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Video-1: youtube.com/watch?v=q3Qha-ajbSo

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we review the meeting minutes. I just want to take a quick uh moment and if it's okay, Eugene, and just um I think introduce we have a we have a transition coming on our board, right? So, um Tim Putnham will be uh stepping away and I think Tim, if if I understand correctly,

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this will be your last official meeting serving on the board. Is do I have that correct? >> This is as everything goes. I will be um no longer on the board here very soon

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and will be uh well replaced by Rob uh as the role of representing uh the acute care hospitals uh on the GME board. So yeah, this this will be my last time. I will try my best not to cause too much trouble today.

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>> Okay. Well, we uh we're glad you're here today to to end uh that you're still with us one more meeting. We appreciate again everything you've done for us as board chair, your service with this GME board. You've been instrumental to everything we've done and uh and you know we will we will miss you. But we

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are excited that today um Rob Rob is it minn do I have your last name correct? Robin >> yes is here joining and listening in as a guest today and then next meeting he will be officially uh on the board with us. Um, Rob, do you just want to do a a

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real brief introduction for those of us who are on the board and we'll have you joining our team next next time officially? >> Yeah, absolutely. Thank Thank you all. I'm I'm really excited about being part of this group and I'm hoping to learn a lot. We we've just Good Samaritan is in

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Vincent's Indiana. I've been the CEO there for the last 12 years and I've been with the hospital for 30. So, it's a it's a passion of mine. This location is a passion of mine and I I'm excited about residency and GME because we've just u obviously over the last few years

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started one up in consortium with Jasper Memorial with St. Vincent with Deaconists and and it's been a wonderful relationship along with Dr. Becker and and I am I'm excited to be part of this because I want to see it continue to grow and thrive throughout the state.

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So, I think the opportunities are great. And the one thing I promise, I will try really hard not to be nearly as much trouble as Tim probably was. [laughter] >> Duly noted. All right. We appreciate that. Well, welcome aboard and we we we look

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forward to having you in with us in official uh capacity next time and your background uh will will be a wonderful asset to our group. Thank you. All right. Um, so I think the next item on the agenda today is to to review the

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minutes from our last meeting which was on October 29th. Those were included in your packet. Um, if wanted to take a chance to see if anyone um had any comments, changes, corrections. Okay. Hearing none, I will uh entertain

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a motion from the floor to approve the minutes from >> approve. >> Thank you, Beth. >> Curtis Ward second. All right. All in favor of approving the minutes as they stand.

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>> I I >> Okay. Any opposed? All right. The motion carries to approve the minutes from our October 29th uh meeting. Fantastic. Thank you. All right. The next item on our agenda,

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uh, Eugene, is, um, another introduction. >> I think you're on mute right now. >> Sorry about Sorry about that. Um, yes. So, uh, want to introduce everybody to Greg Herrell. Greg has joined, uh, the team, uh, uh, that Josh and I, Greg is one of my team members. We both report

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to Joshua on the uh policy legislation um and program implementation team. Uh Greg has been with our office about six years and he recently stepped into this role. Uh he is a southern Indiana native and Greg I think you I see you are on the call so I will not pontificate more than that and let you introduce yourself

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to the board and please just tell them a little bit about your background and um what you're going to be doing as part of our team. >> Awesome. Thank you Eugene. And uh I'll just lead off by saying it's it's so good to see you. Um I know we've been texting and and whatnot quite a bit, but

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just good to see you over video and um miss having you next to me in the office, but great to great to see you on here and and thank you so much for the invitation. So um it's nice to meet everybody. As Eugene um said, my name is Greg Harrell. I've been with the commission for about six years um and have stepped into this role. been um

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currently working on the legislation and program implementation team for about five months um where I support um Josh as well as Eugene on um you know legislative matters as well as the commission's policy agenda um and simultaneously um oversee the next generation who's your educator

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scholarship which is um one of the the many awards that we provide at the commission for higher education. So um really excited to learn more about um the work that that you all do. Eugene and I um several months ago had time to kind of sit down and talk a little bit um you know about the board and the

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great work that's going on in the state. So I'm excited I get the opportunity to observe some of that today. So thank you. >> Wonderful. Well, welcome Greg. We're glad to have you join us and partner with you all um further in the year ahead.

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Great. Um Eugene, do you want to um share the legislative update or um Josh? >> Yeah, >> I can jump in real quick. Eugene, I got this. So, uh just quickly, this is going to be a brief legislative update as uh

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you do not want me talking about uh health policy and law. That is not my area of expertise. So I'm going to focus on uh specifically around uh the funding for the graduate medical education board and what we're looking at here coming in the next few months. So although this is

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not a budget session, we are starting our process here in in uh at the end of this session for the next budget session. So we will be looking at at what we are looking to request from the general assembly and developing that. It is a process that will go throughout the summer and then into the fall whenever

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we we pass our full budget recommendation. There is a bill in the general assembly right now that would truncate the commission's timeline on that and I will provide an update. I do believe your next meeting is in April uh for that. So, as this board is looking forward to

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uh the 2023 session, I know that's hard to say already, but the 2023 session, uh we want to get an idea of of uh what we think uh the funding needs will be uh to sustain what what's going on and then any additional expansions. So, we will

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be working on that. Uh, and in in April, hopefully we can have a in-depth conversation about what that will look like. So, I want to put that across everybody's radar that even though we are a year out, that's something we need to be hammering down here soon um on that. And I know that our comm's team

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will continue to work on on a communication strategy as as we enter into the summer here. and and Greg and I at least will hopefully be doing uh if we can if it's safe we can we can hopefully do a road show here uh in the summertime to meet with legislators to

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talk about uh the work that's being done. The second item um that that you may see uh uh is that uh every year uh legislative services agency uh has to do uh work or program reviews for uh

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various workforce related items. And I do believe that this year the graduate medical education uh fund is is up for review. So you may hear some updates or some data coming out of that as well. And anything that they find or that they see or any questions they get, we will also share with the board. Um, I just I

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didn't want whenever it's typically done during the interim study committees uh into the fall when that would be released, but if something crossed your radar, I wanted to make sure that uh especially you chair uh know that that that's out there. Uh um and hopefully we can get some good feedback about the uh

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great work this team is doing. So, with that, I think I've rambled enough. Are there any questions about the budget process or uh the review? Any questions or comments

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for Josh? >> All right. Thank you. >> All right. Wonderful. Thank you, Josh. Appreciate the updates and look forward to hearing more at our future meetings on on where that those things stand. >> All right, Eugene, could you share with us the fiscal update

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>> and where we're at? >> I'm going to share my screen here quickly. Bear with me for one second and I should be able to Nope, wrong screen. Let me uh get that up. My apologies. I'm looking for a certain spreadsheet and not the spreadsheet that I want.

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Uh well, I'm trying to show current information and then um Josh's point some future things going on. So, let me uh see if I switch here quickly. There we go. Thank you, Chair. Thank you, Chair Chairwoman

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Hearn. So, um, the board, uh, everybody has in their packet the current fiscal status of the GME fund. If you take a look at the beginning, uh, right now, the the board's beginning budget this year was 11,900. Uh, >> oh, am I still on mute? >> No, I'm not. >> I'm not seeing your the financial page.

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>> My apologies. Let me go let me see if that is me. Go back to share content here. Um, I appreciate that heads up. Give me one second. Can you see it now? >> Yes. >> Yes. >> Okay. My apologies. I'll start over again. So, the uh beginning budget was

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$1.9 million. Again, this is our beginning budget showing uh anything that hasn't been encumbered, hasn't been expensed, uh funds that haven't been awarded. If you go down to salary expenses, again, um for for public record, um part of my salary and

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benefits are paid from the GME fund, and that's within within statute as the uh staff member for the board. So, uh those are my salary expenses for this current fiscal year. other operating expenses of around $8,000. Previous grants and FYI22 grants that have already been awarded. Uh this is as

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of last October. So again, I should change those dates. My apologies. That was that's incorrect. And this should be uh 126. My apologies. That shouldn't be October. That should be uh January of 2026. January of 2022. My apologies. So again, uh if you look at that, that's

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roughly about $3.5 million total. So the available budget uh if you take all this into consideration is around $8.3 million. Now if you look at future funds that have been already obligated for fiscal year 23 24 and 25 roughly 2.9 million for fiscal year 23 uh that runs

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so for those uh who are new to the board. The fiscal year starts in July on July 1st. So for fiscal year 23 that starts July 1 of 2022 and concludes on June 30th of 2023. Then fiscal year 24, that's uh July 1 of 2023 through June

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30th of 2024. And then fiscal year 25 starts July 1, 2024 through June 30th of fiscal year 2025. So these are grants that have already been awarded by the board. And I'm just doing some backnapkin math here, but that's roughly around $5 million uh give or take uh funds that you've already have

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obligated. And if you look down here on this chart, what you have in your packet, you can take a look and see uh the awards that you have already already granted. And so that leaves the current balance available balance for the GME fund of $3,100 $3,168

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to be precise. Today you're going to look at an expansion grant application from Franciscan Health, which is $135,000 requested for uh three for the three-year one family medicine residency for three years beginning this July. Uh

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just to kind of give some heads up and I was sitting here if you saw me typing on my uh typing on my calculator coming before the board in the future are going to be a couple of uh and this is something that particularly uh uh uh Beth Robo Beth you've been on top of looking at future funding needs.

