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Video-1: youtube.com/watch?v=MOwL04iCqHA

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call the meeting to order and ask that uh Lucas if you could do roll call and determine for for us here. >> All right. Um Dr. Choy >> here. >> Dr. Becker, we will hold on that.

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>> Dr. Knight here. >> Welcome [laughter] Dr. Serman >> here. >> Dr. Shley >> here. >> Beautiful. Um, Angie Zagel

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>> present. >> Uh, Dr. Gky, >> not see him quite yet, but we are expecting um Rob Mlenn here. >> Dr. Hearn >> here. >> Dr. Bryce

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>> here. >> Kelly Colick >> here. >> Is that how to pronounce it? >> Collic. >> Dr. Gap key, are you able to hear us? >> I can. I'm here. >> Thank you. And then Eric Davis said he might join us today, but that would be

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virtually. So with that, um, we have a quorum necessary to business. Wonderful. All right. Well, welcome everyone. Um, I think what we'd like to do is introduce some new members today. And I think, uh, for Kelly, it is your first meeting as our student advisory representative from

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IU School of Medicine. So, would you take a moment and introduce yourself to the board and we'd love to, you know, get to know you a little better. >> Hi, I'm Kelly. I'm from Evansville, Indiana originally. I did my undergraduate up at Notre Dame and I'm currently finishing up my final year medical school at IU. So, I've really

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been taking a grand tour of the state so far. Um, and then this fall I'll be applying forology residency. Nice to meet you all. >> Wonderful. Well, welcome. There's another student member um Eric from Marin College of Osteopathic Medicine. He can't make it today. And uh but I

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have a guest with me today who's following me uh this uh this summer on a leadership rotation and elective. Austin, do you want to introduce yourself to the members of the board? Uh little about yourself. >> Hello everyone. I'm uh Austin Leighton

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and I'm going into my second year at Mar uh University College of Hospital Medicine. Um I'm originally from Fort Wayne, Indiana. So, not too far. Um, yeah. And have been spending the summer with Dr. Hearn and the wellness team uh at community just incredible. So,

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>> yeah. Yeah, we've been getting lots of exposure. So, he's here as a guest public member today just joining >> right. Um, looks like minutes. Yeah, minutes are the next item. So, if you've had a chance, uh, the minutes were sent out, you had a chance to review those from

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our previous meeting in April. Um, if there's any corrections or edits, please let me know. >> I make the motion to approve. >> Thank you, Brock. >> Second. Thank you. All in favor of approving the minutes

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and minutes, raise your hand or say, "I." >> I. I. >> I. >> Any opposed? All right. The minutes are approved. Thank you. Um, okay. Well, let's maybe lead off

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with the fiscal review and then we'll maybe have a discussion about what's in front of us today as a board. >> Um, before that, um, you do have a supplemental document in front of you. It's the onboarding packet. Um, not a discussion item today, but hopefully something that gives some background about what the board is. It's a document

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that I'm hoping to um, distribute at the beginning of each year. Um, so if you have any feedback, please send me an email. I'm happy to do another draft of that before our final for the year. Okay. Um fiscal review. I think we can probably just talk about it more than a PowerPoint this time. Um start square

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one with the board has 6,346,52543 to spend um between now and July 1st of 2025. Um currently the applications that will be considered today, expansion applications total $9,495,000. and then the um additional applications.

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So that's including the program development feasibility will total 575,000. Um so if all applications are considered today um your total will be $10 million7 or $10,70,000. Um so before going any further, are

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there any questions about that? just remind us of the shortfall where that is made up that made up in by next year or >> well so maybe Greg can better explain the process of the general assembly appropriations.

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>> Yeah. So what Lucas just described that $6,346,52543 is what we currently have in the fund um for fiscal year 25 as well as any rollover funding from pri prior fiscal years. So um what Lucas is describing is

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is really a unique situation um for the board in which um prior to this there has always been sufficient funding to fund each application be they expansion program development or feasibility that

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has come to the board. So um you know we predicted at at some point this would happen and due to this now being a mature program um is is kind of where we are. there's a lot of interest across the state. The word has gotten out. I want to thank the board members for all the collaboration and connections that

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you've made. Um so, you know, that is is kind of where we we are today with that. Um Lucas broke out the majority vast majority of the fiscal requests today um is related to expansion grants. Uh but there are also uh two applications, one

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for program development in the amount of patent million dollars as well as one is a feasibility grant for $75,000 which are the applications that um we've received today and um I'll kind of pause there madam chair if you have any um

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additional comments you wanted to add. >> Yeah. Feedback so far. >> Yeah. So I think this is a very interesting day for our board. We have been anticipating this um since the inception of the board that at some point we would be so successful with our

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work which we have been that we would have demand that exceeds what we can fund and um so we are in a interesting spot where we are now testing things that we haven't really had to test right we haven't really seen uh how the rubric

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uh even though we we intentionally put together our scoring rubric We've never seen how the scoring rubric played out in terms of u prioritizing one program versus another in terms of receiving awards. Um you know the weight of the

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relative scores and how we chose those at that time. We made our best estimation when we set that up. Um, and I think that what I'd like to do before we get into scoring and uh this making decisions like have a a real discussion

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about this because we have some very new members to our board as well. Um, and so like I think we just want to make sure we all are understanding what the implications of our this previous decisions have now that we're weighing in today. I think one of the benefits

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that we did this past year or two is trying to come up with this calendar to think things up so that today we have all all the expansion grants here in front of us today. You can see how it would have been had we not done that. we

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might have had grants in March that get the money because they were a little quicker and and and then someone in um or in April I should say and then in July if you come later the money's the money's gone or in October. And so I I'm

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glad that we took this action as a board to bring this calendar together because now we're we're putting like grants against each other and actually seeing the scoring rubric work versus randomly accepting them at any time of the year. Um but we are in a place that is very

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you know we just have not been as a board. Um so I think it's worth a little bit of discussion you know what was the original intent when we build our scoring rubric do do we have thoughts about it do we feel how did we feel scoring this time I mean because there

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are probably some things about this process that we're going to learn into as we are really faced with these um more difficult decisions. So, I'm just hoping that we first have open discussion because we have not ever been in this uh position before and um from

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our board members particularly. So, >> and a quick note um before we begin any discussion, we will have um representatives from the applications joining us in the meeting. Um so, currently we have I believe it's Autumn Thinner um from the feasibility application and then um Michelle Harris from Park View. Yeah. Um so, we'll I'll

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make an effort to announce that throughout the meeting, but just a disclaimer before we start. >> Yeah. And the other piece that also which maybe you got from reading all the wonderful and kudos to Lucas first of all for what he has done to simplify streamline put together the survey

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instead of the Excel workbooks for us to complete the scoring and have stuff prepopulated in there for us. I mean, I think that compared to what we've done in the just the clunkiness, right? It's it's way way reduced in terms of our our work is uh

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and scoring this many. So, thank you for the streamlining the process for us. The other the other nuance of today is in theory we would just be scoring the expansion grants. We did have some um other applications come in this time of feasibility which we have never had a

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date on the feasibilities because they're smaller and they can come in at any time. And then the um program development grant from Parksiatry uh came in I don't know can you share the timing? It came in a little late last time. >> It was after the uh April 26. So it was

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just after our deadline for program development grants. >> Right. Um, but I think that, you know, that may we want to may want to factor in some discussion around that because how do we how do we factor that in because should we score and vote and uh approve grants today potentially we

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could we could exhaust our funds and have nothing left until uh July 1. And so how do we want to factor in uh the consideration of these other grants that came forward even though a little past the deadline and what is the intent of

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our uh of our you know our great work and and our ability to fund different programs. Anything you want to add that yeah especially because we have um you know some board members who have have served with us for for multiple years in

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terms but we equally we have a lot of new faces on the board. Um I did want to talk just a little bit about the statute which established this body and and does give um you know pretty wide latitude for the way by which we conduct business and ultimately facilitate grant

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opportunities. So um the um structure that was put in place uh beginning with the quarter three member uh uh meeting of 2023 was imposed by the board. Um so that is not a statutory um requirement

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the one in which the board voted um to impose on itself. So there are a number um and and I think just reiterating maybe in a more direct way what chairwoman um mentioned is that there are a number of options that the board has um and I think it's our intent to

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start a discussion on that um and ultimately um decide what is the the best route forward um for the funding that we have remain for this this present biium. >> Yeah. Um, are we expecting more um requests for money for like expansions

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to come in throughout this year? Like is this >> I I would anticipate um new expansion applications to be submitted before um July of next year. I am certainly expecting more program development applications to arrive uh likely in early spring. Okay. And so that is

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something to consider today if we were to vote on the program development grant that it would um kind of be just disqualifying those applications until essentially 26. >> Yeah. And just to kind of loop back on our the calendar we imposed on ourselves. The calendar we imposed um

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was in the April meetings and do the development grants for those like against light. in this meeting for expansion grants like against lake and then at the um Q1 Q4 meetings be doing reviews of their progress reports that

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they're sending into us. So in theory this is the time to do expansion reviews for this funding cycle up through July one. I mean, in theory, people could send them, but the way we tried to direct people now was that this

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would be the time to do it. And then next July would be the next time we'd accept new expansion uh grants and then but but if we exhaust all our funds today and there's people who want a new development next April,

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>> right, we won't have any funds if we if we exhaust everything today. >> Can I ask another question? $6 million um just because I'm new lower than we normally get in a fiscal year. Is that unexpected?

