maui and plans are underway to approach the Mayors on Oahu and Kauai for support, as these counties value the programs addressing physician retention in Hawai‘i. Additional supporters that have contributed monies include:
The Barry Taniguchi Foundation, DOH, AlohaCare, University Health Alliance, and others. There has been $315K in federal monies
Ongoing updates to be provided by Dr. Withy and Dr. Grace.
TOPICDISCUSSION / CONCLUSIONS / ACTIONS / DECISIONSTASKS
awarded to Hawai‘i for match this year. This should help support the current program participants and the 13 new applications. There was also one applicant that will be using their own monies to match the federal funds as this represents a personal saving. Last year 9 applicants went unfunded for lack of matching monies.
Updates from the Consolidated Federal Appropriations Act of 2021 (Dr. Aimee Grace):
Dr. Grace shared that she has a 1.5-hour “Federal Budget and Appropriations Workshop” for those that are interested in learning more about the appropriations process.
Annual process starts with the US President, goes to the House and Senate committees (each has 12 subcommittees). There have been many opportunities to engage with Congress, which has been a great for Hawai‘i to strategically think about which bills to choose and how and which partners to approach. It has been helpful for Hawaii to have Senator Schatz and Representative Case serving on the Appropriations Committees.
The final federal bills were consolidated into an “omnibus” package at the end of December 2020. Highlights of the bills that have themes consistent with our workforce needs are listed below.
Labor Health and Human Service bill (Labor HHS bill) – The national AHEC program received a $2M increase ($43,250,000), the bill does contain specific eligible language that will need to be reviewed in detail, in regards to applicability to Hawaii and the Pacific.
Hawai‘i Careers Opportunity Program (HCOP): $15,000,000 – was almost eliminated but subsequently was level funded again.
Centers of Excellence (COE) program: $23,711,000 – level funded.
Dr. Grace and her team partnered with another state to propose a Center for Indigenous Innovation and Health Equity in the U.S. Department of Health and Human Services (HHS) Office of Minority Health. This Center was included in the final Labor-HHS bill with
$2M in funding. The Center would support efforts including research, education, services and policy development related to advancing Indigenous innovation and would include universities that work with Native Americans, Alaska Natives, Native Hawaiians, and Pacific Islanders. An example of an Indigenous innovation and solution that addresses health could be hula and its ability to decrease hypertension and increase equity. Another example would be the program with MA’O Farms and the work being done with community engagement to help decrease the risk of diabetes.
The Education for Native Hawaiians program got an extra $500,000 in the final bill; an earlier bill talked about the pathways for Native Hawaiians to post- secondary education. Next steps include considerations to build pathways encouraging students to enter pipeline programs that would lead them into the healthcare workforce.
Military Construction, Veterans Affairs and Related Agencies – UH proposed a Center for Native Hawaiian, Pacific Islander and U.S. Affiliated Pacific Islander Health. While no money was awarded, it did direct the center to conduct a feasibility study which is hopeful
TOPICDISCUSSION / CONCLUSIONS / ACTIONS / DECISIONSTASKS
to be funded next year. This bill recognized the contributions from Native Hawaiian and Pacific Islanders service with the military and would be an opportunity to increase partnerships with our VA colleagues.
Maternal Fetal Medicine (MFM) Telehealth Pilots – direct the VA to do a study on the extent to which services are provided and to partner with academic institutions that serve a high percentage of veterans.
Department of Interior/Technical Assistance – a $1M increase was provided to support health data projects in the U.S.-Affiliated Pacific Islands (USAPI).
Work still needs to be done and bills are being monitored closely.
5. HMEC Recommendations to 2021 Legislature
L. Buenconsejo- Lum
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 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.
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.
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.
TOPICDISCUSSION / CONCLUSIONS / ACTIONS / DECISIONSTASKS
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.
Discussion: Work will begin after the appropriations process is complete. This working group will help to strategically configure GME possibilities and open to anyone who would like to participate.
Interested participants are welcome to join the working group for recommendation #3.
6. Additional Items All participants present for the duration of the meeting.
 Next HMEC meeting: Monday, April 26, 2021, at 7:30 am, location TBD and via Zoom.
7. Adjournment Meeting adjourned by Dean Hedges at 8:32 am.
Minutes Approved:                                                                             (Recorders Initials & Date)