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Southwestern Indiana so southwestern Indiana GME Consortium did submit an application for consideration at this meeting. However, the application was received after uh after the after the the one the uh beginning of the month deadline and so it'll be considered in April. But their total request is going

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to be roughly 4.275 million to conclude the expansion of their psychiatry, family medicine, and internal medicine programs. When you take a look at the 3 million that is currently available, um that request would have been 4 million and that would not have been able to be funded within

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the current budget. Going forward with with fiscal year 23, the board will receive another $5 million. As you remember, this last legislative session, uh the last budget session, excuse me, the board received $9 million in continuation of GME expansion funding. So, our office will be taking a look,

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we'll take a look at not only the what's coming from Southwest, but Park View Health uh going back to looking at their program development application, correction, program development reports, which we'll also discuss here shortly. Parkview Health is going to be uh submitting a fairly hefty request as

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well. So, we'll need to take a look at essentially available funding versus what's coming through the pipeline, and the board will use that to determine uh what can and cannot potentially be funded. And that is the fiscal update. Madam chair,

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>> you know, Eugene, aren't we behind on what we originally had when we did the trip bumbok um plan? We were supposed to be up above 9 million for bianium, weren't we?

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>> Yeah. At this point, the if you look, excuse me, if you go back and look at the excuse me, the original fiscal note for housing bold act 1323, uh, the board, I think year six was to be roughly I want to say it was $18 million. It was it was 13.5 million and

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it was an incre It was it was stairstepping by $4.5 million each fiscal year. Unfortunately, due to the for one, we had the pandemic and for other reasons that are involved with the uh with the master tobacco settlement fund, which is what funds the GME

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expansion plan. The board has not been allocated that level of funding that was that was discussed in the initial fiscal update. The board has done a great job of keeping our legislative partners involved in knowing what's going on with the expansion. I think now that we're ramping up a lot more uh there's there's

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much more data to show how the how the plan is has kind of you know with under Dr. Putnham and the board has really started to take off. But we are going to need to really work uh legislative partners to get up to that promise level of funding in order to execute

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everything as it was laid out in the initial fiscal note. I know Dr. Becker, I know you and others uh uh some of whom aren't on the board anymore, but I know you were involved in that initial planning to get to get everything laid out. Um so that kind of goes to your point your point, Beth, about current

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funding versus what was anticipated uh at the beginning of of the outset of this plan. >> Does that help, Beth? >> Yeah, I think you know we need to get prepared. Yeah, >> it's it's looking like it gets back to and I know Tim's got his hand up, so I

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feel like I jumped in so shoot me. Um I think we need to prepare for the next legislative session because we're not >> It sure doesn't look like the 9 million's going to >> cut it and do a an assessment. I I know we had we're working um on a um family

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practice residency with um with Northwest Health. So, I'm sure there's others out there and trying to get our arms around that sooner than later. That was my >> request. Yeah. Perfect. Yeah. Tim, you were going to say something. >> Yeah, I this is a question for Josh.

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What's the attitude right now? Um, you know, sometimes it's really really tight fiscally that, you know, all we can do is everybody's going to get cut and all we can do is maybe maintain. Uh, what's the attitude for going and asking for additional funding um to to get us to

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where we need to be? I know our story is good and I think we've told it pretty well. Um, anybody that listens seems to say, "Man, this is great. You guys are really really putting the the state's dollars to good use." But what's sort of

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the attitude and how how hard of a push is this going to be? >> Well, I think that at least for now, the state's in a very good fiscal position. So, that makes it a little bit easier for us to go and ask for for additional funding. So, I I I think in in I didn't

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allude to this when I spoke earlier, but the reason I think it's going to be important that uh we go on the road uh this uh spring and summer to talk about funding is that especially with Dr. Brown retiring. We're going to have to find our new champions in the general assembly um for this program. And I do

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think that there uh there will be appetite especially with the data that is being put together uh to show all of the positive work and especially to show what future could be funded. And I mean right now there's such a great need in

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this area and in in numerous healthcare areas. So I think that there are opportunities for that. Um we're trying to at least uh on my team uh identify funding sources uh uh to say hey we can move this money around we can move this

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money around uh uh for that uh and that uh because it's always easy if you identify specific or current spending then to go hey can you give us some some some more. So if there there's an opportunity for that we would be able to do that. I think pinning a number down

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will be helpful. And we can look to the original fiscal note, but I think that at least at this far away from the fiscal note, uh it's not going to have as much weight. What we're going to need to do is say, "Hey, this is what we think uh we're going to spend over these last these next uh uh two years. uh if

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we want to meet the goals. >> I I think the story that we've been telling and the the you know the infographic and here's how many we've added has been powerful. One other thing that I' I've been bouncing around the back of my head is whenever I talk to

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people from other states and they hear what we're doing, they are just floored. I don't know if everybody else on the board is is, you know, whenever you get questions about this from your colleagues in different states, they're just amazed that the state has taken

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this level of interest. >> Does that pride play into the elected officials at all? And and do we we haven't put that information in an infographic about how many ex how many

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how much expansion we've done in comparison to other states because of >> you know their vision and everything and I'm wondering if that's a good message to put in that infographic and share. >> I I think it is. I am not the

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communications person but we always put that we're first in the Midwest and fifth in the nation for need-based financial aid. So there's probably a communication reason why we would compare to other states. So if if if the comm's team thinks that we can help and we can get uh the um you know we're one

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of this many states or only one of the few states that do this, I think there that there is a message that we could do from a point of pride. Yeah. >> Yeah. >> And Josh, I think we need to tie ourselves to the public health the whole commission the group that's looking at

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what we need to do for that because there is a whole workforce. I'm on the data and so we haven't got into the workforce, but I know there's a workforce and if we can tie that, that's going to be huge. >> That's a really good suggestion. I hadn't thought of that to to to

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uh work with that group and that's something I'm going to look into as soon as we're done here today. That Thank you for that. >> Yeah, good suggestion. >> One one thing I wanted to share and hopefully I can share my screen. Uh Josh mentioned our communications team. So we have for the last couple of months been

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working to start to take the infographic that we use the the one pager uh that the board has used in to really start to regionalize it to uh be able to share that with stakeholders in their areas of the states where expansion has has taken place and really has shown some positive

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results. So hopefully I want to see if I can share my screen to kind of show you what we have been doing. Um so can everybody see my screen? >> Yeah. So this is an example of the greater Lafayette area of our communications team. I worked with them over the last probably three months or

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so to put this together and our partners at IU Arnette. Thank you very much. They have worked uh gave us access to some of their some of their residents and this is giving us the opportunity to show what's going on in the greater Lafayette area. So very specific to that region

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and really showing uh the outsets kind of the impact of what's going on there. So it's it's simple. So, it's just the same front page uh that we've utilized in our main uh in our main graphic. Let me turn that a little bit just so everybody can see it. So, the same kind of front page with our main one pager.

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Uh but if you go to that back page, it shows it for Lafayette. We also have done the same thing with uh let me go find let me go see if I can find the other one here for Southwest Indiana. And again, thank you to Southwest. Hopefully, I'm not showing too much of

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Let me see if I can get this together. Yeah, scroll quickly through your chat. [laughter] >> I don't think I had anything on there too crazy. Um, but um, same thing with Southwest. And so, oh, let me turn that around. So, with Southwest, kind of the same deal where

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uh, we're using infographic to to really localize and and bring some this brings some some focus to what's going on in the service area uh, where residency expansion is taking place. And this is something that we can continue to work on, but we're really excited about uh

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getting this to you guys. I I don't know if I have permission to share this yet, but um it's out there, so I'll get it soon. Uh but we really want to utilize these these kind of local stories to be able to really bring home what's going on in certain regions of the state.

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We're trying to get it get also get this information from our partners at Reed and at Fort Wayne. and we've been in communication with them but it's been a little little more challenging to get touch base with them but hopefully once we can get in touch with them uh we can also get this kind of infographic and

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get this this very specific very nuanced information so that we can share it with the stakeholders with legislators and with other stakeholders in the community to show you hey here's what's going on in your community with GME expansion here's the impact it's had so far and it also plays into another another agenda

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topic for later which is the economic impact study so So, if anybody has any questions about these, uh, please let me know. Uh, oh, did I just I don't think I just shut this I just shut down the hole. No, I didn't. >> So, um, >> Eugene, did you use the econ and may we'll talk about later the economic I,

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um, numbers that I just because I had to prove to my board this is the right thing to do and pull in the local economic development and trip gave us numbers. So, is that what you're using the 150,000 and 1.5 million or whatever?

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We're using that economic impact data right now. But um if you look at it, the trip problem data we we did that that was back in 2017. Actually, Linda and I were discussing this uh yesterday about she had a question. Linda, I think it's okay for me to share. Just we were looking at the the information that we

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use in terms of uh theund was it 133 Linda? The 133 physicians that we lose every year. And essentially what that number came from was at that time there's 520 give or take graduates of from medical from IU School of Medicine and Marian and there were only 387

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available residency slots. Uh so that information you know the board's work has increased those number of slots. So uh this is something that Dr. Putnham and I uh I believe we discussed this maybe two years ago Tim before uh before the recession happened or not the recession excuse me before the pandemic

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and funding was essentially cut. taking a look at doing another economic impact analysis to see okay what's been the impact so far of the the residencies that at that point the board had funded and then taking a look to see okay here's so far we have outcomes we have

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101 new uh residents we have over 300 residency slots what's been the economic impact what gaps have been closed and again the trip data was good but it's at this point to be just transparent it's 5-year-old data and it may be a time to to take a look and get um get it

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refreshed. >> Yeah. >> Hey Eugene, I think I think one thing the Bowen Center data that they brought at our last meeting is very valuable as well. That's new data. Um you know, I think the only thing in that showing

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that we're above uh the regional area in terms of family medicine um but we have a malistribution problem with that. So if we are starting family medicine programs in geographically isolated area, I think it still makes sense to promote family medicine. But you know

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when you look at child psychiatry and psychiatry and um you know just those other area and that is home data. So we need to include that. >> Yeah, that makes a lot of sense.