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>> Yeah. So to that's a great question um Dr. Grace. So uh we we actually received about a 15% increase in funding um you know comparing this bienium compared to last bianium. Uh we were funded at $4 million during fiscal year 22 5 million

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during fiscal year 23. Okay. uh that was expanded um you know doing in part I'll I'll give credit to Dr. Becker and um Dr. died for the advocacy that they did at the state house for fiscal years 24 and 25. We received 7 million and 7 million. So, we did receive a a pretty

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substantial funding increase. Uh we did advocate for uh 10 million and 10 million. We didn't quite hit um where we wanted, but I I think that there's very strong support um obviously from each chamber in the legislature for this program. Um you know, we stress the

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success that we've had so far. Um and I think you know although um there will be a lot of discussion today based upon the interest that we have I think that is even more evidence moving forward as we enter the 2025 legislative session which starts in January and it's a budget year

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to push for you know that larger ask that we had during the 2023 session originally. So just a little background trend of less and less. >> Yeah. In fact, it's the inverse of that. >> Yeah. >> And just more and more programs growing

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and then if they continue in the with the development sort of we haven't put a limit on the timing of when how long development grants have been can be funded. I'm sorry not development expansion grants can be funded. Um and so then as more programs are set up and

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then they need to they do development then they do expansion and then you can just see that compounds compounds in terms of the ask back to this plot being and all of these programs asking for expansions or programs that were

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originally funded by our grant dollars. Um I think um so part of part part of what's happened is um I think there was misunderstanding between entities that had been awarded expansion grants um that that you can apply for more than one for separate programs and that is

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essentially I think is what what's happened today is u just more understanding on the the side of the entities or the applicants of what the possibilities are. Um so I think you know depending on how our discussion goes today if there are any adaptations to the scoring that the board would be

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interested in in the future. Um there have been committees for to formulate our current scoring. Um so it's definitely something that we can discuss >> because you may as you were scoring and maybe you knew or maybe you didn't know but the scoring is like really up to now

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it has not been as material but our scores have been because we've been able to approve everything really generally. I mean there's been a few exceptions where we post an application back and have them work on it a little bit more and give it back uh to us in a future meeting but generally we could not in a

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position where u scoring may be the reason that a program does not get get funding. >> You may end up succeeding. >> Correct. And and this is a great problem but it's it's we're we're here we're here at the date we we expected Jen. So you said there's not this not a policy

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at this point of how long would have expansion but have the projections how we when we approve a program do we project there are fiveyear cost overall for years things like that that we can start thinking about budgeting for and >> yeah so um when we look so the fund that

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um we listed off at the beginning today the 6.3 million is unencumbered funds and so the way that we've kind of calculated everything we look at the full cost and subtract that out of our unencumbered funds. So, um, the applications you're looking at today, um, that is for the full cost of those

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those four years. Um, so that's what we'll be voting on today. And so, um, those programs will be paid for in their entirety. And so, the next round be for a brand new cohort, I guess, to say, does that make sense? >> Maybe. >> Okay. the to for my clarity too I think

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to that the 10 million that you speak to if we were to approve that today all those slots the 10 million is for the fouryear period right >> that's that's not the annual obligation >> is it or is it

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>> it's the sum of the however many years >> sorry from a cash flow standpoint >> correct >> that wouldn't you wouldn't be paying out 10 million per year >> correct it would be the 10 million over four years. >> Correct. >> So the so the 6 million that we have in

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reserves wouldn't be depleted in in the first year by a $4 million delta. Correct. >> That's correct. >> Right. So I that that's where I get a little confused on the numbers. You almost need like a a cash flow analysis to be able to go here's where we would

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be in in year four. And maybe that's what you're saying. you're going to be at a at a delta of four million under if we don't get additional funding or are you saying that we're going to get we got six million now you got 10 million encumbered if we could approve

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everything over the next four years but you're also getting 7 million a year assuming that we don't change the the legislature doesn't change their current funding so >> so what we approve today will cover all all those residents that start and

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finish Okay. So, we don't have to get more money in two years. >> Well, but but if that's assuming we continue to get >> and then of course we're going to try to get million, right? 10 million or whatever coming this year. They So, for those of you that weren't here at the

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beginning, the original bill, >> they had hoped to get it up to 20 million actually. Okay. And the goal was the original number was 500 additional spots in the state at about 45,000. So when the original working group was

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working with the legislature, that was the general idea, but of course they started with the $3 million per year, the first year, and of course you they they couldn't approve it forever. So every two years we go back. So it's been really successful. Um and hopefully the

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state's in good shape and will be successful at bumping it up um this long session. Um, so you know, I think I think that was the history of it. Doc Brown and everyone um that was involved early on. So I think there was an

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initial idea that these programs would continue to get funded because they were shooting to get 20 million a year at maturity of the program, but that was the legislature years ago, you know, 8 n years ago in the world. So, um, so in reality, we're

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on a two-year cycle. I I mean, it would be unlikely they would cut us all the success that's that's happened happened. Plus, we've expanded around the state. The other thing was, you know, early on the goal was to really, and I think we've been real successful at this is to

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expand residencies outside of Indianapolis around regional parts of the state because of the physician mail distribution problem. we were training except for some family medicine programs pretty much all the docs were being trained in the Indianapolis market. So

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that was some of the original intent of the legislation um back 8 n years ago or whatever that was. So would we have the option? So if so there's 6 million unencumbered because we had already approved um in the April

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meeting that applied this year. So that's why there's not the full 7 million. Um and so if we approve more than we have unencumbered, do we then have to sort of put a qualifier on it that um if funds are available in the

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subsequent years is is would that be what we'd have to decide because we have at this point we've never approved more than what we had unencumbered. Correct. So this would be the first time we approved more than what we have unencumbered. So we would we need to put

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a qualifier on that that it we're approving it if the funds are available in subsequent years or how would we do that? >> Yeah, please do please share. >> Thank you for that that question Dr. Knight. >> I'm just trying to think through our

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options. while >> approved today. >> While that option could exist, staff would recommend against that just in in you know as a funer um you know we can assume that that the general assembly because of the strong support we have

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will continue to invest in this program but as a funer you know we're not able to run on on assumption alone. So, um, staff would recommend against funding beyond the unencumbered funds, the 6.3 million that Lucas mentioned, which the

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the board currently has. And so, yeah, Dr. Sunderman and Mr. Mlant to your um comments a moment ago, um, you know, these these expansion grants depending on the specialty run three, four, five years. And so what Lucas um much better

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than than I have ever done has is projecting um fiscal years what those those incumbrances are and ultimately deducting that from the balance of unencumbered funding that the board has available. So um again there are

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multiple paths forward and and staff is is more than happy to advise throughout the conversation today. Um but I'll go back to my point a few moments ago and that that statute you know gives gives the board pretty wide latitude for how um grants are facilitated. So if it's if

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it's funding just expansion just to give a few examples not trying to know dictate one way or the other but if it's just expansion grants today based on scoring up to the 6.3 that we have we're able to do that if it is tableabling discussion completely um so that the

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board can um really dig into this topic as it is a new one um and we do have several new faces in the board that is acceptable as well. we have a quarter four meeting scheduled. Um the board does have the flexibility to schedule,

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you know, additional meetings um in between that as necessary. So there's really a menu of options available. I think this is really great discussion thus far. Um but I do think you know based upon and I think Lucas has really done a good job with outreach and

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clarified he mentioned some groups who weren't aware of the multiple specialties for which they could apply. you know, the demand is growing and that is really, really good evidence to have with us as we embark on these conversations with our legislative

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partners and really try to move towards to Dr. Becker's point, the original intent of this legislation. Um, you know, we've got some pretty big gaps here, some which are more acute than others, especially if you look at locations throughout the state. You've done a great job at at addressing that

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so far. Um, but I'm I'm really, you know, reassured by by what we're seeing with the the year we're moving forward. >> So, staff has recommended we not promise money we don't have. >> That's right. [clears throat] >> Don't don't spend money you don't have.

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And in a environment of more demand than we have supply, does that make the deadlines that loom more important? If there are people who miss the deadlines, >> I I think that's part of the discussion. >> I think there's that discussion. I think

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there's, you know, discussion around our priorities as a board and what was most important because if you think about I mean who apply who was that late applicant. It was a it was a development grant. to spin up a new program. You know, is our priority as a board to spin

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up new programs or is it to continue to fund a program that's been around for a number of years and has received a lot of this funds? And so, this is the stuff that we're going to be wrestling with today and trying to decide. And so, I do think there's some options in front of

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us that uh Greg and Lucas have alluded to. like we could decide to to deal with a portion of what's in front of us today and really table some of our I mean because if we if we decide on everything today we're not [laughter]

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>> is that bad [laughter] but [laughter] >> but I think there I would I would just urge us as a board that there's no there's no urgency right we could really t like sort of set some of this discussion into a deeper dive a workg

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group a meeting in between now and our October meeting to make sure like we've all looked at the source we all feel the rubric is how we wanted it because it we've just never tested it in in the true way that we've um we are about to face today and so did we all score sort

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of understanding that do we feel good about how you know some of these scores when I look at them you know it's 20 points equally for every piece Well, are those equally weighted or are there some things that may be more important to us? And so, you know, I just think we should be philosophically wrestling with that a

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little bit right now before we dig into the scoring. And I'd like to open it up also to people or board members on the uh virtual as well. So, we make sure we hear from people in the virtual room. Um, >> may I make one comment before we move forward? Um I think it is also important

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to consider um how long it's been since we've engaged like a third party consultant to gather data. Um Dr. Becker brought it up that um we're we're nearing the end of what those projections were at least for the return on investment um the $1 for every $12 return. Um and so I think that is also

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something we'll want to consider um prior to going into this budget session. Um so just just a a note. Yeah, >> Lucas, with the money that's uncomfort um would it cover all the expansion grants today

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>> um at present if the expansion grants and thank you all for filling out that survey and um kind of helped me figure out what we would be talking about today at full price at $45,000 per resident per year. Um that totals 9,495,000.

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So just under 9.5. So, um, you'd be have a gap of a little over 3 million if each expansion grant were funded today. That that includes the new requests as of today. And like my question off of that is what is the do what are the 10

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million is tied to those grants that have been previously approved. Previously approved um it would be uh the Southwest. So do one moment. Get that out for you.

