January 31, 2022

MEETING ANNOUNCEMENT

Hawaii Medical Education Council
University of Hawai‘i, John A. Burns School of Medicine
651 Ilalo Street, Honolulu, Hawaii 96813
Medical Education Building, #202

Monday, January 31, 2022, 7:30-9:00 am
This meeting will be held via video conferencing using Zoom due to COVID-19 safety precautions.
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MEETING INFORMATION
In light of the evolving COVID-19 situation, protecting the health and welfare of the community is of utmost concern. As such, this will be a virtual meeting and written testimony and oral testimony will be accepted in lieu of in-person testimony. All written testimony on agenda items received after posting of this agenda and up to 24 hours in advance of the meeting will be distributed to the board. Late testimony on agenda items will be distributed to the board within 24 hours of receipt. Written testimony may be submitted via email at uhgme@hawaii.edu, U.S. mail to address listed above Attn: Office of the DIO, or facsimile at (808) 692-1247. All written testimony submitted are public documents. Any testimony that is submitted for use in the public meeting process is public information and will be posted along with meeting minutes on the Council’s website.

BEFORE YOU COME TO CAMPUS UH MANOA COVID-19 GUIDELINES
Mandatory daily health check
All students, employees and campus visitors who will be on campus at any time are required to monitor their own health daily and screen for the COVID-19 virus. Any individual who refuses to use the daily check-in health app or web form will not be allowed on campus. For more information and guidance, please visit our UH Manoa COVID-19 Guidelines website: UH Manoa COVID-19 Guidelines

This guidance includes information on topics such as:

  • Mandatory face masks
  • Mandatory daily check-in app
  • What to do if you test positive or have been exposed to someone who has tested positive

Questions – public participants may contact Crystal Costa via costaca@hawaii.edu or (808) 692-0989.

Requests for accommodation due to a disability, please email at uhgme@hawaii.edu by January 27, 2022, 4:00 PM. Accessibility access is not guaranteed for requests received after this date.

AGENDA

Items not addressed during this meeting will be discussed on another day and time announced at the conclusion of the meeting.

  1.  Review & Approval of October 25, 2021 Minutes – Dr. Hedges (5 minutes)
  2. Report from HMEC Chair – Dr. Hedges                                                                      a.  GME-related state legislation – Cynthia Nakamuara (10    minutes)                                                                                                                                          b.  Graduate Medical Education updates – Lee Buenconsejo-Lum (20 minutes)                                                                                                                              i.  Annual Institutional Review Action Plan                                                         1. ACGME Self-Study Report (due 4/30/2022)                                    ii. GME Program Prioritization Process/Potential Expansions                                                                                                                                                  1.   CMS Section 126, 127 GME positions
  3. Physician Workforce Data Updates & Synergies – Aimee Grace & Kelley Withy (20 minutes                                                                                                    a.  Federal Appropriations and GME financing Update                             b. Physician Workforce Update                                                                             c.  Preceptor Tax Credit Update 
  4. HMEC Recommendations to the 2022 Legislature/draft HMEC report – Lee Buenconsejo-Lum (0 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.

For disability accommodations, contact uhgme@hawaii.edu or           (808) 692-0989 by January 27, 2022. by 4:00 p.m.

5.  New Business – Dr. Hedges (5 minutes)                                                        6. Additional Items – Next HMEC Meeting – Monday, April 25, 2022 @ 7:30am in-person and via Zoom                                                                              7.  Adjournment

      1.                      Minutes (Draft)

      2. Hawai‘i Medical Education Council (HMEC) Meeting           January 31, 2022  Time:  7:30-8:30 a.m., via Zoom                                John A. Burns School of MedicineMembers Present:  Mary Ann Antonelli (representing the federal healthcare sector), 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 Clementina Ceria-Ulep, Nancy Atmospera-Walch School of Nursing), COL Judy Kovell (representing a hospital conducting ACGME programs), Jerris Hedges (Chair, JABSOM Dean), Robert Hong (representing the health professions community), Colleen Inouye (representing the health professions community), Lorrin Kim (for Elizabeth Char, representing the Department of Health), Lisa Rantz (representing a person of the general public), Linda Rosen (representing the health professions community), and Todd Seto (representing a hospital conducting ACGME programs), Joe Ramos (Interim Director UH Cancer Center).  Members Absent: None, all members present. 