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Well, it's um yeah, it sounds like this the timing is really key right now for us to be telling our story and getting the message out and making sure we we do all we can to maximize the the budget that we'll be able to obtain for this for this important work. So, um yeah,

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thanks for I I love those infographic, too, Gene with the local um you know, personal stories. I think those those will have a lot of impact and so we'll keep this front of mind and see who we can get in front of um face to face or do you know these road shows in the

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months ahead. All right, any other comments, questions on this? Appreciate the fiscal update and this table. It's very helpful to have that in front of us every time. Eugene, thank you.

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All right. So, our next um item on the agenda, I think was a item that um Michelle Howenstein had asked us to discuss. I know she's not here today, but um it was in followup to that Bowen Center presentation that we had last

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meeting and just wanting to have a a little bit of an open discussion around um that data, any reflections from that. Are there any asks that we might have of the Bowen Center to enhance um you know

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the data they collect and uh particularly m Michelle had some questions around you know diversity and how could we get drill down a little better to understand the diversity of our physician workforce and um and so I don't I want to kind of open it up. I

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don't know, Eugene, if you can possibly get those slides pulled up so we could project them if people have questions because they may not remember um everything that was in that deck from last time. Um and we can kind of scan through that while we're talking. Um and

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Michelle Michelle's not here, but um it's like you were reading my mind. I'm going I am looking for that uh that presentation right now. if everybody will just bear with me for for a brief second while while I pull that up. >> Okay. Yeah, I think it got emailed out

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right after that um >> 1029 meeting. Um so uh yeah, so let me open it up and just see if there were any reflections on that after that presentation last meeting and any additional uh data we'd like to see as a

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board that would be useful to us. um you know and and just open it up to see if what people think and yeah it may we may need to jog your memories from getting the getting the slides up. Did you find it Eugene? >> I am I am d let's see I am digging. Yep.

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I just got it. Just hang with me for one second. I'm going to uh save that and then I will pull it up here with one second just to save it and pull it up here. >> Wonderful. Thank you

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>> Dr. Hearn. >> Yeah, >> I'm a guest but you know this as well from internal to our institution. Our data about DEI and national as well as state baselines has been requested and

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some of that is available the diversity of our workforce and our patient populations. Some of that's available in the Bowen data but not the national baseline or baselines by specialty. So that is one thing that I know is on our

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um needs list for us to track any improvements or progress. Great. Thanks, Dr. Zappy. >> Almost got it. >> Okay. And we we could um also, you know, I

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know Michelle was the one who asked uh we talked about this, we could table this also and bring it back to next meeting because I think she's got some specific items she wanted us to be, you know, maybe considering requesting from the Bowen Center.

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um particularly around the diversity questions. So that yeah this one is slide I think is particularly this shows the racial distribution of our workforce over time.

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Um let me see >> and I'll put this uh I'll put this presentation in the chat as well. >> Oh perfect. Weren't they going to start when the license come up ask more questions? Wasn't that the what she was talking

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about? Has that happened? They now have a requirement to ask the questions whereas in the past they did I know they did not have the requirement. So there's more data. I I can't recall what she said specifically about the

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diversity questions and um >> what Dr. Maxi said last time. I'd have to look back at >> I think I put that in the minutes uh if you want to look back in there. But um I

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remember her saying that as of June of 19 those extra questions are required >> um her email once you uh spoke with you and I right after October's meeting and I'll uh if you I want to just read that email real quick. Um hope that we can

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talk about some of these statistics at the next meeting. It will be great to give some input to the Bowen Center on some metrics that would be important to the board. So that was her first thing is what what metrics the board wants to see. Uh but to continue on such as the number of Latinx this measure was not recorded in the statistics. Secondly

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would like to talk about looking at the diversity of our graduates. I know it's in our application and cannot recall seeing the graduate statistics. So I'm going through her email. First thing was looking at some input uh what what metrics the board would want to see the the Bowen Center. And I think this is what we we talked about this briefly

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during the discussion in October uh because to to get the Bowen Center involved in and looking at specific things that the board uh the board may want with that require the board to get into an agreement with the Bowen Center to collect this data. >> Um and then one one thing Dr. Dr. Hstein

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noted just at the end of her email uh she stated that if she understood uh Dr. Maxi correctly. We are currently short of the goal of African-American black physicians to align with the Indiana with Indiana's population believe that state is about 10% African-American and the workforce the physician workforce is

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about half that number. So those were her her primary her primary questions and things that she wanted the board to uh to consider mainly that first point to whether there's additional metrics that the board wants to look at and then looking at the diversity of graduates and the aligning the number of positions

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with the uh the state's demographic population >> excuse me ethnic makeup and ethnic ethnic population as part of the demographics of of the state of Indiana. Ju just on that point, Eugene's data about the African-American,

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I don't know Hispanic, but Hispanic represents about I think it's like 15 to 18% of the population and 5% of the physicians. Um, that's pretty much even with the rest of the nation.

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>> Yeah. And there's been no movement in the last 50 years, I believe. Mhm. >> Hello, this is Kurt and um uh taking what our conversation is around right now and reflecting back on uh something that you all brought up a little bit

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earlier about the um difference between uh the number of medical school graduates um out of the state of Indiana and um those that can't find spots. I'm curious um if those that are leaving our state for um their graduate medical

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education, what is the um uh demographic dis uh distribution there? So, are we retaining um um uh um students that represent our population or are we losing students that are representing our population? And is that an

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opportunity um uh for our graduate medical education in the state to do a better job um both those that we um you know the graduate medical education institutions that we have and those that we were hoping to um create um by this

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board um are we able to retain um a better distribution of those students um uh in the future than in the past? >> Great. That's a that's a great point, Kurt. >> And I don't know that that's a difficult, you know, number um to to

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grasp. You know, I was just having um a conversation earlier this morning um you know, trying to how can we get from the AMC um the pool of applicants um that are applying in their their demographic

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distribution um to our institutions in our state. And um are are we even um uh is the pool of applicants representative of our population as well? >> Yeah. No, that's that's a great point. It may be difficult to get that data,

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but it's it certainly would be really useful and we could inquire. Any other comments? Yeah, I was just going to say being on the admissions committee at IU, I will tell you the school of medicine, IU's population has grown over the past six, seven years in the Hispanic area

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particularly. Um, but a majority of those candidates are out of state. And so that is an important statistics for us to measure because our number of Hispanics have grown that we're graduating. But the question is how many

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are we retaining in the residency program. So I think it's a really good point to bring up to start following that, >> right? >> Because if we're losing all the candidates that we're getting trained, you know, while we may be helping other states, are we helping Indiana,

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>> right? And is Yeah. Is that diversity sta staying within our states if it's reflected in our medical school population? >> Yeah. >> The impact of last two years of >> mandated virtual interviews

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um I think is being studied at a number of levels but I think that also has shown to increase the diversity of applicants from out of state >> but then are persons more likely to lead the state afterward um that may be true because of family

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ties >> and becausefort with our environment so to to add on I'm going to second Kurt's discussion of what we need to be looking at and I don't know how much of that is in the scope of the Bowen question currently. Yeah, it may or may

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not be, but it's it's it's worth the question um to them and see and then if not, you know, how can we um is there any other way we can sort of get um some or a handle on that type of data as a board so we can see if there's you know

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the impact on the state and how diverse that that physician population into those residency programs truly is. Um all right. Well, maybe uh maybe I'll try to connect with um Dr. Howenstein after this and because I want to make

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sure that her she was the one who raised this, maybe we can also discuss this a little further. Uh any other points we haven't covered that she wanted us to next time and then we can make a request um and just inquire to the Bowen Center about, you know, is is some of the things we discussed today possible or or

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should we try to find another avenue for that data? >> And Dr. her. She might have an idea too about how to come up with some of that information we just talked about that the Bowen Center doesn't have because sometimes at the program level they do

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have information. So if we in advance and ask them to be tracking it. >> Yeah. And I presume on our grant reports uh updates where we do do we I think part of her question was also asking if

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we can track if we understand the diversity of our recipients right our individual um recipient the residents who are in our funded slots um from this board I don't know if we inquire about any

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diversity metrics on those um >> I think we do >> we do Okay, wonderful. >> Okay, that may be worth just double checking so that then yeah, we could look within, you know, the impact of our grants, what's the what's the diversity

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makeup of those folks that we've um supported in the various areas of the state. >> We'll check for sure. >> Okay. Yeah, if you could check that would be wonderful. Thank you, Linda. Okay. All right. Great discussion and I'll um touch base with uh Dr. Henstein.