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>> When you say previously approved, you mean >> previous new requests, right? All the ones that we've already said we support. My understanding and I can do a you know inspect this before we continue discussion but my understanding at the

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moment is 5,940,000 would be the sum at full funding for those programs. Um but if we >> we have enough to basically cover those right now that yeah that's the board. So we have

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>> clarify that for me. Cover the ones that are >> that have been funded previously >> that have been funded previously. >> And you also should be able to see that um in the application summaries. Um so as we continue discussion I will go in here and kind of just make sure that

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that's the correct number. Um that's my estimate. >> Um yeah. I want to open it up to anyone any of our board members on virtually. So make sure since you're not in the the physical room to make sure we hear your

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voices as well. Any comments from Dr. Gimpy, Dr. Shley, Angie? >> This is >> Go ahead, Angie. >> Okay. Um, and I'm getting ready to transition so I can get in my video. I

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was in the car. But um I I I'm very happy to hear that we have um flexibility because um I I as a new board member, I've really had some questions about the

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whole um Rubik's and and um did I cut out? >> Yeah, for a second. Bring it back. Okay. Okay. So I I I like the idea of diving deeper with a subcommittee especially those who are a little bit

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more experienced seeing uh you know many applications over the years to kind of help you know guide us with you know how we do um rate in different categories because um what can happen is you're

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sort of scoring based on like when you have multiple applications in the packet you know you might be comparing ing, you know, those that have a little bit more information included in sections such as budget, but I don't know if all of them

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are kind of passing muster for what's minimally necessary. And so I I I also really appreciated the survey uh out where we could ask some questions. And so, you know, when we talk about collaboration, what are we looking for?

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Are we looking for amongst you know uh you know different entities? Are we really looking about collaboration amongst uh you know uh the same but in different ways? So, I I think that that um we it would be very helpful now that

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we have to actually use the this scoring tool as a way to sift through and make decisions on funding um to have better guidance before we actually do decide on these grant grant applications.

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>> Thank you, Angie, for sharing. >> Um just a quick note, I was mistaken. Um I was looking at the current grants. So for grants that have received funding since the board has started um it would total um that 9,495,000.

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So we cannot essentially say that not including any of the new ones being requested today. >> Um correct. I was saying I had looked at the current grants. So at some point each of these programs have received some kind of funding. Um if I could add one more step but stand

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by. Yeah. And uh the other thing we had talked about early on in our board journey I think was kind of long to right I mean we wrestled with this for a long time. Steve and I are are kind of the originals here and we know we know like we were should we be should we fund

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programs in perpetuity or not. We wrestled with that quite a bit. Um, I think there was some intention at the beginning to fund programs up until they could establish the cap and then get funding from the, you know, CMS and from the federal government versus from our

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state pool. Uh, but we elected at one point to try to continue to if we if we have the funds and we can continue to support these programs and they're meeting the mission of what the board wants, we are going to continue to to support them in perpetuity. But we also talked about should we, you know, if

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it's a four-year psychiatry program, do we just fund it for the first four years until it gets that whole first class, you know, kind of graduated from beginning to end and should we stop there? Those were discussions we we had. I don't know, Steve, if you want to add

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to that. I mean, we've wrestled with these things over the years. >> Yeah, this is a really difficult decision. So, you know, again, you go back to the original legislation. it was sort of intended to support them forever to get everyone to launch them, but that you know we're we're going to be at a

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point where we don't have that funding. So we we actually at one point had a sliding scale that if it was a brand new program, they got 25 and by the fifth year they didn't get any more of those points. So we were trying to create something so that the brand new programs

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would get extra points. Um so I think we had come up with that. >> Yes. to to solve for that and that's in our scoring rubric now as you see those get assigned that way. >> So we that's how we sort of address that but we've always been hopeful we will continue to grow the pie and be able to

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keep doing everything. The other thing we've had discussions in the past is when we get to this point should we look at maybe we can fund 30,000 spot and do all of them. So that's that is a potential thing for this year. >> Correct. um you know so you can make me

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think for you know you really want to support all these new programs as long as you can but you know we're going to have some tough decisions to make here. >> Yeah. Um so that figure each of those programs have received some kind of funding that also did include the program and development. So for programs that have not received um residency

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expansion at least from that overall entity that total is 2,655,000. So, if you were to um approve those new programs today, those new residency expansion programs, 2,655,000

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is that >> I'm sorry, >> sorry, plus the nine. >> That is that is for um those residency programs that have not been funded before. They I believe those just finished a program for the old plus 2 million for the new. Yeah, the all those expansions included

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were 900 or 9,495 something for the >> So, let me take those off and kind of close it. >> I think it's six or >> six.4 million is the previously funded

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programs >> and and go ahead Rachel. >> Yeah. Um, just wanted to comment here from the outside a little bit. Um, I I don't see the rush for us to make a huge decision because I think this is a big

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decision with impact. I'd be really interested in us kind of going offline doing some further study on this. I'm strongly in favor of new development grants. Um, me that was kind of purpose

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that I've seen over the years. Um, and then maybe thinking about are there other ways to try to equitably distribute this now that we are at the point that um, we've kind of hit our max.

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>> Yeah. No, that's a thank you for sharing your perspective on that, Rachel. Jen. >> Yeah, I have just two thoughts. One is I think that a lot of places that have a cap already are the places that have actually some educational opportunity outside some of the primary care

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specialties that we may have a shortage in statewide. And so so some some of my thought is potentially you know like Mark you and some others have probably had cap established and as they want to expand that they're going to eat some of this funding. Um same with mention

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Evansville things like that. So I I think somehow we have to account for that a little bit. And the other thing as we engage a third party potentially, it would be really great to have a bit of a workforce overview and some identification of

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workforce need because I think specialty wise I think we have shortages in a lot of specialties that potentially this group could address in addition to some just >> Can I ask one more question and then

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I'll shut up. I'm sorry. the the 10 million per segments is for the for the full years of the programs, right? So it's if it's three, if it's four, if it's five, let let's use four as an average. So did that mean

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that our cash flow off that 10 million over four years is 2.5 million a year? Yes, that would be the >> So, we got 6 million in the bank and you're going to spend two and a half million a year of that.

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You got two and a half years worth of cash flow. >> But do we have grants that last year we approved that are then moving forward? Right. >> What I'm trying to get at is are we are we always going to be upside down when you look at it the way you're looking at

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it. I've got six million in the bank with no consideration given over the maybe you have on the on the six million is that inclusive of the upcoming four years. >> Um the 6 million is free from any previously committed goals. So

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>> you got six million here you're spending two and a half million a year with the expectation and I know it's just an expectation but an expectation of every July getting another seven million. So you never if as long as you get that it as long as you get that you're always

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going to have your six million plus a little bit more depending on what we end up spending right so that that's what that balance is always going to grow right and that's kind of what the point I was getting to was if we want to approve it I think it's important that people know that we've approved 10

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million but we only have 6 million and they may not actually get it >> if they yeah so if they don't get you're limited to two and a half years worth of fun >> the way we've done it before is you get it, you're guaranteed because that money is pulled out and set aside for previous for years.

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>> So, it's just that there's a >> that's a that's a question there. >> Are we at the end of our is the two-year ending the the two-year ending July June 30? >> June 30th. >> Yeah. Second fiscal year started. We're

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in the first month of the year. So, we're going to have to go to the legislature for announce for the July 1, 2025 in those two years. Okay, >> which is a good position to be in. We won't >> correct. We're going to be able to have a full story.

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>> We're guaranteed one more year of the seven current >> this current year. And we only got six million left the final round of the guaranteed. So yeah, we just have to decide whether you get you basically have two maybe two and a half years worth of funding if you don't get any

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more any more money if we were spend the entire 10 minutes. >> So you could you could say for all these expansion grants we're we're going to do two years of each one of them we have enough fun unturned money and that depending on what we did legislatively

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you may be able to come in. >> Yeah. So that is another all kinds of options. There's a lot of right >> and I think that's important right what I would do it'd be nice to say yes to everybody however you're not getting quite as much

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that and you can do that as we give 45,000 for two years versus 30,000 for >> three years right would it be would it be better given those two options >> to do a shorter duration

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>> but I guess my question would a much lower amount per resident. >> Can that number even be adjusted pending another two-year approval at the budget level? Like if you were to get So we're basing all this on assumption we're

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getting nothing as of July 1 of 25. if we were to get another two years. So then then you wouldn't then you're gonna have a pretty large balance with a declining payment because you're going to drop it from 45 to 20 or whatever the

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number is. It just seems like there's some caveats in there that we need to make some decisions on as to here's what we're willing to approve pending budget approval for the next two years. >> Yeah. And this I I may not even have

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this right in my own head either, but next year these same programs >> can come back with the same as >> for the new cohort >> for the for the class right behind that they go out for four years too. So I think we >> yeah it's like you're several if you

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pull from next year's fund >> then you're pulling from the fund then it's going to be that next ask for next year's class that starts if I am right then people >> which is why we've historically only

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>> right >> fun granted funds out of the unencumbered so that we weren't sort of >> mortgaging you correct because there's a new class right behind for all of these programs that are going to come back next year

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and be here at our next July meeting. >> And a reference um because the feedback in the survey was pretty much split down the middle. Um if the board did decide to decrease the funding for each resident by half to 22,500 each year, all programs included would total

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$4,747,500. So if the board wanted to approve every program at a diminished amount, um that's just an example of what that cost would be and half. We could pick 30 or something. There's a little bit more funds or what throw throw a number, [laughter]

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>> right? >> We we all seem to have an appetite uh when there's a lot of detail that we want answered. If [clears throat] we did table these requests pending putting together a work group ostensibly we would at our at our last meeting of the year we would be looking at this Trisha.