        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.), Holly Olson (Deputy DIO, JABSOM), Susan Steinemann (Assistant DIO, JABSOM) and Kelley Withy (Director, AHEC), Cynthia Nakamura (Government Affairs and Legislative Consultant),  Derek Wong (Interim CEO, University Health Partners of Hawai‘i)

        HMEC Administrator:  Lee Buenconsejo-Lum Recorder:   Crystal Costa / Marybeth Kotrodimos
1. Review of
Minutes		Minutes from the last meeting, held on 10/25/2021, were reviewed. Dr. Hong suggested a correction to the adjournment time, and additional updates were incorporated from Dr. A. Grace. A copy of the final minutes with updated corrections will be emailed to council members after the meeting. Minutes were approved unanimously without any abstentions. The motion for approval came from Dr. C. Inouye, and was seconded by Dr. M. Antonelli. Voting was conducted by raising hands for those in person and attending via Zoom. Dean Hedges paused to welcome any commentary from the public; none was offered.Crystal Costa to email members the revised and approved minutes.
2. Chair Report -
Dean J. Hedges		Report from HMEC Chair (Dr. Jerris Hedges)
The 2022 legislative session is underway and JABSOM has been working on several bills that are related to expanding medical education training opportunities, health workforce, as well as others. Cynthia Nakamura has been invited to speak about the measures related to Graduate Medical Education (GME) that are JABSOM’s priorities.
a. GME-related state legislation (Cynthia Nakamura)
Bills related to GME with JABSOM input have been introduced by Representative Takayama in the House and by Senator Keohokalole in the Senate:
1. House Bill (HB) 1547 and the companion Senate Bill (SB) 2657 request $6.7 million to support expanding residency training to the neighbor islands. The funds will be used to support additional residency positions, as well as faculty and administrative staffing. The purpose is to expand residency training opportunities on the neighbor islands.
2. HB 1548 and the companion SB 2656 request funding to expand residency positions and training through the Veterans Administration.
3. HB 1550 and the companion SB 2655 seek to reestablish the Hawaii Medical Education Special Fund to provide a mechanism to pay for the aforementioned expansion of residency positions.
4. HB 1549 and the companion SB 2597 request state matching funds for the Hawaii state loan repayment program administered by JABSOM. $500,000 is requested in state matching funds. The federal grant that Dr. Withy administers needs to be renewed this year. It is hoped that if more state money is obtained, it will be matched by federal funding so that there will be a total of $1 million available to repay educational debt for practitioners in shortage areas, in exchange for service in that shortage area.
5. Bills which are tangentially related to the GME strategic plan and a HMEC priority are the Preceptor Tax Credit Bills, HB 1975 and SB 3208, which seek to expand the definition of preceptor and clarify the definition of volunteer-based clinical rotation so that more preceptors will be able to qualify for the tax credit. Similar bills were heard but did not pass last session because there was concern that requesting a tax credit would affect any federal grant funding received.
6. HB 1795 would establish and fund the Rural Healthcare Provider Loan Repayment Program. This is not a bill that JABSOM initiated. Although the Rural Healthcare Provider Loan Repayment program was enacted in 2012, it was never funded. The bill will be heard tomorrow in the House Health Committee. JABSOM has submitted comments on the bill. There is a		NA.
Informational only. Ongoing updates.
Acronyms: ACGME = Accreditation Council for Graduate Medical Education; AHEC = Area Health Education Center; AAMC = Association of American Medical Colleges; CEO = Chief Executive Officer; CFO = Chief
concern that this bill could divert funds from the JABSOM Loan Repayment Program, which has been successfully operating since 2012.
The bill relating to the Hawaii Medical Education Special Fund would reestablish the HME Special Fund. Ms. Nakamura explained that this fund was intended to support GME programs, but never funded and thus never incurred any expenditures. The HME special fund would provide a place to receive funds which would support the expansion of JABSOM’s residency programs to the neighbor islands and through the VA.
Dean Hedges explained that the Medical Education Special Fund has to do with the mechanics of moving money between state agencies and working with legislative allocations. Without this bill, it is possible that we could lose some of the funding due to the processing of monies coming to the University.