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Um, all right. And then now we I think the next item on our agenda, let's go ahead to the we're going to talk about our program development grants and we've got some reported outcomes for those large grants. Uh, I don't know Eugene or or Linda, which one of you will share

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that as that's our PowerPoint presentation that we have. >> That's correct. Um, I'm going I'm going to go ahead and get the PowerPoint up and then Linda, if you will just jump in where um, please any gaps that I'm missing. uh Linda uh helped me to go

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through and take a look at the program development grants. Uh Dr. uh believe it was uh Beth, you actually last meeting asked for a report, wanted an update on where we are with uh with certain grantees. And so each of the program development grantees has two grant uh two reports they have to provide each

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year. One at the end of June and one at as of uh the end of January, which will be this Monday. So, let me let me see if I can cue this up and let's see go there. Hopefully that should pull up. Can everybody see the uh

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the PowerPoint that is hopefully it should say okay perfect. So, uh what this is is just a quick a quick run through of current program development grants. So, as everybody uh those who don't know what those know the program development grants are for entities who are creating a new starting a new

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residency program. Essentially, it is $500,000 uh two-year grants, so paid in $250,000 increments to help with startup costs. So, that is everything from acquiring staff, uh other cap capital assets necessary really to the that that money

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to get the program off the ground and get everything started. So, it's the stage before a new program would then come to the board to look to apply for the expansion grants, which are the grants that actually pay for the the residents themselves. Um, I'm going to see if I can make this

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a little bit bigger on my end. So, so everyone should see uh the slide that says program development grant. It's a little tough for me to see. I do apologize. I'm going to try to see if I can make it a little bit a little bit easier for me to see. Can everybody Is everybody seeing a full page or are you seeing a grid?

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>> I think we see a a slide with a grid. >> Okay, let me go take back this. All right. Where we at now? Everybody can see. Okay. Yeah, there we It's a little bit bigger for me now. I had to turn the chat off. So, um, looking right now, we have, um, a couple of of program development grantees. This is just a

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quick rundown of who has outstanding deadlines right now. So, if you look at Park View, Parkview Health at Fort Wayne, their general surgery and internal medicine, they got they received a total of a million dollars in program development grants. Those are going to be expiring at the end of July.

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It's the end of June. And so they had a report due uh this past uh December 31st. I might have to say January 31st, excuse me. December 31st is when they provided that and we got that right on time. And then the same thing with the Northwest Indiana GME Consortium. Uh they received a program development

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grant almost about a year and a half ago for psychiatry residency. And again that grant runs through the end of June. So right now again I said there were two there were three there three active ones. We don't have a bunch of data yet on IU Health because that is the newest program development grant. They received

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that uh at the last meeting. The board awarded them a million dollars for their emergency medicine and internal medicine uh programs that they'll be starting down in Bloomington. And as I mentioned previously, the program development grants a $500,000 uh two-year grant agreements payable and two annual

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payments of $250,000. So going through the Northwest Indiana Consortium of Psychiatry and everybody has a copy of that report in their meeting packet, but this going going through a few highlights. Uh that was approved by the board back at the beginning of 2020. So on January 29th,

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20 uh 20, almost two years to the day. Two-year project term that ends this June. Uh their program is expecting to have 16 residents at full complement. It will be sponsored by IU School of Medicine. Uh and they will be contracting for DIO services through IU School of Medicine. Right now they've

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hired six employees for that psychiatry program. Uh the host site is going to be regional care group. And I know Beth uh if you I know you might have some comments about this particular uh this particular this particular program and this consortium. So I'll uh I'll let you speak here once I get done with this and

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then we can move forward with the with the other two. Uh the questionnaires and surveys for the MATS were completed back in September uh for interviews that started in that were that were scheduled to start in uh October of 2021. So, I know again in Northwest Indiana, Beth

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and and Beth and your shop, your FUCC is is involved uh with with IU and GME and consortium with their psychiatry uh plans for their psychiatry residency. If you have anything that you want to offer now or we can wait till the end of this uh slideshow and then I'll I'll

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>> I think you covered it. They're moving ahead. They're just waiting for match day, I think, at this point. Had a lot of interest. >> All right. Thank you, Beth. So, moving forward, uh, Park View Health. Again, Park View Health is in Fort Wayne, the Fort Wayne area. Uh, an area that was

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first the board first engaged with Fort Wayne through the Fort Wayne medical education program, uh, through their expansion of their family medicine residency. That goes all the way back to 2017. Park uh, Fort Wayne Medical Education Program was actually one of the board's first expansion grant recipients. Uh Park View Health has has

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moved forward with a a a big expansion in the Fort Wayne area and again they're going to start two residencies for uh plan right now internal medicine and emergency medicine. So their grant application was approved during the middle of June uh at the beginning of June, excuse me, of 2020. Uh they're going to be sponsored by Park View

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Health. So Park View the hospital, Parkview Health will be the sponsoring institution. And they again have also put together a sta a program staff. uh their plans is going to going to have a 20 uh 26 26 patient room uh outpatient continuity clinic and that should be uh

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and the report said it was going to be completed in late 2021 which means that should be done now. We can get an update on that. Um if anybody on the board would like to request the status of of that of that clinic. They conducted their virtual interviews uh actually right now they just ended them this week

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and what was really interesting from their report is they got almost 2500 applications for their 12 approved positions. So, uh, going back to to Beth's point about significant interest in Northwest Indiana, you're seeing the same thing in in Fort Wayne. Um, as far as general surgery, uh, again,

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sponsored, I mean, sponsor, I put down the ACGME, I believe that should be Park View Health. I need to my apologies for that for that air. I believe that that sponsorship is also to Park View Health. Uh, but they received their initial accreditation back at the middle of June of last year. uh virtual interviews they conducted between November and this

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month, so this January and over 650 applications uh were received for four positions. And then IU Health uh that was recently approved. So uh last October is when the board approved that application uh for those uh two $500,000 grant. So a

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million dollars total. That project term right now is scheduled to run between July 1 of 2022 and June 30th of 2024. Uh, I actually want to check with IU Health because I'm not sure that I I actually believe that project the contract is it starts in July, but it seems like that contract should be

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starting sooner. Uh, so I'm going to reach out to the leadership at IU Health down in Bloomington to to check and see whether we need to amend that contract for that to be able to uh begin sooner so they have access to have access to those funds sooner than than June. That seems to be a little bit of a ways off.

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Um, that that date just doesn't strike me as the plan. I'm not sure. I think things have been delayed there a little bit. Um, Eugene, so that's a good idea to talk with Dr. Kathy Hiller probably who presented at our board

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meeting last time. So, >> thank you. >> I'll touch base with her and and get a get an update on that and then if we need to uh we if we need to make adjustments to that contract, if it's the way it's supposed to be, that's fine. if we need to um adjust that contract and make that start date and

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end date sooner, uh we can take care of that as well. It's a it's a process on our end that we can take care of. Does anybody have any does anybody have any questions about any of the outstanding program development grants right now? Um again, that does tie into what we talked about earlier in the

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meeting about the the future funding and and funding. As you can see, there are several programs that are near ready to go. Um, and and to, you know, something that that that Beth Robo that Beth brought up early in the meeting and, uh, Dr. Putnham, you touched on as well. Um,

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it's a matter of the funding commitments for these for these programs. I think again, if I'm speaking out here, Park View was kind of uh, Dr. Rebecca, I'm not sure if you if you can if you can speak on this, but Park View, I don't know that Park View was part of the initial planning for uh the GME

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expansion program. We knew that there would be interest significantly. I think Park View, again, as far as I sit, and again, I I only sit in in the seat here at the at the commission, but uh Park View very aggressively has has moved to to uh to create their residency, their

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their program, and they kind of have have broken uh broken partnership with Fort Wayne Medical Education Program. So, that's thrown a little bit of a wild card. Um, but again, I think if you look at the the the fiscal that was planned for 1323 versus where we're at now, if

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the fiscal was followed as and funding was received as as listed in that fiscal, the board would have been able to absorb uh that that new program kind of coming out of out of left field. But um >> yeah, I think that's true, Eugene. I

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think I think there was anticipation that there would be new programs starting in the Fort Wayne area just because of the the population base that's there and really only having one family medicine program. So, you know, they really have the capacity to do what

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we're doing in southwestern Indiana certainly and and Gary also has that um potential longer term. So, um, you know, I think I think the original information suggested that they would be able to start new programs.

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>> Mhm. >> And I think it's important to realize, you know, they the one the two programs they're jumping out with general surgery, very important program, shortness, short general surgery around the state. And that's a hard one to start. So, you know, they jumped into

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that. Um, and internal medicine. And when we look back at our Bowen Center data, I think having another internal medicine program certainly both of those programs are well timed for our state. >> Any other comments? Thank you uh Eugene

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and Linda for pulling that PowerPoint and summary together for us. I think that's it's nice for the board to have that snapshot and be able to quickly kind of see where where the status are of those larger uh program development grants. Any any other comments or needs?