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Is that right? I mean I think we should right. These programs need an answer on what they're going to get. But I do think that three more months might give this board a chance in the interim between now and our our late year board meeting to have some discussions, look

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at our scoring rubric, make sure we feel comfortable, talk about some of the options that are in front of us and not rush to that today and then we could absolutely implement something in the October meeting and score it and then let people know just a few months later

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than than um than they would are expecting. right >> and then people who have pay requests of us that three month delay does that do we have the knowledge whether that causes major problems for anybody >> I I would need to reach out institutions

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and and find out >> I'm done is I'm just having been in this a long time I think they'd rather know they're going to get 25 or 30,000 for the duration versus we're going to wait three months and they're thinking oh man was counting you know so >> yeah it's hard to

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Yeah. Whereas this way that we know we can do 25 or whatever we decide that we have enough money for. So they can count that into their their planning and budget and then next year depending how much we get, we can make the decision to try to go back up.

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I mean, have you have you have you [clears throat] put together sort of some recommended ideas or different types of I don't expect that you already have, but I mean we're coming up with all these ideas got 18 different [laughter]

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>> run this through chat GP2. [laughter] Um I have um [laughter] but I think it is important that um it's up to the discretion of the board. I've had a lot of time to sit with this um and I I think it would be appropriate before I

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voiced any of those opinions to sit down and just look at more of the data. Um and I I can put together a projection of like on these applications when were they first started um things like that in a short similar to what you have in your application summaries. Um which might be additional help with the the

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scoring. Yeah, I mean I I think there's some benefits, right? I hear some urgency around like, oh, we want them to know and we want to give them information so they know they can work and build from what their their budgets. I I totally hear that. Um I I think

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there's also I lost my train of thought for a second. Hang on. Come back to it. Well, I'll have to wait a second. No, you'll it'll grant your grand overview of the 10 million that you sent to us earlier that that is inclusive of all

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the ones that we're currently funding, >> right? So, the park views Northwest, the Porter, the Sigmax, the Union, the partner th those are the only ones that right now we are funding. >> They comprise the 10.07. >> That is um and programs that we have

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not. So, the the ones that we have not ones that are being requested now. Yeah, I got you. Yeah. And and that and that 10.07 is for four years. Um it it ranges so to sorry I'm sorry I'm making it too easy. >> Yeah. Correct. >> Yeah. Three to five.

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>> Okay. >> Yeah. Go ahead. >> Well, I'm just saying and that and that again am I am I too simplistic in saying then that that 10 million over whatever that average number of years is is how you come up with an average annual cash

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outflow. >> Correct. that that is right correct. So when you make your assumptions on whether funding is going to continue or not then that annual cash flow will be impacted by how much you're getting in fund. >> Yeah. So and this is the the layout that

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kind of looked at um it was also in that that workbook. So um we'll use the one that I had a typo on as an example. the um family medicine um Southwest GME um 675,000. It's three years for five residents and 15 residents. Um each year

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I guess that's 225,000. >> Yeah. Per year. >> Yeah. >> In cash flow. [clears throat] >> Yeah. >> With the $6 million balance now that >> available to pay for those funds and then having to make some assumptions as to whether the the state government will

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continue to support this program. There's some funding. >> Yeah. And the point I I got my point back. So the point I was thinking about was that if we decide to reduce you know cut the award in half let's say provided today

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there's all there's other programs starting right and so it sort of sets a precedent for us that then next year like if another program another couple programs have developed now we're at 12 million is the ask next year at this time then do we go are we going down to

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like 20,000 or 15,000 per program I mean I think If we make a decision like that today, it's not totally prevident setting because we can we can decide as board what to do. But you can see where it may diminish the awards

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over time because more and more programs hopefully still start and then they need expansion funding and then and then we're we're diluting that award potentially. That's our >> that question of perpetuity. >> Correct. >> Or a time limited stardom period.

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Correct. >> Going back to the legislature, we've cut we have work was done originally saying about 45,000 is the deficit per spot >> and a hospital hasn't subsidized and >> you know so there's a disadvantage of cutting this year for that going back

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for the ask next year. >> Yeah. Um, so you know, I'm slowly thinking in my mind what I would like to what I would recommend, but I mean this is so complex. >> Okay, I think Angie Sable has something.

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>> Yeah, Angie, go ahead. I was wondering if this board has the option of scheduling uh a special meeting in a month or so after those of you who have were involved with the um

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original development of the scoring tool or those who've been on for a while could maybe add in some elements to the tool that we've maybe can agree upon. like is it more important you know for those who have you know not received

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prior funding is it more important what's is there a geographic region that we feel like is more of a priority than others just some guidance on you know what's the difference between 5 10 15 20 you know and then I would be willing to complete the scoring over again with

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just a little bit more guidance that might allow us to still you know distribute funds timely, not have to wait till the next meeting. Um, if that's sort of the deal breaker, but principally I I think um I like staying

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within our means, the 6 million. Um, I I would be if we have to come to a point where we have to, you know, use the tool to exclude um people out, you know, that might that's a sign of success, I think, honestly, for this board. Um, and I also

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would not want to overestimate, you know, what the legislators might be able to do in the next budget just because I know they're looking under every rock right now for um, savings because of the, you know, Medicaid shortfall and everything. So, I think we we have to

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plan as if, you know, I mean, who knows what the future holds, right? Um, so those are my comments. >> Thanks, Andy. Last time we reviewed it took us almost

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a year to go through revising the scoring metrics. So I'm not optimistic realistically in a month or two. You know, my gut is we should decide what we're willing to do today and then

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plan so that certainly by next year's thing we have it nailed down exactly what we're all comfortable with. That gives us at least, you know, 9 to 12 months to actually work through and review everything. >> Yeah. Um I mean it was it was not easy

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in >> this is not it is it was it is a I mean there are some there's some advantages to waiting for the next three months where we can you know people can understand my score employ you know people may not have all realized what the impact of these scores were going to

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be and understanding it a little more deeply what the impact of these decisions are. there's that benefit, but you're right, Steve. It took a really long time to it it takes there's a lot of different things that could get weighed into a scoring rubric and um you

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know, and so we could decide to we have a lot of different options. We could decide to score some of the like the feasibility grant today and small grant. We could decide we want to do the development grant today because you know

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that's a priority to us. and then take the rest of the money, figure out how to divide that amongst the remaining expansion, whether we lower versus whether we use the scoring rubric. But I I think I don't hear consensus from us yet on whether we want to lower the

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awards or whether we want to rely on the scoring rubric. And that in and of itself, that's probably the biggest crux of the of the decision that we have to make first is are we more comfortable lowering awards to get more people what

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they need or are we comfortable using our rubric and and uh maybe we need to refine the rubric, but using the rubric to do what it was meant to do. >> Rob, are you think the only se hospital CEO on the board? Is that correct? I'm

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just curious from, you know, obviously you're biased because you're in a certain situation you're in, but from a CEO's perspective, >> would would they be would they be happier? Okay, we got 30 got 25,000 30,000 for the course of this or we got

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45 this year and maybe 45 next year and then maybe nothing after that. That's tough because where where I would initially stand would be if we if we were in and obligated for the for the 45 which we baked into our program which

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right now is is as Steve said really kind of helping us cover our costs. Term lettuce is not exactly making oozing money. So it it it helps us cover cost. If you if you cut that then I'd come have another loss leader as a health care executive and I can't afford to

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have any more healthcare leaders. So it would turn us into a program that if that funding continues to go down then I have to make a decision where I can stay in it and I would hate that because it has been a phenomenal program and it has been really helpful to be able to keep

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those residents doctors here in our communities. So my selfish recommendation would have been that we fund up to where we have funds available. And if that means that's for those that are already existing, then

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that's as far as you go until we get approval for additional funding where you can expand programs out, expand more slots. That's that's the that's the CEO self because I I know what would end up happening. I know that rule rule

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providers like me will invariably say, "Okay, you drop this to 225, then I'm basically taking a 225 per resident loss every year. I can't that's not sustainable." And so, I'm going to have to look for a way to get out of this, right? >> And I don't I would have to shut it down

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eventually. And I would hate that. And that's why I'm asking so many questions about the cash flow side because before we jump into the cash flow and before we jump in and say six minutes all you got, nobody else gets anything or you got to go down. It if we think that there is a

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likelihood that there is an opportunity that the government will continue to fund this in some way, then I hate to jump backwards and say we're going to drop it down because this is all I've got when the reality is we don't think that's all we got. We think going forward that this is going to continue on and at least you know you got two two

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and a half years worth of funding available for those programs that are already in existence and it's there is no good answer. I promise you there is three times more people in this group that are saying the opposite than what I'm saying. I'm just telling you from a

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hospital executive standpoint it is it's kind of a life or death for us to get this fun. It's not a it's not a madeup number for us. did a lot of work on kind of figuring out what's it take to at least break even.