Dr. Rosen expressed disappointment at not seeing in the bills any mention of the Hilo Residency Program, an entirely neighbor-island based residency program which has been in existence for ten years, and does not know what JABSOM’s position is on this program.
Dean Hedges responded that there is no mention here of the Hilo Residency Program because the request from the Governor’s office was to propose an expansion of GME rather than to support existing GME. If there are significant financial challenges with the Hilo- based program, it may be that there will be a need for a new bill or an expansion of the one just discussed, i.e., the inclusion of support for existing residency programs with financial challenges. The intent in part has been to expand programs where there may not be critical mass to support some specialties on the neighbor islands, and to create the opportunity to rotate residents primarily based in O‘ahu to provide resident exposure on the neighbor islands and thus establish bonds with practitioners. Dr. Rosen expressed support for this goal and said that this has already happened with residents rotating to the East Hawai‘i hospitals. She said she wasn’t necessarily talking about increasing funding, but increasing recognition for the Hilo Residency Program, and expressed the hope for the program to work more closely with JABSOM in the future.
Dean Hedges said that in discussions with legislators, they point out existing programs, which are not sponsored by JABSOM that need support, but there probably is a need to expand discussion regarding existing programs in the future.
Dr. Finn Davis, regarding HB1795, highlighted the existing controversy around adding incentives for psychologists and social workers and inquired if funding is just for physicians or if there was opposition to adding these two groups?
Dean Hedges said that there is broad representation in the loan repayment program that JABSOM oversees. Much of the support in the past few years has gone to nurse practitioners, but it is open to psychologists and social workers. Perhaps an expansion of that program would be helpful.
Dr. Withy said that HB 1795 is a well-intended bill that goes back to the Hawaii Health Corps Program concept, which was passed into law but not funded. She noted that the State Loan Repayment program has funded three psychologists, one social worker, and one marriage and family therapist, to date.
b. GME updates (Dr. Lee Buenconsejo-Lum)
i. Annual Institutional Review Action Plan
1. ACGME Self-Study Report (due 4/30/2022)
Acronyms: ACGME = Accreditation Council for Graduate Medical Education; AHEC = Area Health Education Center; AAMC = Association of American Medical Colleges; CEO = Chief Executive Officer; CFO = Chief
Every Sponsoring Institution (SI) goes through a 10-year accreditation cycle. About two years before the start of the cycle, the institutions need to do a self-study. Many HMEC members are part of the assembled writing group. The writing group for this study looked at the past six years of strategic plans, institutional action plans, and much of what this group has been discussing. Opportunities addressed have to do with implementing the health system integration of University Health Partners (UHP) faculty to the Queen’s University Medical Group or Hawaii Pacific Health Medical Group, with affiliation agreements intended to strengthen the partnerships and align many processes that will result in improved GME programs and improved patient care, as well as helping address health disparities. The rural piece of this is very critical, as well as issues affecting Hawaii’s aging workforce, an aging population, cost of living, chronic specialist shortages, and other concerns. Learners from other professions and outside the SI and Hawaii may exacerbate the faculty shortage for GME trainees in SI sponsored programs.
Three aims identified in the self-study are:
1. Quality & Patient Safety (QPS) and culture of safety integrated into the GME curriculum, mentorship by faculty, etc.;
2. Expansion of rural and neighbor island training sites with GME trainees participating in interprofessional education to improve population health;
3. Best practices for geriatric care and developing age-appropriate pathways.
The self-study asks about the ways that the SI’s aims are aligned with the work of the ACGME’s national community for sponsoring institutions. It was determined that the aims are aligned in 15 different ways. Also required is a description of the SI’s resources, processes, and/or policies that contribute to these aims. Examples include: The recent integration of academic practices and work identifying needs in the patient-safety program. The SI’s Diversity, Equity, and Inclusion (DEI) efforts were identified as being critically important to the SI, in addition to professionalism, faculty development, and expansion to neighbor islands. It was noted that the Department of Geriatric Medicine has already helped Queen’s and the Family Medicine Clinic at Pali Momi become certified by the Institute for Healthcare Improvement (IHI).