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Uh Beth, did you get that was it did that meet the needs of what you were hoping for the report and any other needs that we should consider for those? >> Yeah. Yeah, that's perfect. >> Perfect. >> Wonderful. >> Seems like they're all on track. So that's that's a good thing um for the

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most part. So wonderful. Okay. Um let's move on to our old business. I think the the first item we have on old business today is to revisit that discussion around that that Eugene and Josh were alluding to earlier around the economic impact study. And um you

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know since it has been a number of years since uh we got the the trip on Bach recommendations to this board and and some of the data that we're using. Is it time for us to have someone come in and

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kind of give us a general uh assessment of where our economic impact has been to date? What is the current state and you know projecting ahead? Um, and so that was one of the the things we wanted to bring forward that we had I think

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discussed a touch last time. And um, and so that would be I think we would have to open that up as a like an RFP or something. Is that right, Eugene? Is that how we would have to go about that process? >> Yes. So to to um if you go back for

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anybody who's interested if you go back and look at the minutes um I want to say it would have been 2019 but in effect the board did approve uh did approve doing an e economic impact study >> uh and approved an RFP to be for no more than $20,000

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for that economic impact study. And that was to that was that was back uh we were actually prepared to post that RFP uh right before the pandemic hit. And at that point we were told that you know not to essentially spend any more money. Uh and so we we've held that RFP uh

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since then. And so now that we have uh you know obviously still in the pandemic but the state's fiscal situation has become a little bit clear uh revenues are are are doing better than anticipated and uh the you know our initial the board's initial thought was

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to get this economic impact study and for prep in preparation for the 2021 legislative session which was a you know which is a budget session and to have that data available to be able to show to to lawmakers and other stakeholders here is the the positive economic impact act of the GME expansion plan at that

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point. Uh looking at where we are now to Josh's point earlier, we're uh we're in session right now, but we're we're essentially preparing for the 2023 budget session. So, it's an ideal time right now to revisit doing that economic uh that e economic impact study, putting

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that RFP out, determining what the board wants to spend on that, and then hopefully having that data done and complete to then incorporate that with some of the the other, you know, those documents I showed you earlier so that we can, as we, as Josh talked about, hopefully uh being able to get a road

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show going, we can have that data to to follow right along with the the stories of the the stories of of of expansion and uh the feedback we've gotten from from administrators in the areas where expansion has taken place. >> Any discussions? Does it sound that do

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folks feel that this is a good time for us to do this and folks um any concerns? Oh, lost you Jean your volume. Oh, I got a couple hands up. And go ahead, Eugene. You were talking, I think, just on mute and then I'll

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>> um my apologies Dr. Warden and Dr. Putnham. I'll be quick. Uh I think one of the things just to consider for today, uh I think it would be good for since it's been two years for the board to revisit uh to take a formal vote, formal action on on approval of a study and then to determine whether you still

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think $20,000 is the appropriate amount. Again, I have no data to back up how the how pricing may have changed or what, but just to determine an amount that uh the board wants to spend. Again, the board does have at this point the $3.1 million that we discussed u and the way

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that uh the legislation is written that the board it does allow the board to continue to uh pay for consultancy services, nothing has changed within the within the statute for that. So, um that's just for points of discussion. Thank you. >> Yeah, makes perfect sense. Thanks,

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Eugene. Uh Kurt, >> um I I um I still consider myself new to this board, so I apologize if I'm going to ask questions or um say things that are really not part of that should be part of this discussion. So feel free to

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put me in the parking lot. Um uh but my question is um and I'm economic development is awesome. Um, but I also can't help but hear about uh and and reflect on the state of our health care

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outcomes in our state and and where we are in maternal and infant mortality and morbidity and the other um health outcomes in our state and um um and I and I realize that that doesn't get the

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same attention probably from certain populations that fund etc. But I would hope that as we increase the number of physicians in our state that we could tie in training that we could tie improved outcomes. I know that's a

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long-term um uh issue, but if we could tie some of the work that we're doing to improvement in our health outcomes, um I think that that would be really important as well. So, um I that's probably clearly a

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different study than the one that you were just talking about. So, I appreciate that. Um uh I and I apologize I but the governor I think has a new effort in regards to um looking at health outcomes in our state and

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improving um um and I can't remember what that particular commission or that work is but I feel like like um Dr. Judy Monroe and somebody else were supposed to be leading that particular project uh for our state. And if um there was a way

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we could either partner with them or um uh uh something uh around that as well, I I would I would be interested in in in that in addition to looking at how we are economically impacting um um our

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communities around our state also. Yeah, that's a great that's a great point, Kurt, that it's not all it's not all about the economics. It's also, you know, what what's happening to our patients because of and our population because of this. And I I think you're referring to that public health in

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consortium group. I don't know if I have the right word for it that that um Beth was referring to or maybe is a part of. Um but I got a couple other hands up. So, let's let's get some more discussion going. This is good. Um Tim and then uh Rachel.

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>> Yeah. And and I what Kurt's saying. I do think that study will be a little bit tough because directly connecting infant or maternal mortality to an increase of 4% of the number of physicians in the

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state would would be tough to correlate, but I'm glad he's going to be the one um uh coalesing that data and not me. Um the but but I I think the reality is when you go into the state house there are people who only care about the

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economic impact. Was this dollar invested wisely and did it return more than a dollar to the people of the state of Indiana? Um if we get good health outcomes from it, I think that's that's good. But there are some people and Josh

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Eugene please correct me on this. They only want to see the fiscal math. And I I think that's that's that's kind of where we look at it from the economic study. And I and I've always believed this is a great fiscal investment. If we don't care about outcomes at all and

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just wanted to turn cash, this would be a great place to put it. And I I so I think the story is good regardless. >> Um >> so I I think it's a it's a good investment. I have no idea about the 20 grand >> whether that's that's good or not,

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whether we'll scare good people away from doing the analysis or not, but I think we need it and I think it needs to be timely u to get our message out here soon. >> Yeah, thanks Tim. Uh Rachel, >> yes, I was going to add I actually

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attended a session with Dr. box and Senator Kinley are leading the um they did a road show to ISMA specialty docks uh back in December about the governor's new commission on um primary healthc

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care improvement. So I think that could be a really good spot for us to try to um connect with um in terms of outcomes because I do think what we are doing can have a big impact. Judy Monroe is is leading that as folks had alluded to,

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but um was a really exciting group to hear um what they're trying to do with trying to improve outcomes with healthcare >> and I think we feed into that. So, but Senator Kinley um Dr. Box and Judy

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Monroe are um leading that. >> Perfect. Thanks for that update, Rachel. That's that's helpful. And yeah, there may be a a bridge there that we could create because they do feed on each other. Ste,

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>> yeah, I was just going to um sort of second what Tim said. I think you know one of the things when the original legislation there was a I mean certainly there's a need. We all know that and you know that's easy to document. But the

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economic impact study I think is very important and it is a way to to justify doing it right now um to the legislative and and we need to we gave indications that certain things we thought were going to happen. It would be useful to

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see I I can tell you I I would expect in our region most of our leaders in southwestern Indiana are incredibly happy with the direction this region has taken. um you know from the economic impact side of it plus just the new residency

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programs have really had an impact. So so I think as we are trying to get this expanded around the entire state it's a critical time to get funding increased next year. >> So I think it's it's the ideal time and and you know ultimately we want better

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health for hers and better outcomes. Those things are going to be measured. Um, and you know, I I don't think it's the the purpose of this committee to do that. I think it's more we have a role to play to try to expand graduate

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medical education in a in a way that allows for these other things to happen. >> Um, and I'm afraid if we studied that right now, the data we would get, it wouldn't help our initial purpose right

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now, which is to expand GME. Great point. Thank you, Steve. Beth, >> yeah, I agree with what everyone said. I guess my question and and I truly believe because I've done some of these economic studies that that if we get

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health if we have providers, especially in the primary care that that improve the health of Hoosiers, that's an economic driver because it brings in more businesses. businesses look at Indiana right now although they say we're doing well and I know we are that

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you know the health care costs and we're all facing that the issue in the state are driving it. My question is I really think I and I don't remember the stud the RFP you know is it a paper kind of

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like desktop or was it a interview I think 20,000 is going to be pretty on the low side. Um, I would like to say, and again, I'm probably get shot for this, that we give staff up to $100,000

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because I'm not sure. I just I'm doing two, one's 55 and 175 for not exactly the same. Um, but a pretty intensive study um up to 100,000 to use, but to

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try to be as economic about that as possible. Okay, thanks for that recommendation, Beth, and that perspective. Um Sarah, you were gonna share some input. >> Yeah, if it's okay. Um yeah, I want to

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say I I really appreciate all of the um economic stuff that's going on and and think that's a great idea. Um but just a thought I had about um the outcomes. I agree that maybe there wouldn't be like a maybe we couldn't get data to bore out outcomes with the small percentage of

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folks that we're adding into our workforce, but just like you all are going around getting stories about the residents, um if you wanted something qualitative to take to the state house about outcomes, you know, could you reach out to those same programs and say, is there a patient that has been specifically impacted by one of these

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resident physicians and would you um care if we shared the story? um that could be a way to bring outcomes in like a qualitative way without waiting for a study that may or may not bore out um what we want. >> That's a I love that. That's a great suggestion, Sarah, because it Yeah. How

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do we keep those personal stories connected to a region that really uh speak to the hearts of the the folks who are making these decisions. So, thank yeah, thanks for speaking up and sharing that. Eugene.

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>> Yeah. I just wanted to share a couple things and it it kind of ties to what somebody uh asked earlier. I think Josh might have Josh might have stepped away for a second. So I think he's back and I'll let he and uh Greg and our team kind of kind of kind of touch on this and obviously some know Dr. Putnham, Dr.

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Becker, uh those have been over at the state house. When you look at in terms of what we take over, who we speak to and what we the audience that we're speaking to, there are some that we get basically 10 minutes and we have 10 minutes to get them the the the highest

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level meet and the, you know, what's going to grab their attention. So what's going on in their region, the economic impact, how many doctors are in their area and once you get that 10-15 minutes, if you can get that meeting, you get it and you say thank you and and then we're out of there versus other

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folks [clears throat] who are we so if we're looking I I won't say names. I don't want to say anybody's name per se but people who are we know are going to drive and continue to champion we can provide them with a lot better a lot more data uh related to not just the

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fiscal data but the long-term impact for those health outcomes uh the uh the number of the ratio of patients per per no ratio of doctors per per um per resident a lot more of that of that of

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that good highle data that then they will utilize to then go and work with their stakeholders to continue to garner support. So I think we've tried to work both those angles in the last six years that we have been championing this plan.