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>> Go ahead, Greg. So, um you know, I think our our main responsibility here staff is is to advise options and um I think all the discussion has has been phenomenal so far. Um what I would like to share is you know I think there are

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two paths um which the board has options to and within those paths there are various um suggestions that that Lucas and I can make as as staff members. Um you know if there is voting today that can take place in a number of ways. Um Dr. Hearn mentioned, you know, if the

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desire is just to vote and approve or deny the program development and feasibility study today, the only thing that the board would need to do in terms of administrative action would be to suspend rules that were voted on during quarter 3 of 2023, which um established

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our current B current structure. Um for the expansion grants, um there are a number of different options. You could go the reduction route, changing the 45,000 to the 225 that Lucas suggested. We could also look at I'm not aware of

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what specialties all of them are, but if it's just funding them, you know, for sure for a few fiscal years living within our means and then conditionally saying, hey, upon appropriation coming in and we have sufficient funds, we can commit to the school psychiatry

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residency, for example. Let's say we fund that in two years. We can't commit to that third year, but we can say on condition of the appropriation coming, funding being available, we can fully commit to that. That would be that would be just a few options today. We're also

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happy. Um Dr. Shley has mentioned it. Um Miss Sagel has has mentioned it for um you know, working groups or executive sessions prior to the October board meeting. Um, you know, Lucas and I would

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be happy to piece together a full menu of options by which the board could could choose uh with the funding available that way. That's that's all in front of you. Um, those meetings could be uh virtual. So they wouldn't although it if that is the board's preference we'd be happy to facilitate an inperson

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meeting but so long as no official vote is taken on the way in which we plan to conduct business it would just be an informative session open to the public and an opportunity for us to present all options available to best inform and advise the board members of the

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different options moving forward. So that is another option. Um you know that could be one or multiple meetings. um the board could choose to, you know, move up the October meeting. I I heard some discussion about potential impact of programs and if that is a concern, um

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the board does have administrative flexibility to change the date during which the quarter quarter 4 board meeting would occur um to allow for that. So um again, there are a number of options available um but there are really two routes. There's there's

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voting today partial or full or there is the opportunity for us to um you know work together um Lucas and I in the near future to u bring together that full video of opportunities um you know that you all would have for voting and

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present that you know to you all for discussion. just to pull on that thread a bit um to give you an idea. Um if if we were to only vote on these these applications at $45,000 per year and only consider one year till we know what the next banium looks like. Um your

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total for the expansion grants would be $2,880,000. If you were to approve each program for one year, two years, $5,760,000. So have a remainder of about 70,000. Um

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so just two more options um on that. So there there are a number of ways to slice and dice that. Um I think the letter recommendation is really good and as far as looking at different options >> and I also think more we can get in

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person the better thing it's easier to be able to sp >> well that's that that yeah >> with Lucas's suggestion um you even that commitment to funding each expansion

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grant for two fiscal years, we are within our within our means. And so, operationally, board members, the way that our our contracts work is that we would we would have that 2-year fiscal year period for each grant. And then, um, you know, once budget passes, we

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know what our appropriation is going to be. Uh, statutoily session has to end by the end of April. that funding for fiscal year 26 gets deposited um after July 1st. So at that point it would be it's a pretty simple process us working

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with our finance team to adjust contracts we could make that um amended in order to fully fund each of those opportunities assuming the appropriation allows us to do so um to what our grantees are asking for. So

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>> reflections or comments from anyone? This is a lot to let us digest. I'm just like my head is spinning. >> Yeah. Especially for somebody that's new to the >> right. Yeah, >> right. We've been here, Steve and I have been here the the longest and I my head

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is still spinning and I just want to make sure we feel really good about the direction we take because I do think this is a little bit you know that we're just it's it's new territory. It's a pre it's going to create some precedent for us as a board and um you know even

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though we we don't have to say what's our our plan I think there is this year is maybe a good time to really re-evaluate the scoring group the intention what how we're going to how we're going to deal in a deal with these situations of of scarcity of resources

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but um yeah um just for for reference the um application summaries that you Obviously, um those left-h hand columns have hyperlinks in them and so that should direct you to the pages that I am using to um to find those scores and so

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um match catch AI is one of them that looks at nationally um the different um residency programs and it pulls data from ACGME the match several other entities um and so that's part of how we got the score in terms of like density of programs or IE program know there were some questions about that and then

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the Robert J. Woods foundation. Um when we think about more rural areas um that data is lagging a bit. It's from I believe it's 2022 I believe is what it has listed on there. Um and so when we're looking at the current state of things that that is the set of data that

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I'm operating with and if it was up to the board to to form a subcommittee to reevaluate scoring definitely discuss other ways of doing that. Um a lot of that was brought on to me by Linda Bradard was incredibly helpful. Um, so just just another note.

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>> Yeah. And as I'm listening to the conversation, trying to digest it, I it seems like we're at we have two big options today. Well, and please correct me if I'm not, you know, because there are still more options obviously, but we could uh go down the route Lucas just

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described of funding for the two years at the full amount, any grants that we feel are meet the, you know, meet the criteria. The other option that I'm hearing a fair amount of support for is the pausy and giving, you know, some interim time between now and the October

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meeting. Understanding Pete's point is a good one about, you know, it it's hard to like totally wrap this up in a bow in a in a short amount of time, but it could allow for some deeper conversations looking at the rubric, thinking about it. Um, but you know, so

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I'd hear those the two top options that are on the table now. I'd kind of like to hear um kind of like to hear from everyone what your thoughts are, but am I off base in those in that assessment? Yeah, >> I kind of feel like it's a I think both

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can be on the table at the same time to be honest. Okay. kind of I I really feel like I hear Rob's point probably the other hospital systems are going to be the same vote where they're kind of counting on X dollars for this year and and we need to go to the table and talk

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about scoring. The other thing as we go to the table to talk about scoring, I would be in favor of naming this a continuation grant and not a new expansion grant because it's in my mind continuing to fund the program that we

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started and not taking a program that's set at five per year and expanding to six res. So in my mind I feel like we're actually not talking about expansion. We're talking about so and it would just clarify as new

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member for what the world >> yeah in the past we did do some expans some true expansion take existing programs and went from a class of six to eight >> right >> we did we did do that um it's been a minute since we've had an application like like that u but you're right it is

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um rightation then you almost need a little bit different data it's about resess performance it's about faculty performance It's about that kind of not it's about where your dollars are coming from, how many slots you have in your cap and things like that. And that's

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going to maybe help support our decision on how long we >> call it first five years and then it becomes a >> sh note with that. Um that is why I brought up engaging a third party for data. um

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just considering my bandwidth um transparency I have um I now get to facilitate the events here at the commission and so um I do not I'm not able to dedicate full-time to GME um and so just something else to think about if we are wanting to pursue that data what

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realistically are we able to achieve internally >> well that's just unacceptable is not sleep every day these institutions should be boss per night and Yeah, would be helpful for

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>> definitely and I think um the board does have some gravity to to use to request information like that. Um I guess to answer Dr. Becker's question, that's kind of what I spend more of my time thinking about. >> Well, and and really this is it's a good segue into what we set up for our next

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quarter meeting. actually our next exported meeting. It's supposed to be the surveys that a small work group develops that are progress reports because we really got um historically I think that the the progress reports from the programs back

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to the the boards were limited in ter you know catches hand and we sometimes got progress reports back. But what we had um a year or so ago was small work group come up with a simple progress report that we could get and we could

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relook at that as we're thinking about what data do we need from the programs to know whether to continue them. And we were going to do a quick as an alchemy survey, right? to then the programs that are asking for expansion and you know what's your accreditation, how many

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residents, what's the you know what are your barriers, what are your a simple one or almost like a onepage survey but we we do not have uh progress reports that have come in consistently but this was our attempt to start to get a very

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simple but consistent process and then ideally our Q4 meeting would be reviewing at the state of all these programs that because we had not we've mostly been thinking about awarding grants on this board body and not so

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much how these programs continue so I can make sure I understood it correctly. So we do have monies available if we would approve every expansion grant application in front of us today. We we have money for that two years for two years. >> For one or two years, correct? You would

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have about $70,000 excess if you awarded two years worth of funding. >> How much excess? I'm sorry. around $70,000 almost as enough for the fusibilities bill but not quite a new >> enough to fund those

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those additional grants if you want to consider that entertain that today >> and and I do I do believe that it's not either or it's both and you know in considering this and then of course the work group to really plot our course going forward

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yeah Um, so if you were to vote for the expansion grant applications today at the $45,000 per resident per year, that would total on $5,760,000.

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You would have in excess of $586,000 $586,525. >> That's magical, right? Then we could potentially consider those other two grants, right? If we want if we decide if we wanted to spend our capital.

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>> That was just one year. >> Oh, that's if you did one year. >> That was two. Yes, >> two years. Correct. One year is 2,880,000. So in theory we could do two years of funding for all the expansion grants and

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the feasibility and program development for psychiatry parking with the remainder of about 11,000 >> $1,000 [laughter] [clears throat] 4 million and we go to the legislature if that [clears throat]

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>> I can live with that >> and then we wouldn't be able to do anything else for the rest of the >> I mean that is the issue we're box we would be boxing out development grants that come for next >> um next spring there would not be any opportunity

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>> anything else we would approve this year would not be able to be implemented until the next fiscal year >> well that's true we could approve it >> right if we get other feasibility grant requests or that sort of thing in November January

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You could approve them for effective July of 25. We just they just wouldn't be eligible right then. >> That's true. >> You'll know what's exist >> once we have the >> could move the development grant next year till July to sleep. Then we know

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exactly what's >> Yeah. Right. >> You'll know. You'll know after April, right? >> Well, we'll we'll know in in January what you know initially when the House releases the the budget bill. Obviously things change between January and April

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when session concludes but you know hypothetically um you know this is this is far down the road but we could get if that were the desire of the board it would shift precedent and and change things I think philosophically

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uh from board practice since its inception. It's also um counter to to the way that we facilitate our grants and contracts at the commission. Um there are ways that we could get creative with the language in order to do that if that were the wish

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of the board. It would just be a contingent. Um we wouldn't be able to sign any any grant agreement with the recipient until after the funds had been deposited to GMAD for the fiscal year 26. Um so um it could could be a

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possibility we'd have to work through logistically how that would work. No, just I think it might be helpful to visualize what the amounts were looking like, the trends since the board started. Um, these ability grants really

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we have not interacted with much. Um, so it's it's kind of outstanding that we have an application today. Program developments um seeing a bit of a decrease which I think is expected just naturally as you know outreach by the board has happened. Um, but you will see

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a large increase in the expansion grants. So when you think about that 14 million from appropriations, this is where a majority of that money is going. And while there's decline on fiscal year 25, that's just because we have not, you know, added any new potential grants.

