Evaluation of Payment Transformation in Hawai'i Based on Physician Perspective.

The Hawai'i Medical Service Association's (HMSA) Population-based Payments for Primary Care (3PC) system has been in effect since 2016. There is limited literature regarding physician opinions on this payment transformation policy change. The objective of this study was to evaluate physician responses to a survey regarding the 3PC payment transformation system and identify methods to support physicians in Hawai'i. An online survey was sent to 2478 Hawai'i physicians and yielded 250 responses. A total of 77% respondents reported being unhappy with payment transformation, while 12.9% and 10.1% reported being indifferent and happy, respectively. Of responding physicians, 60.6% reported a decrease in overall income, whereas 24.9% and 14.5% reported no change or an overall increase, respectively. Open-ended responses were categorized into theme clusters: negative impact on primary care, increased administrative burdens, decreased quality of patient care, decreased physician reimbursement, preference to treat healthier patients, harm to private practice, harm to newer practices, ignored physician sentiments, and worsened physician shortage in Hawai'i. Respondents, especially those working in primary care, are dissatisfied with payment transformation. Future research is needed to compare the thematic clusters identified in the current study with relevant literature.

Hawai'i Registered Dietitian Nutritionist 2019-2020 Workforce Assessment.

There is scant literature available on the Registered Dietitian Nutritionist (RDN) workforce in the United States, but a review of healthcare systems suggests that implementation of RDNs in primary care settings may improve access to care, patient satisfaction, and quality of care. The Area Health Education Center (AHEC), in partnership with the Hawai'i Academy of Nutrition and Dietetics (HAND), investigated 395 providers to evaluate the status of Hawai'i's RDN workforce. The research team utilized all available provider information and direct calling methodology to collect data from August 2019 to February 2020. Microsoft Excel software allowed for data analysis and ArcGIS mapping software was used to visualize provider totals and Full-Time Equivalencies (FTEs) across the state. This study identifies trends in workforce demographics and provider supply. Researchers found 100 RDNs providing direct patient care for a total of 82.4 FTEs. Women account for 94% of survey respondents, and the average age of providers was 48. RDNs who self-identify as being Asian American (41%) or White (47%) were the largest ethnic groups providing direct patient care. Seventy percent of the RDN workforce was located on O'ahu, while RDN FTEs are concentrated in mainly 5 zip codes, 1 on each of O'ahu, Kaua'i, and Maui and 2 on Hawai'i Island. Provider demand trends, increased training and retention efforts, and integration of nutritional services in healthcare teams should be further investigated.

Hawai'i Physician Workforce Assessment 2020.

The Hawai'i Physician Workforce project, launched in 2010, investigates state physician workforce trends. Over the past decade, workforce demands have continued to climb as the state struggles to maintain the physician supply. This article describes the current state of the physician workforce, the physician age landscape, past trends, as well as initial changes to the physician supply with the COVID-19 pandemic. Data on practice location, full time equivalency of time spent providing patient care in Hawai'i, and specialty of non-military physicians were clarified and informed via survey, internet search, and direct calling methodologies. A proprietary microsimulation modeling methodology was used to assess physician demand. The current estimated physician shortage is between 710 and 1,008 full time equivalents, the largest shortage in a decade. The unmet demand for numbers of additional physicians is greatest on the largely urban island of O'ahu, however O'ahu's neighboring islands have the largest shortages by percentage of demand. In fact, Hawai'i island has over a 50% shortage of physicians for the first time since the supply has been calculated starting in 2010. Primary care has the greatest demand with a statewide shortage of 412 full time equivalents. The average age of physicians in Hawai'i is 54 compared to the national average of 52. The authors estimate that more than 52% of providers are utilizing telehealth and that 10% of providers have retired or closed their practices since the start of the COVID-19 pandemic. Hawai'i is now in an urgent state of need for recruitment and retention of physicians.

Utilizing CRISPR-Cas in Tropical Crop Improvement: A Decision Process for Fitting Genome Engineering to Your Species.

Adopting modern gene-editing technologies for trait improvement in agriculture requires important workflow developments, yet these developments are not often discussed. Using tropical crop systems as a case study, we describe a workflow broken down into discrete processes with specific steps and decision points that allow for the practical application of the CRISPR-Cas gene editing platform in a crop of interest. While we present the steps of developing genome-edited plants as sequential, in practice parts can be done in parallel, which are discussed in this perspective. The main processes include 1) understanding the genetic basis of the trait along with having the crop's genome sequence, 2) testing and optimization of the editing reagents, development of efficient 3) tissue culture and 4) transformation methods, and 5) screening methods to identify edited events with commercial potential. Our goal in this perspective is to help any lab that wishes to implement this powerful, easy-to-use tool in their pipeline, thus aiming to democratize the technology.