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And so getting that fiscal data gives us that that just the the raw numbers and show the impact and those are those convers those those 10 and 15 minute conversations that we have to go have with I don't know 10 15 stakeholders across the street during legislative sessions. But it gives us a real good

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way to show okay to make a case and say please continue to support GME. But then we get that higher level data to speak with the uh chair of you know the the chair of the house or or um chair of Senate fiscal or the chair of house ways

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and means and we utilize those relationships to then go and feed that data down to the rest of the general assembly. So, uh, Greg or or or Josh, am I your thoughts about that? >> Yeah, I think what you said there is

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good. Eugene, [clears throat] do you want me to to go ahead and mention the RFI idea or should Yeah. So, one of the things is since the price range is is there's kind of a debate on what be the the most appropriate price range, what we can always do is put out an RFI, which is just a request for information

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to find out what what uh providers might think that cost is and then come back with a better uh range. So, if we think that putting it out at the what the the board originally thought might be too low or would just be I don't want to call it a waste, but an ineffective uh prop uh proposal, we could put it on

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RFI. Takes a few weeks. uh get some price range back and then come back with a good estimate for the board of what that might cost. So, if that's something you'd want us to do, uh Eugene and I can work to get that out and and posted uh if that that would help on the decision-m process.

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>> I like that idea. But can we also see what the RFP looked like before? I don't even to be honest, I can't remember what it looked like. >> Yeah, I I can send it out. I I we drafted it two years ago, so I I'll dig and find it and I'll send a copy of that out to uh to the board this afternoon.

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Let me see if I can find that. If I don't get it this afternoon, I'll get it uh sometime this weekend or early next week. But yeah, we uh I'll show you what it was and and and if anybody has any changes um to Josh's point, we can do the RFI and you'll have the what we proposed two years ago to see what needs

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to be changed, if anything, on that document. >> Great. Kurt, did did you raise your hand again or is that I'm trying to track raised hands. So, >> I'm good. Thank you. >> You're good. Okay. Wonderful. Okay. So,

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good discussion. It sounds um anyone else want to comment on the RF RFI? I know Beth said that sounded like a good idea or if we should try to because I want to move us towards a motion here. Um, but just see if there's

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any other comments on the price uh that we should attach or if we should just go with that RFI process to get more information. Steve. >> Yeah. I'm thinking since we don't meet again for 3 months if we, you know, do we want to or whenever it is April, um

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should we maybe make a motion that up to 50,000 say initially and then if the RFI comes back and it that doesn't look like it's going to be adequate that we let the chair make a decision about bringing it back to the committee um or something like that so that we don't have to wait

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three or four more months to get that because we're going to be going to the legislature. I'm suspect in the fall. >> So, we're going to want to get that. So, that would be my only suggestion. >> Yeah. To keep make the timing work uh and not be held up by our next meeting

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>> because aren't we going to have to do this in the summer? I mean, we're going to be hitting them up maybe summer, too, the legislators doing our road show like we didn't like when we originally went out. >> Yeah. >> Yeah.

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>> Yeah. So, in terms of timing, >> we we can do summer into the fall. Um, it's and it's never a bad thing to hit hit them more than once. So, lay the foundation with whatever information we do have at the time. And if it if we don't get uh the impact study back until end of August, even uh a second meeting

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uh or follow-up information wouldn't be a bad thing to do as well. >> Okay. Um, so hearing all the input, go ahead. >> I was just gonna say if if if we could use Dr. Becker's

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suggestion as a proposal, I would second it. >> Okay. So, um, Dr. Becker, would you like to make a motion? >> Yeah. Before I do that, let me ask Joshua, what Joshua, what what is best

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for you? >> Um, yeah. Or getting getting the data would you I mean, >> I just I want to make sure you have and the group that's going to be, you know, um, educating our legislature has the

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information. Um, so I guess I'm asking you whether waiting till the next meeting and if we have an RFI, if we get it back by then, can we, you know, wait till April and then not do this? If not, I would be happy to make a motion that

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we go up to 50,000 if that covers it and letting the chair decide whether to execute it or wait for the April meeting. I think that's a good idea because if if if Eugene and I can get this out in the next week or so and then we get that back and they say, "Oh,

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20,000 is good, then we can get the RFP posted right away and and get uh get that out." I think that you Eugene would have a better idea than I would about how long the economic impact study would take just because he dealt with the original uh reports and all that. So,

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uh, I I I think if there's a a top end that you're comfortable with, whether that's 20 or 50, uh, uh, say that and we'll move. If it's, you know, if we come back, it's 125, we'll we'll pause and come back to you. >> I I will I will share that. I did

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discuss this a couple of months ago with uh with Hannah Maxi at the Bowen Center, and there there's some other things that falls into above a certain price point, we have to do an RFP. Um Josh, I forget what that price below a certain price point we can do a sold source where essentially we can go out and find a

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vendor and we can select that vendor but above a certain amount of money we have to post in a formal RFP. We have to notify three v [clears throat] vendors of that RFP and then we have to leave it out there for a certain amount of time. So I did speak with Dr. Maxi. Um, I want to say back in November, we were having

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a discussion and I did just casually mention that the board may be looking to do a economic impact study and I mentioned the amount and at that time she seemed that essentially her shop could potentially do uh that

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work for that amount. Now, how whether that's changed or not, again, this is just a casual conversation. Uh, but the board may want something more exhaustive than than what's even on the uh when I sent out the RFP. And so just to keep that at back of mind that that's one entity that has expressed interest in

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doing so. But again it falls into how just and again Josh I'll ask you to jump in what that amount is that we above what amount that we have to go out and post an RFP uh for the formal formal study. >> I I believe it is that 50,000 number but I'm look I'm trying to find it right

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now. I I don't have that off the top of my head but I I believe it's right there. Eugene, one of the things um you know, so we've started the three programs here. I mean, in reality, this is going to be sort of an economic impact of

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southwestern Indiana because we'll have 95 spots, you know, so sort of will have the major bang for the whole state right now. Um so you know in a lot of ways that will look diluted when we spread it out

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through the whole state. >> Um but in reality it's quite intense down here. Um so um but I think it's we should do it. Um >> so so I am tempted to make a motion to

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authorize the chairwoman to approve it up to $49,000. Um and um and if it's above that or um the chairwoman believes that it's you know we need to bring it back that we

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evaluate in the next meeting. >> So am I understanding this correct Steve that you are making a motion to do the RFI? >> Yes. to do the R to approve up to $49,000

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to to do the evaluation we want done, but we will do an RFI, initiate it right away. >> Initiate the RFI and then if the RFI comes back,

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then do we have to do an RFP after the RFI? I'm just making sure I understand the steps. I'm trying to authorize you to make a decision on behalf of the board to go to move forward and start the the evaluation process. >> Okay. >> Yeah. >> So, how I how I word that to get that

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intent out is the question. [laughter] >> Okay. >> And and and you know set an upper limit of say $49,000 not knowing what the requirement for the RFP would be. >> Yeah. So, a motion to do an RFI,

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I think, followed by an RFP that then could be authorized by the chairperson up to $49,00,000. There you go. Well done. That's my motion. >> All right. Does anyone second Dr. Becker's motion? >> Second Beth Robo.

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>> Okay. Uh, all in favor say I. >> I. >> Or raise your hand. >> I. >> Any opposed? All right. I'm supposed to I missed a discussion time. Am I supposed to what am I supposed to [laughter] I messed up my Robert rules of orders, did I?

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>> The only thing that I would suggest as a discussion and I don't know if if it's relative, but I think Dr. Dr. Becker's point's very good that the the outcomes that we have are very focused in an area so that if there's a sub component of

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that um study could focus in the southwestern area um so that we get that focused um understanding in addition to statewide understanding. >> Great. And I think it plays into the

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return on investment. Even if it's local, if you look at what the return on investment is, I think for the state, I think that's part of I hope that's part of the RFI, RFP, whatever we're doing. And also, there are national numbers

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that say that, you know, even with the residents, they bring in $150,000 per resident, you know, even when they're residency, and it it jumps to 1.5 million when they're out. So there's a lot of outside data. That's why I'm saying I don't know if this is going to

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be a desk or we're actually going to go out and and and look at that. So I'm anxious to see the RFP or I whatever it is. >> Okay. Okay. So I might have messed up my my order here a little bit. So any other

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discussion? All right. And so um the motion does it stand as as you previously stated, Steve? Yes. And we had a second. Um, we had some followed up with some discussion. And then all in favor, I'm

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going to ask for the vote one more time. All in favor of the U motion that by Dr. Becker say I please raise hands. >> I. >> And any opposed? Same side. Okay, that motion carries. So, we will

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move forward with the RFI uh followed by the RFP and see where the numbers fall in. and I'll look at that between now and our next uh board meeting. Hopefully, we'll get some some real interest and uh this will be really helpful for us as we move towards yeah this summer period and and what we need

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to advocate uh to the legislature. So, thank you. All right. Uh let's I want to keep us moving along so we can get through our agenda and get us out on time and maybe a little before one, I hope. But, uh, the updated summary sheet she sheet, Eugene, do you want to bring, uh, any that to the board's attention

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and any, uh, things we need to help you with on this and we can't hear you if you're talking? >> Yeah, it's tough to hear me if I if I'm on mute. My apologies. So um just want we provided an updated summary sheet just a little bit of updated data uh for

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some of the newer programs that have been funded uh over the board's meetings in 2021. So um just some new data showing you know now we're over a 100 resident positions over 330 residency spots uh listing you know this point over $20 million has been awarded. So

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really again that sheet showing legislators and showing stakeholders uh where the state's investment has gone and really using this color-coded map that you see in front of you to show the statewide impact. Um as we continue to to expand, we continue to have uh

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residency programs and and new physicians that are having impact in communities around the state. Uh that color-coded map is really showing just the statewide impact that the GME expansion plan has had so far in the six years that this board has been in place.