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Um, so, you know, I I appreciate Dr. Chroy's comment about an expansion versus um continuation grant and because this as as a lay person, I would probably assume that we have 600 residents looking at something like this. But I think it gives um a context

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of finances before started. Yeah, that's awesome. Thank you. Okay. Any comments from anyone on on the in the virtual room? I still I want to make sure you guys aren't excluded. >> Yeah, thank thanks for uh thanks for uh

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the call out. Um, I had to step away for a call for a few minutes, but um, is there it it seems like we're discussing all ornone with with uh, regard to the expansion grants as opposed to

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going through and and looking at it based on um, which ones were uh, received the highest rating um, with the scoring system. And I I completely agree with re-evaluating the all of the inputs for the scoring system, especially if we

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have data um for outcomes and can tap into um where we stand across the state with providers and and using some information perhaps from the um the Bowen Health

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Service Workforce studies and uh other inputs. I I'm just, you know, maybe if you could catch me up on that, that would be great. >> Go ahead. >> Um, so definitely the the Bowen Center,

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we I have a good amount of data from them. Um, I guess anecdotally, just to kind of understand the the landscape of GME. Um, I would be a bit hesitant to include new data into the u applications that have already been submitted. Um, some of these have already been submitted since since April, since our

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last meeting. Um, and so I think for this round of scoring, I think it would make sense to maybe do a deeper dive in what's already listed for more understanding. Um, and reserve any um further developed scoring for later votes. >> New new elements, not good deals at this

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time. Yeah, >> I would agree with that. >> Yeah. And and we're we're discussing uh Kevin to fund the programs all of these potentially uh if we the board votes to all of these programs for two years and

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um not guaranteeing the full amount the full duration that they have applied for um because we have don't have adequate funds to to assure that that's I think the an option that is bubbling to the top of our discussions right out.

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>> But but doesn't doesn't that doesn't that change doesn't that change the intention of the program? And I was under the impression that applicants were applying with the understanding that it was for the

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duration of the program as opposed to just partial. And I think Rob, it's hard to tell who's speaking in the room, but I think Rob made the the point that um you know, depending upon the size of the hospital or system, they may or may not

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have the resources to say, okay, yeah, we can go forward if we know we have one or two years of funding or that might be that might be a gamecher and and that might be um that that might be a no-go.

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I think we're hoping that if we are awarded uh if not the same amount if not more with the next bianium then we would be able to in fact support beyond uh beyond the two years.

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>> If it is the board's desire to approve all expansion grants in that fashion for two fiscal years. Um, you know, the motion would just need to be that in addition to, you know, for the remainder of of monetary ask of all these grants,

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it would be on the condition of sufficient appropriation from the general assembly during the 2025 budget session. And so, um, Dr. Gy, I think you, um, had to step away for a moment when we were discussing this this part. Um, at the commission, it's an easy

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adjustment um for us operationally for contracts to build that language into the agreement. And when the timing is right after the legislative session has concluded, assuming that our funding is sufficient, we can make an amendment to that agreement, which would then expand

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each of these expansion grant opportunities to the full number of fiscal years for which they've requested. And um there there is that language in the request for proposals. So when these um grantees are submitting their applications that that is included as a

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disclaimer. Y >> So should the board want to move in that direction, do we need to uh should we just go ahead and address the individually or do we need to make a motion to sort of set the table of the

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approach we're going to take? either one. Okay, got it. >> Yeah, we we traditionally we've done them individually practice, but um >> do we want to vote on that we collectively agree that we're going to take this approach or do we just we you

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know because then trying to figure >> Can I ask a question? I need to jump in because >> I I'm having a hard time understanding. I need a little bit more information I guess from the board to know how I'm

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gonna lean way on this. Um, so I mean I I it sounds sounds like we really haven't had to use the scoring tool. I I honestly scored assuming at some point in time that might need to be a deal breakaker. But I'd like to hear a

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little bit more from you guys on um the the the reasons or the philosophies or the hesitation on using the scoring tool today to fully fund people as we normally do, sticking with precedent at the 45,000.

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Um, just I'm I I'm curious and I want to learn learn more because I'm sure you guys have some some expertise or knowledge or history on the board that as a new person I I'm trying to catch up. Um because I'm sitting here thinking that, you know, um these are the tough

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decisions that we're here for to make. So, um, I wouldn't know how to to vote right now way I'm sitting and I'm thinking about the, you know, the the the applicants who maybe were

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really counting on the full funding cycle as well. >> Good. It's a good question, Angie. I think we're we're hoping to be able to get the full funding cycle through this vehicle. I mean, we're sort of taking a gamble um if we go through go with this

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approach today is to hope that the funding does become available and they do get the full duration of the of the of the their programs. I I think that's what's uh you're right. I mean, we the rubric is meant to be used to weigh

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programs against the other. I think what as a board I'm what I'm guessing is we feel that all of these programs are meeting the mission of the board and if there's a way to provide funding that will not disrupt a program or make a a hospital system consider closing or

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reducing one of these programs then that would be our our preference in order to sustain the continued existence of all these programs while also hoping hopefully developing continuing to develop build new programs or explore

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the feasibility of a program in an area we haven't yet considered. So I think that that's that's the I anyone add to that if you have anything else to share there. Well, just again question is really good and I think my response to

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the question on why wouldn't we score these while everybody now is that the way I recall the scoring those entities those programs that have been in play for the last x number of years are at a

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disadvantage from a score standpoint because they're getting fewer points than the brand new ones. So we're we're already going to be behind 20 to 25 points. 15 20 points maybe. I don't know why. I think it was max is 20 maybe max of 25. And the and if you've been in

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play for four or five years it's five. So you're already 20 points down to the new ones coming in. And so scoring alone puts those existing programs that are relying on this funding equally as much as anybody else at a disadvantage. That

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that's the only problem. I think all the other questions are really good and I know why we set scoring up that way. I know it was important to make sure that we gave credit to those that are wanting to put in new programs because that's the initiative but the existing programs

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are in it for an equal reason. So being disadvantaged by those lower points because of their tenure is a problem for the ones that are relying on those funds. and and it was intentional when we did set it up that that was a way

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that we thought if limited resources we want to keep people coming into the the pipeline creating more programs and so there was intention around it but we all know what the health systems are facing these days and how difficult it is to think you're getting funding and then

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not and what that may do to a program's existence or size or ability to continue it in the same fashion. Um, so these are this is really hard, really hard discussion. >> I feel like just from a new member and

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my second meeting just sort of feeling like um, yeah, you're sort of at this crossroads that you knew was coming um, but it's just now arrived and the board is may have to really redefine what is the purpose. Is the purpose to

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um um support programs that we've hoped to set up or is it to continue to build new programs potentially at the expense of other programs and in addition it does look like I mean we can certainly do

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that do this now because >> we aren't sure what direction to take and we don't want to fail anybody we've you know supported in the past but potentially we also need to evaluate that scoring rubric and understand how we're going to deal with this into the

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future because it's just going to keep coming up over and over again. >> 100%. Yeah. And and I and I don't think we thought about that issue that we're, you know, like if you continue to fund new, you may close. >> Yeah. Yeah. >> That we really never had a robust

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discussion around. >> But I think that's what we're sort of like >> Yeah. kind of where we are. >> That's kind of where what you're what you're basically. >> Yeah. Our definition may be we're a helping hand for a certain number of years. >> Correct. >> And then and and they you you would know that

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going in that well we have this funding for x amount of time but it may not go on for two. >> Yeah. But there are some big there's a big want to do that new programs but not support existing and I don't know if

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that's really >> hopefully we'll get a bunch of funding next year. >> Well, right well >> you're not always >> just like I think we've been able to do both this whole time but now we're realizing we cannot probably cannot do

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both. You know, and then one of the reality is where we are now and the success we've had in being able to grow the programs and people continue to request for more slots is that we've created a scenario now where we're going to have the are we going to have this argument every one and a half years, >> right?

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>> Because you're still going to be relying on the state to approve the next two years and the next two years and the So, I hate that we're in that. That's good that we're in that spot, but it it puts those that have were the originators in

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a tenuous position or constantly going, "Okay, we're going to get for the next two years." I would rather to one of the requests up there. I would rather go with the scenario that I know I'm getting full funding for two years so that I've got plans that I can plan

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ahead two years to say, "Okay, I've got funding for these two years. Once I find out in six, nine months that I'm going to either have additional funding or not, then I've got a a year and a half window to be able to adapt to can I afford to stay in or do I need to get out

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>> as opposed to hey, I'm just going to cut it now everything in half then I know I can. Maybe every year the the board decides we're going to set aside this percent for new programs, this percent for feasibility, and this percent to

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kind of expansion. So we understand and then we have a scoring system for each one of those pieces. And then you know in if we want to if we only have so much money to support ex

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expansion or continuing then some years that number might have to fluctuate. >> I'm distracted here. You know, I initially thought that I wanted the extra time and and I was going to make a motion that we table time start certain until October, but I

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feel like this is a nice compromise as far as being cautious but taking some action today. So, I'm going to make a motion that we um and you'd prefer we do this on an individual program by program or can we go ahead and do a blanket for

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all like consent agenda? Yeah, put sent agenda. >> You tell me if I'm out of order. I'm going to make a motion that we um uh for all of the expansion grant applications that have been submitted today that we approve two years uh in each of those

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cohorts. Um, >> I'll just stop with that. I second. >> Okay. Any discussion? >> Discussion discussion. >> Any discussion? And one other piece staff would would uh

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ask to be clarified in the motion is um approve two years at the full amount of $45,000 per slot each year for each of the expansion grants and then um conditionally agree to fund the

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remainder of each expansion grant um peron. >> Yeah. Contingent upon fund. Yeah. Thank you. Thank you. >> Sorry that was kind of a long-winded way I think of saying that >> by second. I support that. >> Wonderful. All right. Any other

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discussion? >> One last question. You need to be recused from any of these can be it can be [clears throat] bought out. >> Yeah, we we have the rule of necessity in place. I I know the board has invoked

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that um at least most meetings since I was uh first became involved with the board about a year ago. But if we are that that was the one thing I was I was thinking about suggesting when the motion was made is that because there are so many and board members are well connected with different you know

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hospitals and qualifying entities throughout the state um we should you know void I think void that motion Dr. to earn and just get those on record for >> do them individually >> individually. Okay.

