October 22, 2018



Hawaii Medical Education Council
Monday, October 22, 2018
7:30-9:00 am

John A. Burns School of Medicine
Kaka`ako Campus
651 Ilalo Street, Medical Education Building
Room 202

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, October 22, 2018, 7:30 a.m. – 9:00 a.m.
Location: 651 Ilalo Street, Kaka‘ako Campus, Medical Education Building, Room 202
Honolulu, Hawaii 96813


  1. Review & Approval of July 30, 2018 Minutes – Dr. Hedges (also distributed via email to members)
  2.  Report from HMEC Chair – Dr. Hedges
    • Announcements
    • Update on Legislative Strategies (with Cynthia Nakamura)
        1. Comprehensive “story” and combined efforts needed to supplement education visits
    • UHealthy Hawaii – Dr. Aimee Grace
  3.  Physician Workforce Data Updates – Dr. Kelley Withy
    • Data / Maps
    • Healthcare Preceptor Tax Credits law – (Kelley Withy & Laura Reichhardt)
  4. Next Steps – Dr. Lee Buenconsejo-Lum
    • HMEC Subcommittee Update – no new updates; continued work with HHSC is needed
    • Models to consider for supporting GME programs and/or expansion – no new updates
  5. Follow-up to final 2017 HMEC report / Review draft of 2018 HMEC report
    • RECOMMENDATION #1 – in progress, several initiatives to help w/ long-term recruitment & retention (scholarships, loan repayment, working with health systems & faculty practice plans to create job opportunities) but no clear direct options for new GME funding at this time. Working with DOH and Congressional Delegation toward “island” designation or other that would make available other opportunities for GME or primary care expansion. Working with State DOH to secure new funding toward Addiction Medicine Fellowship.
      • UH JABSOM/HMEC recommends that UH JABSOM and the legislature work with vital stakeholders to identify options for funding GME and the return on investment to the state of Hawai‘i in funding GME.
    • RECOMMENDATION #2 – prelim discussions occurred but timing is not optimal; recommend continued effort on this
      • UH JABSOM/HMEC recommends that the 2018 State Legislature assess the advisability and feasibility of an annual GME Appropriation to fund HMEC designated residency/fellowship programs with a particular emphasis on primary care.
    • RECOMMENDATION #3 – in progress
      • UH/HMEC recommends that the 2018 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 Matching program to augment GME funding.
    • RECOMMENDATION #4 – prelim discussions occurred but timing is not optimal; recommend continued effort on this
      • UH/HMEC recommends that the 2018 State Legislature, UH JABSOM, the Hawai‘i Medical Association and other stakeholders explore potential remedies or reforms to protect residents and fellows from being named in malpractice suits while they are in a formal training program and providing care under the supervision of a fully licensed attending physician.
  6.  Additional Items
  7.  Announcements
      • Next HMEC Meeting – Monday, January 28, 2019 @ 7:30am in MEB 202
  8. Adjournment


Hawaii Medical Education Council (HMEC) Meeting

October 22, 2018 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:  William Dubbs (representing federal healthcare sector), 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), Joseph Sterbis (representing hospital conducting ACGME programs), and Sharon Vitousek (representing health professions community).

Members Absent:  Katherine Finn Davis (for Mary Boland, representing the School of Nursing) and Todd Seto (representing hospital conducting ACGME programs).

Others in Attendance:  Chip Ellis (UHP of Hawaii), Aimee Grace (UH Director of Health Science Policy), Cynthia Nakamura (Government Affairs and Legislative Consultant), Holly Olson (JABSOM), Richard Philpott (Hawaii Residency Programs), Laura Reichhardt (Presenter), and Kelley Withy (AHEC).

Via Zoom or Phone:  Mary Ann Antonelli (VA), Curtis Lee (Hui Kahu Malama), and Sydney Tatsuno (Hui Kahu Malama).

HMEC Administrator: Lee Buenconsejo-Lum, UH JABSOM Designated Institutional Official (DIO) for Graduate Medical Education