Additional three-to-five-year goals relevant to expansion of GME training to rural areas include ensuring the rural faculty members are integrated in the academic core with thoughtful faculty development opportunities, as well as continued advocacy, working with the state and health system partners to leverage ongoing efforts to expand broadband access to rural areas in order to maximize telehealth capacity, and develop age-appropriate protocols in different clinical care settings.
The UH JABSOM Graduate Medical Education Committee (GMEC) has approved this self-study; next it will be sent to the UH Board of Regents for review and approval. Dr. Buenconsejo-Lum anticipates presenting this study to the UH Board of Regents in March 2022, then submitting to the ACGME before the April 1, 2022 deadline.
ii. GME Program Prioritization Process/Potential Expansions
Update on GME bills in the federal government: Dr. Buenconsejo-Lum showed slides from the Association of American Medical Colleges (AAMC) on the Centers for Medicare & Medicaid Services (CMS) Rules on the Consolidated Appropriations Act (CAA) GME Provisions. She, with Dr. A. Grace and others have been working with others in Alaska, Arkansas, and with leadership of Minority Serving Institutions to make these provisions more favorable to Hawai‘i’s unique geography. The CAA
creates 1,000 GME slots (200 per year for five years) starting in 2023, with a maximum of 25 new slots per hospital over the		The Council will be asked to continue reviewing and providing feedback on the Self-Study document. Sent via a separate email to members.
Acronyms: ACGME = Accreditation Council for Graduate Medical Education; AHEC = Area Health Education Center; AAMC = Association of American Medical Colleges; CEO = Chief Executive Officer; CFO = Chief
five year period. All applications must demonstrate likelihood of filling the new slots within the five years. The slots will be distributed at least 10% to each of the 4 categories of hospitals:
● Applicant hospital is located in a rural area (i.e., neighbor island) or, if located in an urban area (i.e., Honolulu) must partner with a hospital in a rural area.
● Hospitals training above the CMS cap (we qualify)
● In a state with new medical school or branch campus since 1/1/2000 (non-applicable to us – although the previously proposed and unfunded Maui college based JABSOM campus would have favored this category)
● Serve areas designated as Health Professional Shortage Areas (HPSAs) (None of our JABSOM SI GME programs meet the requirement of having 50% of training done in a single geographic HPSA at this time.)
Additionally, the proposed curriculum must have 50% of GME training done in a rural area. (This is the new definition of a rural training program, which aligns with the ACGME definitions and other HRSA funding.)
Given the March 2022 deadline and required documentation to accompany the application, we have time to have more discussions, prioritize what specialties (of those whose curriculum is amenable to a rural training program/track), make preparations and documentation to put forth an application next March 2023.		The 2022 annual HMEC report to the legislature has been previously emailed to Council Members and can be accessed online via the University of Hawaii Legislative Reports website which may be
accessed here.
3.Physician Workforce Data Updates & Synergies
Dr. Kelley Withy Dr. Aimee Grace		3. Physician Workforce Data Updates & Synergies – Drs. Aimee Grace & Kelly Withy
a. Federal Appropriations and GME financing update (Dr. A. Grace)
The AAMC has been pushing the Resident Physician Shortage Reduction Act for years, seeking for Congress to provide 14,000 new Medicare-supported GME positions. The Consolidated Appropriations Act of 2021 (discussed above) was considered a “down payment” on this goal by providing 1,000 new positions, the first increase in Medicare GME positions in 25 years.
JABSOM has weighed in with CMS regarding its implementation of these provisions. However, the final CMS IPPS GME rule released was discussed above by Dr. Buenconsejo-Lum; the rule puts significant limitations on Hawai‘i’s ability to qualify.
UH leaders, in partnership with a growing coalition of Hawai‘i and other organizations, are advocating to change any forthcoming legislative provisions related to GME (such as in the current Build Back Better [BBB] draft bill) to add the following:
(1) an inclusion of non-contiguous areas in the “rural” priority category criterion; and