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>> Points of interest should be done individually on the grant. >> I'm sorry. I should um so I will make that. I can just go down down the list and down the list. So I'll make that motion for the internal medicine program at Northwest Health and

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[clears throat] I second. So just to clarify, so you're saying >> two years, >> two years for this. So we're gonna and then we're going to have people rec. >> I'm with you. Okay. All right. I motion from Dr. Knight.

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>> I second. >> Second. All right. So we're just looking at the internal medicine northwest. And do we need to ask for recusal? Are there recusal? >> I didn't ask for that one. Okay. Okay. Any other discussion?

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All right. All in favor of Dr. Knight's motion, uh, I or raise your hand. >> I >> I >> I opposed. I'm opposing only because I um would

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like to go the route of having more information, but that's fine. >> Okay. One, but that's so it'll still carry. >> Yeah. All right. Okay. Fantastic. Um, >> same motion. [laughter] >> General surgery at Park View Health.

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>> Second recusal. >> Just Yeah. Recusal. No recusals. Any discussion? All right. All in favor of um the same being applied for the general surgery of Parkview, say I or raise your hand.

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>> I. I >> I post one. >> Okay. Thank you. >> Was there a >> one opposed? Thank you. >> All right. Uh motion

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>> make the motion for approval. Two years uh for the internal medicine residency park view. >> I'll second. >> Wonderful. Reccusals for that I presume. Still none. Any discussion?

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All in favor? I or raise your hand. I I >> Any opposed? >> Okay. What? >> Make that motion for the OBGYn resident part of Portland. Second.

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>> Second. There be no recusal since it says the health system. Uh any discussion on this one? All in favor? I raise your hand. >> I I

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any oppose one. Okay. I'm not hearing from everyone on board. >> Is everybody okay? >> Well, I'm just the ones I should be hearing from Shockley and um Angie. Are you all three? Have I

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just want to make sure I haven't missed >> Yeah, I I raised my hands or voted. >> Okay. Okay, Kevin. >> Yeah, I said yes to all three. Yep. >> Okay. Okay. I just want to make sure we're not we got it. Okay. >> All right. Moving on. >> I'll make that motion um for the um

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Southwest Indiana Graduate [clears throat] Medical Education Consortium for Family Medicine. >> Okay. Recusal. >> Recuse myself. >> Okay. >> Oh, that's okay. And I'll second it. >> Thank you. Second. Um, all right. So, we have three recusals.

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>> Members have. >> Okay. And then, um, all in favor of same motion for the family medicine southwest I or raise your hand. >> I >> I >> I. Any opposed?

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>> Okay. >> It's it still passes, right? >> Yeah. Okay. [laughter] >> Passes six to one. >> Okay. >> Who seconded that motion? Sorry. >> Uh Dr. Sandman I think that in the second you guys

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>> we're not going to veer from this pattern but working for us. Okay. >> I'll make that for internal medicine southwest education. I [clears throat] will enthusiastically second that. >> Okay. Recusals >> that

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>> Dr. Grace is also recusing from that. >> Okay. So those the remainder of us who are uh any discussion remainder of us who are are not recusing all in favor say I or raise your hand. >> I I >> I

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zero. >> Okay. >> Perfect. Any opposed? No opposition there. Uh next >> and then I'll make that uh motion for the psychiatry residency that's in the Southwest Indiana graduate medical education. [clears throat] >> Perfect. >> I second that motion. Thank you.

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Recusals. Okay. Three recusals. Um any discussion? All right. All in favor of same motion for the psychiatry Southwest raise your hand or say I. >> I.

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>> I. Any opposed. >> All right. [laughter] for for clutter for you. Lucas, how much money do we have left? >> So, what we voted on was

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pull this over here. Let's go ahead and change this. 585,6 or 5,760,000 is what we've voted on. Um, and you're asking about the remainder. So we know if we now move through the agenda, are we going to be okay?

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[clears throat] >> Um, >> yeah. >> Yeah. So you'll have a remainder of 586.5,000. So that would be enough for one program development grant at full funding and one feasibility grant if that was the decision of the board.

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>> Um, so I understand you need a motion for us to suspend the rules, right? >> Yeah. >> To be able to consider. So I'll make a motion we suspend the rules to consider the feasibility grant from union. >> And before we do that I mean do you mind if we just sorry

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>> do you mind if we look at the score scores if we didn't just because I think it's interesting to see how our current scoring rubric is playing out and and then um >> even though we didn't necessar we didn't use it to differentiate anyone but let's

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see how the scores played out. And um a reminder that a lower score does not necessarily reflect or application but rather just the structure of the screen that the board decided to use. >> Is it possible to share that screen? >> Yes sir. One moment.

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>> Are you able to see that Dr. Deppy? >> Yep. Thank you. >> Okay. >> Make it a little bigger. >> Yes. >> I might be able to read it. >> I'm I'm used to a used to a mouse. This is a little >> There we go.

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>> Okay. >> Um so the scores currently range from 43.7 points to 73.5 points. Um the maximum is 105. Um and so this is this

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is just the range that we're working with. This is an average of each board member that submitted um that did not list a conflict of interest. Um even if those um figures were included from what I was I saw this morning, it might change by one point less than two. Um so

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it pretty much a consensus throughout. But it's interesting because if we would have applied this rubric, right, we would have approved Northwest, probably Parkview, OBGYn, Internal Medicine at Southwest, Internal Medicine at Parkview. Maybe

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those other three might have been the ones that were I mean I don't see the exact dollar amount but that would have yeah it's just it's just sort of to look at it the how how does this rubric work and go

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>> the um the the years since um establishment really was >> essentially a determining factor from what I could see when scores were >> super yeah >> okay >> okay >> any comments or are

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with us by mail so that we all have access to that. >> Yeah. Digest that any >> and I I feel like this exercise that we just did where we just kind of blanketly like approved everyone shows that we have to change this like formula, right?

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Don't you think are we still going to work on that truly be a competitive thing where somebody's going to get and somebody's not, >> right? >> Or we no longer score them. [laughter] The answer is we need we need more money.

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>> We need more money because we want to we do really want to >> Oh, that is >> I think that like we really do and so and if we can we want to do that but yeah I mean this will be the whole purpose of that separate discussion that we need to have.

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>> Yeah. But yeah, I just and we know so much more as a board than we did when we had these discussions about making that rubric that you're describing, Rob, where less points to the more established programs. We sort of thought, well, those programs need to take it on as their own because

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we can keep making new. But it is true health systems are going to consider program closure or reduction if they are not getting the funding. And that is not our intention at this point. I think the addition of a continuation grant category of the four cat.

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>> Yeah, we've needed that and it's never been state but we're now there. >> Yeah. Yeah. Yeah. Well, this is really so appreciative of the robust discussion we had today and how we got to a good I think what I feel like is a really good

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solution. So, thank you for the wisdom of the group and putting your heads together. All right. So, I think we can move on to our last um two items, right? We've got the feasibility study from Union as well as

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the development grant. Is it develop? Thank you. I need to turn over my page. Um and [laughter] and the development grant for psychiatry and Parkview are our last two. And I uh you may want to share those stories if you can with

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other but yeah >> the program development and feasibility so we need to first to suspend our rules so we can >> yes that's true yes because we are g well we don't need to suspend the rule for the feasibility because that can be

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scored at any time based on our calendar >> the only one we need a suspension is for the psychiatry uh medart view development public things. >> Yeah. Okay, let's do that. Okay, so we'll first um since that's next on our

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agenda, that works out perfectly. So, what we'll do now is just um look at the feasibility study from Union Hospital that we received for 75,000. They were specialty agnostic in terms of which specialty they're going to consider. They're just going to see what what

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comes out of um in terms of a specialty to consider for expansion. Uh and so open up discussion if we want to have any discussion on that grant application. >> I move approval of the feasibility grant tendered by Union Hospital as presented.

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>> Thank you. Any further discussion >> and I I know Autumn um Finner is on call you would like to make a comment. Okay. >> And because the um the money left over, we have enough to both of these and then

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move. >> Yes. Um remainder of 586,525. Correct. >> Yeah. For the rest of the year. >> Yeah. Okay. Um so all I think we had a motion and a second. We have a little

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discuss time for discussion. All in favor of approving this feasibility study, say I or raise your hand. >> I >> I opposed. [clears throat and cough] >> All right. Congratulations to Autumn and the team at Union and we look forward to

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seeing what comes of that feasibility study and where you may consider opening new programs. >> Would the board like to know their score? >> Yeah. What was the score for >> out of 100 points total? um they received the 66.9 >> and there were no I guess I should have

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asked about recusal but I don't think there was anyone >> for the last two correct all right and now suspend the rules considering the >> [laughter and clears throat] >> uh uh program development application

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>> perfects thank you uh any any discussion on that topic I have a question. Have we done this before? Are we setting a precedent? >> Um, did we do it last meeting?

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>> We did not. So, um, just for uh context, Angie, this is the first calendar year that we have had this um calendar applied that we put together. And so um we have not yet encountered that in meeting one or two this year which would

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have been the only two meetings where we could have had to make an exception. >> In the rules it says this should go in April. >> This would have been uh the way we set up our calendar it would come to the April meeting. All development grants would come at the April meeting. I think

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it came in a little bit behind the deadline if I >> the feasibility by about one week. by one week. >> This development >> this program development >> uh it was submitted a bit after I believe our April meeting. >> Yeah. And so the deadline for those

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development grants is um uh 30 days prior. So essentially March 23rd or so that's when they should have put it forward. So, um, so I think entities are learning that this is our new system this year is, uh, a little bit of what I

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I think may be part of it. Like it's it may not have been totally widely distributed to everyone because historically people could submit a grant at any time as long as they got it in before the deadline of that particular board meeting.