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And as we continue to develop, continue to fund new and expanding residency programs, this map will continue to be uh filled in. And so this is a living document. This is just our ne our current version of of um of a document

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that the board has first authorized about three years ago, three or four years ago and and continues to grow and to show show great gains. Uh this document uh I know people like Dr. Becker and Beth and myself who have gone to uh conferences, Dr. Dr. Hearn, you went to the one of those the initial

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GMEI conferences, but uh this document has been wellreceived and people have been very impressed going back to some of the earlier conversations about Indiana's investment in GME. And so we continue to use this document and from all I can tell continued to find uh good results from from this this one pager uh

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that the board you know first was very wise to to bring up about three or four years ago and say hey we need to do a one pager to have a talking point that can be passed around across the street and across the street by my nomenclature is uh the state house as well as with stakeholders around Indiana and at this

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point nationally. So, >> Mhm. Great. Any comments on that? Um, our infographic or any things people want to see differently. I think it's super powerful

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and very succinct. >> Yeah. Let me give credit to Doug Doug Doug Litner in our office handles all of our graphic work and so I want to uh to give Doug credit. Appreciate Doug and his team working on this the communications team. They're they're pretty awesome. Yeah, it's it's really powerful, I

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think. All right. Well, if there's no other uh comments on that, then we'll move into our new business today. And the new business, as you all know, was uh voting on the new uh or the I should say the expansion grant application for the

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Franciscan program. And uh Eugene uh do you have uh what you need to from our board members to calculate and tabulate scoring? Um >> I I do. Thank you all. Thank you for getting that to Linda. Uh, Linda has

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been my right-hand person, especially as I've been a little bit incapacitated the last few weeks. And really appreciate Linda uh, you know, jumping in and taking on some new some things that she doesn't she hadn't done previously. And really appreciate her uh, both for getting the minutes together and reviewing the outcomes report and then

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everybody getting her score their scores to uh, her scores [clears throat] to her. So, let me run through what's going on with the Franciscan application. Uh, I'll read through each category and read through the scores for those. As everybody knows, the board uh revi revised the evaluation criterion a

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couple of years ago to uh give some more uh standardized metrics to to some of the uh some of the application points. And so I'll walk through those evaluation criteria for a residency program. Uh this is the first criterion of five residency program development in an underserved area of Indiana. This

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again is based on Robert Wood Johnson Foundation data. Uh the Franciscan application received a 20. uh their rank is in the uh 70 to 92. So we have 92 counties in Indiana. Um in the notes Linda noted that uh ranked 72nd overall in healthcare outcomes. Uh residency

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program development in rural areas uh ratio of of 1500 to1. Uh that got 10 points for the uh Franciscan application. The max on that was 20. And again this this goes to give additional points. The board has been very strategic in looking to give

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additional points and weight to uh those programs that are looking to establish themselves or expand in rural areas. So, Franciscan came in at 10 there. It's a possible 25. Franciscan got a 10 there. I'm a residency program involving in a collaborative approach such as a

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consortium of FQC hospital system, critical access hospital or other. A maximum of 20 available there. And the Franciscan application uh received a 15 on that one. I'm just looking over my apologies for a quick pause here. Priority score for five-year and newer

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programs. Again, the board not only looked at giving that priority weight to the rural programs, but also to new programs. Um, a maximum of 25 points available. Franciscan scored a five on that. That is because their family medicine ro program residency program

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was originally accredited back in 1973. So, they are in the category of five years and beyond. uh first year program would get 25 points, second year 20, third year, 15, fourth year 10 and then fifth year and beyond will be five. And so Franciscan scores a five on that. And then finally uh the strength of

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application. So this involves the letters of commitment any letters of recommendation the financial commitment as everybody knows each entity that applies for uh any of the state grants any of the grants in terms of the GME grants has to provide a 25% match. And so um Franciscan I had to provide

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documentation of their match. A maximum of 20 points on there uh they received a 16. So out of um a total of 105 points Franciscan Health received a 67. Again I want to reiterate that that score um you know reiterates as a 67 out of 105. Some

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people uh particularly those in the public may go wow that's a low score. But again, it's just the the main thing that that gives Franciscan ai a 67 is the fact that one, they're an older program and then two, uh they're not as much in they're not in a rural area. And

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so those are the things that kind of give them a little doesn't doesn't take anything away from the strength of their application. It was a good application according to the board's other metrics. These are just things that the board has built in to make sure that credit is given for those uh residency programs that are starting in rural areas and

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areas considered to be underserved. >> Thanks for that summary, Eugene. And and to be clear, I think we've funded this position previous two years in the positions behind it. Right. This is like

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a continuation of um the PGY1, the PG or you know each incoming class, right? Yes. Yes. This would be Franciscan. Franciscan got approval to expand a couple of years ago from a 24 uh to 27 and so they applied for uh for three for

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funding for three positions. This is the last of those positions. So, >> right. So, any discussion on the grant application? Uh anyone wanted to bring up any points of discussion on that application? One more

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thing to note sh uh one one more thing to note uh madam chairwoman is that just so uh the 67 that they scored this falls in line with this with similar scores they received in in 2020 and 2021 again going back to what I said explained about yeah >> um the the um about the uh the

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evaluation criterion. So this doesn't really change anything uh in terms of the score I guess the same >> right thank you for that context. >> Any discussion comments? Sometimes there's questions on the application. Uh Steve, >> I'm just getting ready to make a motion

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to approve. [laughter] >> Wonderful. Okay. Uh you're you're my motion guy today. Thank you. Um >> I'll second. >> Okay. So, it sounds like Dr. Becker wants to go ahead. Did you go Did you make your motion, Dr. Becker?

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>> Yes. >> Okay. And I heard a second from >> Cliff. >> Cliff. Thank you, Dr. Knight. Any any discussion? All right. Uh, all in favor I or raise your hand. >> I >> I >> I.

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>> Any opposed? Same sign. All right. The motion carries. we've approved that uh Franciscan grant for the uh that position for 135,000 and um yeah, thanks everybody for for your support of these and uh

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continued good work for from the Franciscan program. All right, that's our only new business today, our only new application. Uh, and I think uh the next item was just to mention that uh I think Eugene's already touched on this that we did get that uh

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grant application from uh Southwest uh Indiana and um we'll look we'll look to be scoring that those applications in advance of our April meeting. Is that correct, Eugene? >> That's correct. I'll provide that application. Um and again just noting just keeping it in the back of

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everybody's mind the this kind of falls in line with similar um was it last year 2020 where uh there was an application before the board where the amount that was being requested the board did not have the amount of available funding and so it was a I think at that time the

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board did a 75% approval with uh approval of the other 25% contingent on receiving funding from the general assembly. At this point, we would fall into a similar situation moving into the next fiscal year. At that point, we do have the board does have $5 million that

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has been appropriated for next fiscal year. So, you would be in a position to uh if that grant application were to be approved and we I'll get you the fiscal data as I start working that up. Um I'm just going doing back napkin math. But again, keeping in mind what we discussed earlier, uh, with some of the program

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development grants and what's coming down the pipeline, we'll we'll need to talk about that and and and really get a a handle on, um, being prepared for what's coming. But, uh, that application will be in front of the board in the April meeting, >> right? Okay. Thanks for that context and

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reminding us how we handled that last year. That's uh, helpful uh, as we prepare for that. Hey Eugene, do do you want to talk at all about the request we got from um Caraval about um just to bring the board

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up to date that there may be a new rural family medicine program or wait till the next meeting? >> Yeah, I I I you know I didn't even put that on the agenda. Dr. Becker, you're right. Um but she did bring that up and again I don't have the context in front of me what she did. she did notify us

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about a potential new uh new program and I don't know any I don't have any fiscal data behind that but just to be aware that a new rural medicine program could be will be could be forthcoming within the next year or so if I'm not mistaken. >> You met with them right Steve? Yeah, I

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met with um with Carara and her team um who they received a grant to um to uh help start um a rural family medicine program between Logan'sport Memorial Hospital and Marian Health.

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>> And uh so they're at the early phases of that and really they reached out to Eugene and the board to get some advice on sponsoring institutions and some other type of information. So, um I met with them for about an hour and a half to give them some information about

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steps to move forward. Um I also forwarded to them um just recently a doubleAMC outline of a new hospital um Medicare uh funding guidelines and and what it means. So, um I think I don't know if I forwarded that to you, Eugene,

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yet. That's a very um Dr. Howenstein sent it to me and going through it, it's a very good thing for new hospitals to to uh have as they're looking to start new residency programs. >> So, I'll forward that to you. >> Thank you. I appreciate that, Dr. Becker. She did reach out to me and uh

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my I told her again my context of what my role is, but I I offered asked her to speak with both you and Dr. Howenstein, and I appreciate you uh jumping in and stepping to take the time to meet with her so that they can really get have strong roots to get their program off the ground. Thank you for for being

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willing to take your time to do that. >> Mhm. >> So, I think there's a reasonable chance they may come before the board in the next 6 to 12 months. >> Yeah. Good to have on our radar. Yeah. And thanks. Yeah. We'll support support them with information as we can and help

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them, you know, with this journey. So, I'm glad they reached out to us. Um I know u one other item maybe for open discussion then we'll do public testimony. I know Tim, you had forwarded maybe a um oh an email that Eugene you

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sent us yet. I think it was yesterday uh around this uh the CMS releasing on something on the rural health. Do you want to did you want to talk about that a little bit Tim? make sure we're aware of what >> Yeah, it's gets bit of noise and I think there's some funding and I think there's

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some some it's it's funding for GME in general, but I think there's specific dollars that are earmarked for rural programs and it and I' I've always felt like the funding the state has for GME is is is

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always the seed money or used as a force multiplier. So, I think having us understand exactly what that money is for, what the program's for, how it opens things up for us is really important. And I have to admit in

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reading that, I couldn't understand it. I got in the general gist of things, there's some money uh to encourage more training in areas that are historically

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medically underserved. Mhm. >> Um, so I I think it's worthwhile for us to to know that and follow that and you know, if we can give a message out, you know, and the example for the IRA with Caraval is ideal. They've got a grant

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for it. We've got state funds and there's additional funds coming from CMS. If you did the calculation on whether your community hospital could have a residency program two years ago, the calculus is different today.