(2) a category for hospitals with special need being those that partner with GME programs whose Sponsoring Institution is a Minority-Serving Institutions (MSIs), such as UH which has campuses that are both Asian American Native American Pacific Islander-Serving Institutions (AANAPISIs) and an Alaska Native / Native Hawaiian-Serving Institutions (ANNHs).
President Lassner sent a letter advocating for these changes, and we have sent two letters advocating for these amendments. The BBB legislation is stalled due to internal Democratic opposition, but later today, there will be a Senate Finance Committee staff member meeting attended by JABSOM and partners to formally request these amendments. We have been in close discussions with HI congressional offices and are considering reaching out through President Biden’s Initiative on AANHPIs.		Ongoing updates to be provided by Dr. Withy and Dr. Grace at future HMEC meetings.
Acronyms: ACGME = Accreditation Council for Graduate Medical Education; AHEC = Area Health Education Center; AAMC = Association of American Medical Colleges; CEO = Chief Executive Officer; CFO = Chief
We are still on a current FY22 Continuing Resolution through 2/18/2022. There is hope that a bill with strong funding for Title VII & VIII health workforce and nursing programs will pass. The UH Rural Health Research Center, which we have proposed, is in this bill.
a. Preceptor Tax Credit Update (Dr. Kelley Withy)
The preceptor tax credit program is in its third year.
● 2019 – 181 Preceptors, 371 Credits
● 2020 – 185 Preceptors, 368 Credits
● 2021 – 253 Preceptors, 559 Credits
Dr. Withy shared a table showing how the money has been distributed in these past three years, one showing the number of credited rotations per preceptor, and one showing the percentages of preceptors in Honolulu, Hawaii, Maui, and Kauai Counties. All islands had preceptors receive tax credit. As noted above, we will be going back to the legislature to request broadening the scope from just primary care providers to those providers who help train future primary care; this would broaden the specialties that can participate in this tax credit.
Additional clarification is being pursued regarding preceptor compensation. This credit is for Hawai‘i-based educational programs and half the students in the covered health professional educational program must be residents of Hawai‘i.
Dr. Withy reported that each year starts anew; any unspent money goes back into the state budget. There is no carryover.
Dr. Finn Davis asked if psychology would be added in this program. Dr. Withy said that she has not heard that psychology wants to make an amendment. Dr. Withy has sent her annual report to the legislature to HMEC Council Members and mentioned ways in which Hawai‘i will have different needs and demands than other states such as how the impact of having such a large tourist population will affect our needs for emergency services.
Anyone interested in working to more accurately reflect our demands for health workforce, in addition to this Preceptor Tax Credit Program, should contact Dr. Withy (withy@hawaii.edu).
4.HMEC
Recommendations to 2021 Legislature
L. Buenconsejo- Lum		HMEC Recommendations to the 2022 Legislature/draft HMEC report (Dr. 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 (SLRP). 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.		Informational only.
Acronyms: ACGME = Accreditation Council for Graduate Medical Education; AHEC = Area Health Education Center; AAMC = Association of American Medical Colleges; CEO = Chief Executive Officer; CFO = Chief
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 need 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 to 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 regarding these recommendations:
The bills are in the governor’s budget. JABSOM leadership has met with leads of the health and higher education and house finance and has an upcoming meeting with Senator Dela Cruz this week. All the discussions have been positively received. Two very lengthy responses posed by Senator Donna Mercado Kim and the House Finance committee have been submitted. Recommendations #1 & #2 are moving forward while the timing is still not right for recommendation #3.
5.Additional Items● There were no additional items proposed.
● All participants were present for the duration of the meeting.
● Dean Hedges offered one last opportunity for public comment – there was none.
● Next HMEC meeting: Monday, April 25, 2022, at 7:30 am, location to be determined and via Zoom.
6.Adjournment● Meeting adjourned by Dean Hedges at 9:02 am.
Minutes Approved: MBK                          (Recorders Initials & Date)
Acronyms: ACGME = Accreditation Council for Graduate Medical Education; AHEC = Area Health Education Center; AAMC = Association of American Medical Colleges; CEO = Chief Executive Officer; CFO = Chief