October 26, 2020

MEETING
ANNOUNCEMENT

Hawaii Medical Education Council
Monday, October 26, 2020
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 October 23, 2020, 12:00 PM.
Responses received after that may not be guaranteed though we will try our best. Upon request, this notice is available in alternate formats such as large print, Braille, or electronic copy.

AGENDA

Hawai‘i Medical Education Council (HMEC)

University of Hawai‘i, John A. Burns School of Medicine
Date: Monday, October 26, 2020, 7:30 a.m. – 8:30 a.m.
Via Zoom – Due to COVID-19 precautions

1. Review & Approval of July 20, 2020 Minutes –Dr. Hedges (distributed via email to
members on 10/23/20)

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. HMEC Recommendations as proposed to the 2020 Legislature – Lee Buenconsejo-Lum (5 minutes)

4. Physician Workforce Data Updates & Synergies – Aimee Grace & Kelley Withy (20 minutes)
a. Preceptor Tax Credit Update
b. Physician Workforce

RECOMMENDATION #3
UH/HMEC recommends that the 2020 State Department of Human Services and other stakeholders explore the mechanisms to obtain Federal Medicaid GME funding since many of the residency programs provide inpatient and ambulatory care for Medicaid populations.

5. Additional Items
a. Announcements – Next HMEC Meeting – Monday, January 25, 2021 @ 7:30am
location TBD

6.   Adjournment

Minutes

Hawai‘i Medical Education Council (HMEC) Meeting

October 26, 2020  Time:  7:30-8:30 a.m.

John A. Burns School of Medicine, via Zoom due to COVID-19

 

Members Present:  Nicole Apoliona (representing the health professions community), 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 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), Linda Rosen (representing the health professions community), Kathryn Ryder (representing the federal healthcare sector), Todd Seto (representing a hospital conducting ACGME programs), and Joseph Sterbis (representing a hospital conducting ACGME programs).

Members Absent:

Others in Attendance: Mary Ann Antonelli (Medical Education Director, VA), 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.), Courtney Matsu (for Richard Philpott, CEO, Hawaii Residency Programs, Inc.), Holly Olson (Deputy DIO, JABSOM), 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 7/20/20, were reviewed and approved. Dr. Hixon made the motion for approval, which was seconded by Dr. Buenconsejo-Lum. Approval was unanimous. No members opposed or abstained.NA.
2. Chair Report Dean J. Hedges & Legislative Strategies Updatea. Announcements (Jerris Hedges)
Dean Hedges welcomed our new HMEC members – Drs. Nicole Apoliona, Leslie Chun, Linda Rosen, and guest Dr. Courtney Matsu. Drs. Apoliona and Rosen will be representing the health professions community, and Dr. Chun will be representing Hawaii Pacific Health as a hospital that hosts ACGME training programs. Dr. Matsu is joining the meeting on behalf of Richard Philpott, CEO of the Hawaii Residency Programs, Inc.
Impacts and adjustment due to COVID-19:
Due to the pandemic, all residency/fellowship interviews will be conducted virtually this year. The JABSOM/UHP media teams have been working together to support GME programs by creating recruitment videos to post on their websites and share during the interview day. These videos would replace onsite tours and provide a glimpse into the program. JABSOM students have expressed concerns regarding the time difference across the U.S. while scheduling interviews (e.g. 2:30 am Hawaii time for an 8:30 am interview on the East Coast). Dr. Buenconsejo-Lum has sent requests to the AAMC to ask that programs factor in time zone differences when offering interviews.
Update on Legislative Strategies:
Many legislative initiatives have been tabled for future sessions. The medical school expansion to Maui will need to be deferred due to the recent economic impacts and uncertainty caused by COVID-19. JABSOM would still like to have trainees rotate and get exposure to neighbor island clinical settings but will need to consider the financial impacts and educational/supervision capacity of each site. The preceptor tax credit language modification (to expand the verbiage of types of eligible providers) was also tabled. Also, the loan repayment program was denied and without the State matching investment of $300K this program will be limited and unable to expand.
Graduate Medical Education Updates (Dr. Lee Buenconsejo-Lum):
COVID-19 dashboards are being monitored closely as the State and US experiences impact GME rotations. Programs have been vigilant in enforcing COVID-19 precautions (e.g. eating /taking breaks in shifts, physical distancing requirements in breakrooms, wearing mask and PPE, telemedicine, hybrid didactic sessions, limited in-person meetings, etc.). To date, all reported COVID-19 positive GME trainees or faculty within JABSOM have contracted the virus outside of the hospital setting and all have recovered.
Due to the pandemic, all recruitment interviewing will be done virtually. The Electronic Residency Application System (ERAS) was delayed a month and opened on 10/21/20. The remainder of the Match calendar remains unchanged, resulting in a shorter recruitment season. This online recruitment tool (ERAS) allows for various filter options that can be used to help identify those with permanent Hawaii addresses. Programs are extremely busy reviewing applications (e.g. Family Medicine opened with 1,000 applications for 7 open positions) and will be looking closely for potential applicants with Hawaii ties or interest in practicing in Hawaii. Part of the virtual interview challenge will be identifying those truly interested in coming to a Hawaii program and staying.
NA. Informational only. Ongoing updates.
TOPICDISCUSSION / CONCLUSIONS / ACTIONS / DECISIONSTASKS
Travel out of state continues to be dissuaded. The Queen’s Medical Center will be aligning their “return to work & testing process” with Hawaii Pacific Health and Kaiser. If the pre-arrival (in HNL) test is negative, then the individual may report to work. A repeat test would be needed on the 5th day (at the traveler's expense) allow for continued work.
3. Physician
Workforce Data Updates & Synergies
Dr. Kelley Withy + Dr. Aimee Grace
Loan Repayment Program and Preceptor Tax Credit (Dr. Kelley Withy)
The physician workforce loan repayment program recently received a “thank you” posted on social media from a recipient that has paid off their loan using this program. Though this program did not pass the legislature this year, Representative John Mizuo is willing to reintroduce this proposal to the House during the next session. This program continues to pursue additional funding of approximately $200K to keep up with current recipients. As a matching program, Dr. Withy and the team will resubmit the grant in 2022 to help match locally raised funds.
Ongoing updates to be provided by Dr. Withy and Dr. Grace.
The preceptor tax credit program remains unchanged from the previous year after the request to adjust the provider definitions was tabled. JABSOM will continue to pursue revisions in upcoming years. Less than half of the program’s monies were awarded last year. The program anticipates lower numbers in calendar year 2020 due to COVID-19 impacts and reductions in rotations. This program continues to emphasize primary care.
Physician Workforce (Dr. Kelley Withy)
There are currently over 10K licensed physicians in the state of Hawaii. The physician shortage is at 730 and (last year this was 507), but more than 1,000 when you adjust for the neighbor island and specialty demands. A new model to review the physician workforce shortages is being developed that will now include hospitalists, as they were previously unaccounted for. The current age distribution of licensed physicians in Hawaii is older than the national averages with 46% over 55 years and 21% already 65 years (or older).
Women currently make up 37% of Hawaii’s workforce. Ethnic category is included for the first time in the survey and telehealth services have grown since 2014 (2%) to 2020 (52%).
While the percentage of employed physicians are slowly rising (54% (2014) to 58% (2020)), number of small group practices are going down (54% (2014) to 47% (2020)). The greatest shortages remain in primary care (family medicine, internal medicine, pediatrics, and geriatrics), colorectal surgery, pathology, pulmonology, infectious disease, allergy and immunology, and hematology and oncology.
As of August 2020, 415 of 989 (42%) physician offices that responded to a survey question indicated that COVID-19 has impacted their practice. Impacts include reduced hours, now providing telehealth services, closed the practice temporarily or indefinitely, reduced patient volume, retired, increased hours, and/or additional reasons (e.g. practice protocol changes, more time with patients, travel restrictions, etc.). The Council recommended a follow-up survey regarding telehealth services that could be administered next Spring to help understand continued impacts and rebounding measures. A prior survey showed that the HMSA per member per month (value-based payment) model adversely impacted primary care. However, there are reports from some practices that the value-based payment model helped keep the practice afloat at the height of the pandemic.
Dr. Withy to develop telehealth survey for next Spring.