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And I I think it's probably worthwhile for us to put that message together somehow. >> And by us, I mean the staff um and and and clarify it to the state and maybe the Indiana Rural Health

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Association could be a an asset on that. I don't think the funding's exclusively for rural. I think there's just this this trunch of money and then there's an earmark for rural in it. But again, I got it earlier this week and I didn't

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quite understand it. It had enough acronyms in it to make it appropriate for this board. That is [laughter] >> Tim, do you know if they got the teaching health center um funding or because there's a ton of more money coming from that. I I think

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there's a lot h I mean clearly with the pandemic >> when I talk to my colleagues across the nation the workforce has suffered from this pandemic >> and how we're going to rebuild the

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health care workforce in this nation is a big question and I think there's a lot of money going out there and people know that it's vital that we rebuild the nation's healthcare workers force. So, I think people put a lot of funds in there, but which bucket, I just don't

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know. I don't think there's going to be one bucket. And I think there's going to be magic in understanding that a program might qualify for three or four different buckets. Money from the state, money from CMS, and money from these other programs.

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>> Yeah. And how do the program how does how does a new program navigate this and figure out Yeah. the right. >> Yeah. >> You know, and and you have to admit if you're I I'll ask Rob to step up on this. You know, he's been through it, but it is it is difficult to understand

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if your day-to-day job is running a hospital or running a rural hospital, understanding how this funding works and whether you win or lose. And we'll talk, Rob and I will talk to our colleagues across the nation. They'll say, "Oh god, don't go into that residency program.

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It'll just suck your cash dry." And that's as far as the conversation goes, but I don't think that's the case today. And I don't don't think it'll be the case moving forward over the next couple of years. >> Yeah. >> Well, thanks for Go ahead.

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>> I was just going to say, Tim, I you know, having done this now, I will tell you I think that is exactly an area that I don't know how the board can really do that. But, you know, there's a lot of people that understand the educational

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side of GME. There are much fewer that understand the CMS, and that's because of the complex nature. And I've been at it for I don't know how many years, and I'm I'm dangerous. I know enough to be dangerous, you know. So, um, so it is a

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thing for people starting new programs and it'll be one of the first things hospitals will say is what does this look like? What's the economics of it? Yeah. >> Um, and you're right, they're changing. So, um, actually Rob may bring some value to the board, like you said,

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because he has been through it. Um, and he has a CFO background, too. So, um, >> yeah. >> Yeah. And just a note, I don't know if you all looked at this, but there's a thousand positions to be appropriated,

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but it's at 200 slots a year. So um so they will only give out 200 a year. So >> for the whole country. Yeah. >> Yeah. Yeah. >> Absolutely true Steve about understanding GME finance. I have been

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in the education side for 30 years and we dealt with you know paying the residents but it really was at the hospital level where that's understood. So yeah there's so much to it. Yeah, it's a complex. Some someone else was jumping in. Was that you, Kathy?

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>> Yeah. I'm in I'm in the boat that Dr. Becker indicated, which is enough knowledge to be dangerous. I've had conversations this last week with our consulting group about the three buckets that we look like are going to get from

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CMS. Um, one of the things to also note is that the ACGME is now a piece of the puzzle. they are uh CMS is saying that they will only look at funding programs not in that development phase but once

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you have acquired some uh approval whether it's initial approval or uh later on so programs what I see is that the state process that you guys have um where you can ramp up and develop a program prior to ACGME

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approval may be the more critical one for new program development because CMS has a lot of restrictions in each of those three areas where they are looking to fund. I want to ask um a few years ago when you were developing this

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process, Trip Bomb did an educational session for all of the hospital leaders. Um, I wonder if it might be useful to have them or some other group bring us back together with some basic information so we all understand some of

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the same principles. >> Yeah. The larger landscape. Yeah. >> You need some deep pockets, don't you? [laughter] >> Yeah. I I think that the ca the Kathy just to give some reference um you know when the board first engaged with TRIP umbbach was at the outset at the the

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outset of the development of the expansion plan um and we know just kind of even talking about the the fiscal amount with the with the economic development study that trip engagement was roughly a $270,000 engagement um at that point back in 2016

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and just to so I'm just I'm just saying that just in context of uh I I would need to discuss with the with the board with board leadership and with my leadership uh because I I don't I you know I actually agree with you and going back to what I said about statute the statute still provides that the funding

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is available for consultancy services things like that that's just that's public information uh but it would be up to the board to decide at what level if they wanted to engage in that kind of uh you know that kind of robust conversation uh >> which you know which was the board's version of its road show back in 2017 uh

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but that robust conversation and what would uh the financially what what commitment will we need to be able to to take part in that? So, >> um but I would love to touch base with you, Kathy, if you have other other ideas and thoughts and that way I can I can propose that run that through the board at at your convenience. I'm

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available just let you know. >> Yep, that's a great point, Eugene. Thank you. You uh Cliff, I see your hand raised. >> Yeah. Um and I apologize. I dropped off for a couple minutes, so I apologize if I'm saying anything that was already said. Um, you know, one of the other things in those thousand new slots

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that's being considered are the the states that have new medical schools. And so, Indiana is one of the 37 states that they point out as a priority state uh from that standpoint. So, we really are in a good position, I think, to get additional funding here if we can help

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those um sponsor institutions that are are looking to um to to get new slots. So, >> um so I think there is opportunity. The other thing, I know Beth touched on this and that was about when I dropped off was the teaching health center GME funding and that there continues to be I

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think a few bills nationally that are um active um to try and expand that fairly significantly and Indiana is a state that does not currently have any teaching health center GME funding that I'm aware of. So that that does feel again it feels like there between what

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the Indiana Rural Health Association is trying to do, what u you know looking at rural and those potential opportunities there, it it feels like there is a lot of um momentum to to be able to accomplish that. >> Yeah, thank you for sharing that, Cliff.

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That makes a lot of sense. All right. Um well, let's go ahead. Um, well, thank you, Tim, for for bringing that forward. And I just uh you know, again, want to thank Tim for his lasting imprint on this board and everything he's done uh to help uh lead us up to

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this point. And uh you know, we we will always have you in our hearts with this work and how you started us off with it. So, thanks again, Tim. And uh all right, I'm going to pivot to public testimony and see if there's anything from the public that we anyone

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wants to share. Okay. All right. Well, hearing none, then um I want to thank everyone for their participation in today's meeting and we will see you at our next meeting that's in April sometime. I don't Eugene, I don't have the date in front of me. Yeah. Can you help me? Uh yeah,

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it's April the 29th and uh Tim, I changed my background to match yours just to say thank you very [laughter] much, sir. You will be missed immensely. Um and I mean that not just from the what you've done for the board, but I as a personal matter. Um, thank you for taking uh somebody who was a neoight at

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anything related to GME and uh helping me not only not speak over myself and get myself fired and say anything crazy, but uh to help me just in my small role and the work that this board and these stakeholders around the state have engaged in. It's been an honor and a pleasure, sir. And uh you will be

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missed, but I know you won't be far away. So, uh, please continue to work through me as I can and and work with this board as as as necessary. But, uh, thank you. And again, my my wife always says it's not good. It's not goodbye. It's see you later. So,

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>> well, it it is it is honestly been been an honor to be part of this. I I look back on my career and this is one of the highlights of being able to work with this team um and and make the progress that we have. I mean, I I truly I said it earlier in the meeting. I I'm just

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amazed at what we've been able to do um and and the impact we've had and and you think about the number of physicians that are continuing their education in places that never would have been done before

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and and the caliber of physician that'll be produced for that and the number of patients that will be impacted by that and the number of of hospitals that would never have gotten into education um and and seen it as their

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responsibility. It's just an outstanding work by this team and and foresight for the people that that put together the idea for the graduate medical education board. It's been an honor to be part of it and work with all of you guys. So, I wish you all

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the success in the world. If I can be of any assistance, you know, I'm here for you. So, um and Dr. Hearn is did a great job today. Honestly, I think it's one of the best chaired meetings we've had in a long time. [laughter] And um no offense

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to Beth who chaired chaired one just recently as well. Um but but but no, you guys you guys are doing the right work for the right reasons and it's just an honor to be part of that. So thank you all. >> All right. Well, thank you, Tim. We will and I will I will reach out I certainly

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will reach out to you in my new capacity when needed and uh we appreciate the connection always and everything you've done. All right. Well, uh with that said, we will we were finishing just a few minutes shy of our one o'clock deadline. So, I'm considering that this

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first meeting is chairwoman a success. Um I'll take a motion for us to adjourn the meeting. >> I move that we adjourn. [laughter] Thank you, Dr. Ward. >> And a second from Dr. Putnham. All right. Uh All right. All in favor

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>> then. Let's sign off. All right. Thank you. All right. Thank you all. We'll see you guys in a few months and reach out in between if you need anything to me or Eugene and we'd be happy to help.