Recorder: Crystal Costa

1.       Review of Minutes Minutes from our last meeting, held on 7/30/18, were reviewed ahead of time via email sent on 10/5/18. Motion to approve came from L. Rantz and second by W. Dubbs. Motion to approve carried unanimously. No opposed and no abstentions.NA.
2.       Chair Report Dean J. HedgesA.       Announcements/Introductions around the room were followed by an announcement of the Ryder Onopa (JABSOM graduate) Blood Drive being held at JABSOM in his memory. All are encouraged to give blood. FYI/Update.
B.       Primary legislative strategy for 2019 (Cynthia Nakamura):
Focus will be on the State Loan Repayment Program (SLRP). Funds previously obtained for this program were secured for only 2 years and will expire on 6/30/19. The next request for funding renewal will be asking the state to match the federal and private monies that have been secured by Dr. Withy. Our previous ask of the legislature was for $250,000 while the new request will be for $350,000. The Department of Health (DOH) will continue to allow the monies to flow through DOH then to JABSOM. Senator Baker will be introducing the bill along with a House companion bill. Currently providing funds to all those that have applied and who qualify. A pilot program has been created to help fund those physicians that have a solo and/or part of a small practice with state funds if they are part of a non-profit.
C.       UHealthy Hawaii – Vision for a healthier Hawaii and Pacific:
Dr. Aimee Grace, UH Director of Health Science Policy, shared the workforce initiative of UHealthy Hawaii, which focuses on the UH health sciences programs to improve healthcare. Flyers containing more information will be distributed. The budget will look at the federal appropriations first. There will also be a research component, which includes convening a working group with the Department of Human Services. Four main priorities are to: 1) ensure a robust statewide workforce, 2) improve and extend lives (research and innovation), 3) promote healthier families and communities, and 4) advance health policies. UH has been working with the Chamber of Commerce of Hawaii to bring together industry partners with academia to identify and address future workforce needs. To attract and retain graduates in Hawaii, options are being developed to promote rural training experiences. This includes partnering with airlines and launching the UH homestay Aloha Program to help reduce the costs for housing during a neighbor island training experience. The overall goal is to expand health science programs and support programs in as many ways as possible while building partnerships across the state and Pacific.
3.       Physician WorkforceUpdate on data and maps will be provided at the January meeting. Ongoing updates to be provided by Dr. Withy.
Kelley WithyHealthcare Preceptor Tax Credits Law (Act 43 (18)):
a.       Received $1.5M in funding. Preceptors for students in Pharmacy, Nursing, and Physicians will get $1,000 (either per student or per 80 hours – still being determined) and up to $5,000 per year for a designated number of hours provided on a volunteer bases. To qualify, preceptors must be providing training in primary care to students that are enrolled in a state training program.
b.       Discussion continues in defining “primary care” and if social work should be included in this group.
4.       Next Steps HMEC subcommittee report: Ongoing updates to be provided by Dr. Buenconsejo-Lum.
L. Buenconsejo-LumContinued work is needed in collaboration with Hawaii Health Systems Corporation (HHSC). Since the last meeting, exploration of the following has occurred and are ongoing: 1) extending the current loan repayment program and 2) work with HRSA and the federal government to help broaden definitions for rural settings to include all islands of the state of Hawaii.
Models to consider for supporting GME programs and/or expansion:
Exploratory discussions continue regarding the possibility or feasibility of the legislature providing GME-specific funding – perhaps a line item – that ideally would not be limited to the 2-year state budget. Funding could be used for GME-related expenses (i.e. faculty, rotations, administrative fees, etc.) but not FTEs for residency/fellow positions as positions require salary commitments for the duration of the training program. GME-specific State funding would help reduce the financial burden on our hospital partners. We also continue to work with our Congressional delegation and others in the State on measures that could lead to additional sources of GME funding.
5.       HMEC ReportFollow-up to final 2017 HMEC report / review draft of 2018 HMEC report:Lee will continue to seek input from HMEC members and provide updates at future meetings.
L. Buenconsejo-LumCouncil reviewed last year’s report and decided that the executive summary should continue to highlight the workforce and importance of GME in creating our physicians for the state of Hawaii. The report should also include:
a.       The decrease in federal GME funding, updated data from Dr. Withy, and remove the Transitional Year program.
b.       GME strategic planning outcomes: 5 major areas addressing 1) resources, 2) retention, 3) prevent burnout and promote well-being, 4) expansions for neighbor island and telehealth training, and 5) incorporate population health and inter-professional education and training into all GME programs to better prepare future physicians.
c.        Scholarships provided by Hawaii Pacific Health, The Queen’s Medical Center, and the Weinman family. Council noted that the goal is to provide full scholarships to the most competitive local students who are offered admission to JABSOM. Having no medical school loans could help to encourage students to stay in or return to Hawaii after residency training. JABSOM is working on processes to tie these scholarships to a required commitment to practice in Hawaii.
Report Recommendations to be updated as follows:
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.
• Strategies to explore include, but are not limited to, Legislative line item, funding to UH JABSOM to support GME costs (excluding resident or fellow salary/fringe), alternative arrangements with health insurers, all-payer GME financing models, or new models of teaching in partnership with hospitals
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.
• Since 2016, JABSOM and its faculty practice plans, as well as HHSC, have had discussions with the Department of Human Services and outside consultants to determine details and processes that would be needed to implement a successful Medicaid GME Matching program via the Federal Upper Payment Limit or Value-Based Purchasing programs.
• Of note, in 2015 the Hawai‘i Medicaid program reported contributing an additional $70,000 to hospitals for GME training, as a percentage add-on to routine per diem and ancillary per discharge rate.
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.
• In FY2016, twenty-nine States and Washington DC made separate GME payments directly to teaching hospitals, managed care organizations, or to teaching programs under managed care contracts. States do not separately report GME payments that are included in base payment rates to hospitals.
Comments from the Council for continued discussions include:
·  Working with training hospitals to ensure that trainees’ case conferences, quality improvement and morbidity/mortality conferences are convened under the auspices of the hospital’s peer review processes so that those discussions are protected.
·  Continue working on risk management & mitigation to help reduce the number of trainees being named in lawsuits.
·  Build pathways for retention of TAMC physicians to practice in Hawaii after completion of military service.
·  Continue providing neighbor island rotation experiences
·  Explore scholarships and other pathways for students from the neighbor islands to return to practice on their home islands after completion of GME training.
6.       Announcements·         Next HMEC meeting: Monday, January 28, 2019 at 7:30 am, JABSOM MEB 202.
7.       Adjournment·         Meeting adjourned by Lee Buenconsejo-Lum at 9:00 am.