Federal Appropriations FY 2021 Bills Update (Dr. Aimee Grace):
Dr. Grace provided an update on the annual federal budget & appropriations process. This process leads to the funding (or not) of important health research and health workforce programs, including the National Institutes of Health (NIH) and the Health Resources and Services Administration (HRSA), the latter which includes the Center of Excellence (COE), Health Careers Opportunity Program
(HCOP), and Area Health Education Center (AHEC) programs.
TOPICDISCUSSION / CONCLUSIONS / ACTIONS / DECISIONSTASKS
To help educate and raise awareness of the federal appropriations process, Dr. Aimee Grace has developed a workshop that was provided to JABSOM leaders entitled “How-To Guide: Requesting Funding in the Annual Federal Appropriations Process.” This includes the basics of the overall appropriations process (e.g. types of federal spending, steps of the budget process) and aims to provide guidance and offer specific tips and strategies for federal requests.
In terms of the annual budget process, agencies work on budgets for the next fiscal year (October-September cycle) which are submitted to the President who then submits requests to Congress. Only Congress has the power of the purse. The federal Appropriations Committees (House and Senate) oversee the submitted requests and determine the resolution for the next budget cycle. Hawaii currently has U.S. Senator Brian Schatz and U.S. Representative Ed Case on the respective Appropriations Committees. There are 12 Appropriations Subcommittees, and JABSOM and the University of Hawaii are largely focused on two areas: 1) Labor, Health and Human Services, Education, and Related Agencies (LHHS), and 2) Military Construction and VA (MilCon/VA). When considering federal appropriation requests, strategically aligning the needs of the state with mutual partners/stakeholders considerably increases the chance of obtaining appropriations language and/or funds. Additionally, requests should be reasonable, not include any “earmark” requests (related to specifying projects or funds to a particular district), and include strategies that emphasize Hawaii’s uniqueness and partnerships. In the LHHS subcommittee bill, the push is for a Center for Indigenous Innovation and Health Equity that has $2M in the House bill and could include key health workforce components. Further updates will be provided as available, as the FY21 appropriations process is ongoing.
4. HMEC Recommendations to 2020 Legislature
L. Buenconsejo- Lum
Continued Work Needed to Stabilize & Expand GME
JABSOM and HMEC reports continue to prioritize and explore options for obtaining funds to support GME programs. The annual report to the legislature will be due the first week of December and should include updates to recommendations. Council members will be asked to submit their comments, edits, and recommendations to Dean Hedges and Dr. Buenconsejo-Lum before 11/6/20.
The GME Advisory Council (held quarterly and comprised of the CEOs of the major training sites, HRP, JABSOM, and UHP leadership) understands the need for expanding GME (e.g. increasing program sizes, creating new programs) and will be discussing indicators for
HMEC members to submit comments and recommendations no later than 11/6/20 close of business.
prioritization, given current budget constraints. Having a process will ensure that current programs are not adversely impacted by any
expansions and will require programs to identify sustainable funding sources (e.g. synergistic opportunities, partnerships, etc.).
Discussions from the Hawaii Medical Education Council (state-wide recommendations) impact the GME Advisory Council.
The current three recommendations are listed below with additional updates and comments discussed:
2020 RECOMMENDATION #1
UH/HMEC recommends that the 2020 State Legislature and State Executive Branch continue to support and provide a State match to
continue the Hawaii State Loan Repayment Program. Ideally, this match would be provided as a supplement to the annual Department
TOPICDISCUSSION / CONCLUSIONS / ACTIONS / DECISIONSTASKS
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 Hawaii - including coordination of the National Loan Repayment Program Federal match.
Discussion: The legislature continues to process funds through the Department of Health (DOH) which then contracts UH JABSOM to implement the program. This process has continued to work successfully over the last few years and will be continued. Mahalo to the DOH and Lorrin Kim for assisting with this process. Dean Hedges and Dr. Buenconsejo-Lum recommend carrying forward recommendation 1 to the 2021 Legislature and Executive Branch.
2020 RECOMMENDATION #2
UH/HMEC recommends that the 2020 State Legislature and State Executive Branch support the expansion of JABSOM faculty and staff to provide satellite educational programs for year-round undergraduate medical education on Hawai`i and Maui Islands which will allow expansion of the medical school class size with more neighbor island medical education, and will allow exploration of residency training expansion to these islands.
Discussion: Before further expanding rotation sites, JABSOM would need to seek funds to maintain current educational operations (rotations) on the neighbor islands and centrally on O‘ahu. The budget cuts from the Governor are still being finalized but will impact core faculty funding and student travel to the neighbor islands. Without an additional state allocation in 2021, we may need to reduce neighbor island rotations. JABSOM’s strategy includes asking the state to dedicate more funds to shore up central operations.
Recommendation #2 will need modification.
2020 RECOMMENDATION #3
UH/HMEC recommends that the 2020 State Department of Human Services and other stakeholders explore the mechanisms to obtain Federal Medicaid GME funding since many of the residency programs provide inpatient and ambulatory care for Medicaid populations.
Discussion: Judy Mohr Peterson, Medicaid Director and Administrator of Med-QUEST is generally supportive of recommendation #3 though unable to prioritize this while they focus on their request for proposal (RFP) and revamping Med-QUEST to account for higher enrollment due to COVID-19 economic impacts. Dr. Hixon recommended carrying over recommendation #3 as Medicaid is a funding source for GME. The Council recommendation will be to create a dedicated Medicaid working group to help develop a plan and coordinate the approach when the time is right. Additional recommendations include looking for matching programs or identifying sustainable private + grant-funded sources as partners that could potentially “sponsor” a resident position, considering private insurance companies, and requesting Medicaid to increase access to care on the neighbor islands to help expand educational experiences. Recommendation #3 may need additional wordsmithing.
Feedback from the Council will be collected via email and due by 11/6/20 as the HMEC annual report is will be due before our next HMEC meeting.
5. Additional Items All participants present for the duration of the meeting.
 Next HMEC meeting: Monday, January 25, 2021, at 7:30 am, location TBD.
6. Adjournment Meeting adjourned by Dean Hedges at 8:47 am.
Minutes Approved:                                                                             (Recorders Initials & Date)