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>> It says it came in June. Is that right? development >> be the last one in the packet I believe. So yeah, whatever it has listed there. >> That's right. >> So it came in a decent amount behind what you would have expected. So yeah,

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so we could discuss whether or not we want to I mean we could well yeah we have options, right? We could table it until >> the H >> in April. The other I mean that's the other option is to table it till April

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of 2025 and see what other development grants. >> Correct. And I' I've been notified that there are other entities planning to apply. Um, I can't travel off list, but I know that there are incoming. So, >> something to consider. >> So, we only have 500,000

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and 115 $511,000 left. That's what I am gathering doing our math. So, if we would approve this one that came in late, we would not be able to approve them next year. Although, we could

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do it. Well, that's true. If they actually launch for two years now, [clears throat] >> they could do it for reduce it and do a one year >> and they can apply next year and and then we decided that time they could get

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to one >> or we could table them completely until April 25. >> If we if we approve this today, we're saying the biggest factor in our decision- making is who gets immersed almost in my mind.

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It kind of throws the the scoring again out the window >> because there will be other people applying next year. Correct. [clears throat] >> Yeah. So, >> this application is for the current year

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that started July 1st, correct? >> It would not receive funding until July 1st, 2025. >> Ah, okay. Thank you. I didn't I thought they were applying for the the year that started July 1st.

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They would then anyone applying next April. So they're 11 months early. >> Yes. There's just Yeah, there's [clears throat] >> Could you repeat your question? >> So they were my question is are they requesting funding that would be starting July 1st of this year?

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>> Oh, and yes. Yeah, this would be coming out of this fund. Okay. Correct. Yeah. >> So you won't have any more requesting 7124 funding. >> The next round of requests >> would be 7125.

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>> And the 7125 ones if they come in as they should by March 23rd of 25 would be ones that we would we would kind of know >> whether the funding was going to be available starting 7125. Right. That's right. So you're you're really not

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holding any. So the question becomes, do you want to do this because they missed the date? Not do you want to do this because they got in before the other late ones because the others won't be late. >> That's the only way. >> Okay. Correction. >> So this this then you just decide, hey,

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is this one for psychiatry sufficient sufficiently needed to move forward with even though it was 30 days like and then psychiatry is a good one to say. >> Yeah. Thanks for in that part of the state, too.

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>> Hi. Yeah. Um, this is Michelle Harris from Park View. >> Um, apologies for interrupting, but I know we're running short on time and I just wanted to chime in about our psychiatry application. So, just to clarify, we were looking for funding beginning this July 1st of 24. So, um,

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apologies for the late submission. We, um, it just slipped by us, um, with our other development grant for family medicine. and then um our continuation grants. But just to clarify to the board, we were looking for the funding

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to include um to begin this academic year. >> Yeah. Okay. Thank you for that clarification. And then should we fund this, next April's development grants, we'll get funded with stuff that funds that come in after July one. And for

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that, Greg, can you give any context about when we might be able to expect knowing about what our appropriations would be? I'm not familiar. >> Yeah. >> So, we'll we'll know, you know, when the House releases the budget, their version

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where we stand. By the time we're in March, the budget bill, we'll have switched chambers and in the Senate, we'll have an even clearer understanding of where we need to be. So practice has been in the past because you know this is this is about a year out from where

401
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we are currently that we have been comfortable as an agency the commission as well as the board has decided in the past that we can conditionally approve um you know grant opportunities upon the budget being finalized. Our practice at

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the commission has been not to sign grant agreements until the appropriation hits which is on or after July 1st in this case July 1st of 2025. So >> okay. >> Yep. So the timeline and we were intentional about that when Dr. Hearn and I and with Linda were discussing the

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>> the timeline of which you all approved taking that into consideration. >> Yeah. Okay. Good questions, good clarifications because yeah, this is always a little >> Did you actually already make that? How does that first come about suspending the rules to consider the application?

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Okay. >> Okay. So, >> that needs a second. >> Yes, >> I second. >> And we've had some discussion, but any further? >> All right. All in favor of suspending the calendar for this one, this particular uh grant application, say I

405
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or raise your hand. I >> I >> I >> Any oppose? All right. So, we are able to make a vote today then. Thank you. That that motion carries. And so, now I need potentially another motion. [laughter]

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>> Motion to approve the Fort Wayne Park psychiatry development grant. >> Thank you, Dr. Becker. >> Second. >> Thank you, Rob. Uh any discussion or clarifications needed? >> You want to show us the score real quick?

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>> Sure. Thank you. >> The score for the program development grant out of 105 possible points received 74.1. >> Yeah, I scored. >> Okay. All in favor of approving this grant application say I or raise your

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hand. All right. >> Any >> Dr. That was an oppos. >> No, that was four. >> Okay. Gotcha. I did not I think I got in front of me. >> Thank you. Thank you. Thank you for clarifying. All right. So that um so no

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one's no opposing votes. Okay. Then that uh grant application also approved. congratulations to um part of you and uh look forward to the work trade and she's like hey free program up in that part of the state very much needed so

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>> we have 1100 consultant but there's no consultant you can get from >> yeah okay and so that's then rolls into the next year, doesn't it? Don't use it in this year. >> Yeah, that's a really good question. It's a non-revering bond, so it does not

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go back to the general after the conclusion of the Mr. Hero statement. >> Okay. >> And then I think the other piece is we I know we're right at time. We need to wrap up, but the other piece then is to try to figure out the um cadence or frequency or who wants to be involved.

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And I I assume it might be everyone but um in a workg group that we then you know convene with as Greg and Lucas have shared some options put in front of us to consider as well as some thought leadership just from ourselves about looking at the scoring rubric and how we

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want to change it. Um I is there anyone I guess does everyone want to be a part of that those discussions? I feel like it's an important enough issue. probably requires the whole >> I mean

414
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it's there's nothing there's no >> reports of the next meeting >> ideally ideally the the survey that was created by the work group previously and alchemy I'll have to check check in with you if you got all those pieces but those would go to the expansion grant

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recipients to complete prior to that meet that October meeting and we would actually spent some time reviewing those reports next meeting. So, we do have something to do next if um that's funding to to award. Uh but that's a new process for us and so we'll

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work through that. But we could spend you know a significant amount of time at that meeting discussing this topic too because we've taken all the actions we need. >> I mean that >> may I please I will so the the survey will be

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developed again. Um, I would plan to send out a Microsoft Forms survey to you all, um, to get an idea of what information you're wanting to see on that application. Um, ideally, if we could have that done by next Friday, the following Wednesday, whatever that looks like, that'll give me enough time to

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build that alter survey and follow up with. >> But I do think if a work group made some recommendations, make sure that we're not missing anything. >> See if they people are happy with it. Yeah. Perfect. >> Great. Okay, thank you. I always do better when

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there's like two or three straw models to react to rather than, you know, just a blank sheet of paper. So, you know, as we move ahead, if you guys could work that out. >> Yeah, >> I personally would appreciate that. >> So, do we want to try to meet between now and the next board meeting or because we've taken all the actions, we

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need dedicate half of the next board meeting to these this discussion. Is that maybe the best approach? >> The invitation is still open. Um, I'll resend the link to put time on my calendar and I'm happy to connect individually, talk about the scoring in the inter room. But

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>> yeah, but but maybe we do it via the board meeting since that um since we got to or we got to very good closure today in terms of next steps. >> Knowing this is a budget year coming up in the legislature. At what point do we need to decide what

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we want to ask for in the upcoming legislature? because I think that's a question we'll want to be able to start socializing to our legislators very soon. October, November. >> Yeah, those those conversations are already beginning um internally just not

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not just with G but across the board for the agency. Um you know, we'll be glad to keep board members apprised of that. I um you know I think our goal of what we asked for in 2023 um how we projected it made made sense.

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Um so >> that was that was 10 million >> 10 and 10. Yeah. I think that we're in a much stronger position to advocate for that now knowing where we are with our spend down of our appropriation from the current bienium. Um, you know, it's it's

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going to be uh I think a little bit more difficult across the board for everybody this year. Someone highlighted that, you know, economic forecasts are not as uh rosy as they were um back then, but I think that we've got a very strong and compelling message um with what we've done up to this point. And so we'll be

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um really relying on you all and your expertise bringing you alongside us um because your your voices carry a lot further than ours um with the work that you're doing, connections you have and um ultimately what we'd like to see for for Jimmy. So I think um you know in

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addition to that, we've got some really good um data points that were previously provided to us from the survey um and research that was conducted by Trip Unbox. So we'll continue to hit on those points. Um and yeah, I I I think it's, you know, as much as possible, we're

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going to look to have a unified and uniform message um for our ask this this session. So, more to come on that conversations have have begun. >> Okay. Um well, thank you all for everything today. Motion to adjourn our meeting.

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>> Oh, public comment. Sorry, I I over I stepped over public comment. Any public comment? If if able, Lucas, I'd like to just add um Brooke Mullen from the Indiana Department of Health, executive director of the Health Workforce Council, um Dr. Troy, to your point about needing additional data, we would

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certainly be able to um give you whatever information Lucas and I are currently working on something um for family medicine, pediatrics, and OBGYn residencies with the Bowen Center. So, we'd love to share that data with you and give you some some of those answers to those questions, and we certainly

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support a more direct approach in in a rubric. So, thank you. >> Wonderful. Thanks for being here. And >> yeah, is it I can't see. >> Yeah, thank you. Just on behalf of union, I just wanted to say thank you for the feasibility funding. It's um

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it's a relatively small amount, I know, but for us and for our community, it's very significant. So, thank you. >> Of course. Yeah. Thank you. Thank you for being present and for your application. All right. Any other public comment? >> All right. All right. Well, this is a

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very robust meeting. Thank you all. Motion to >> All right.