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Category: Front Page News Front Page News
Published: 23 June 2017 23 June 2017

By Mary Alice Murphy

At the beginning of the Gila Regional Board of Trustees regular monthly meeting on Friday, June 23, 2017, three caregivers were recognized for their multiple years of service to the hospital.

Linda Bluestone, who accepted a plaque of appreciation in person, has served Gila Regional for 30 years, and is now providing service in the Recovery Room.

Jennifer O'Dell, not present, has served the hospital for 15 years, and is now serving in the Recovery Room.

Holley Hudgins, not present, has also provided service to the hospital for 15 years, formerly in the Marketing Department and now as the director of cardiology and the cancer center.

 

Board Chairman Jeremiah Garcia welcomed new Chief Executive Officer Taffy Arias to her first board meeting.

"I will be focusing on patient and staff safety," Arias said. "We want every patient to have safe, quality care through every touchstone of the organization. I also will be looking at finances, finding efficiencies at every point all the time. We will be tightening up the organization and it will be one of great communication. I am a servant of the community and of this organization. I am delighted to see you start every meeting with the mission, vision and values. In addition, we will start every meeting with a safety minute of someone recognized in the organization or something from somewhere else."

She told a story of a physician who, instead of grabbing one of two look-alike medications, identified the one he wanted, and the dosage. "Because the caregiver stopped to check, he avoided a bad outcome. We have to consistently make sure we use safety procedures. The processes are in place for a reason."

Trustee Tony Trujillo welcomed Arias. He again described the extensive process used to hire her, including a group of 15 from the hospital and the community who used a multi-pronged process to narrow it down to two candidates. "We had more than 120 applications and Taffy rose to the top," Trujillo said.

Garcia also noted the meeting was the last one for Trustee Magdaleno Manzanares, who said: "Thank God," and then talked about how he found working with the other members. "We had robust conversations and they all have a dedication to this organization. We kept on working together, even when we agreed to disagree when necessary. It's not always healthy to agree on everything. I do appreciate the work all of you have done with this organization. I came to know some of the staff and appreciate their hard work." He also thanked the loyal members of the press, "who hold my feet to the fire. The free flow of ideas is essential. It has been a wonderful ride. I committed to one term and am fulfilling it. My engagement with HMS (Hidalgo Medical Services) is still there and with the Aldo Leopold Foundation and other boards, state and national."

Garcia also recognized the Grant County Commission Chairman Brett Kasten, who was in attendance.

Kasten said: "Our hospital is one of two hospitals in the state still owned by its county. Gila Regional is substantially larger than the other one." He later told the Beat, the other hospital is the Guadalupe County hospital, which is a critical access hospital, with five beds for observations and 10 beds for inpatient service.

"Are we missing something?" Kasten said. "The other hospitals in the state have moved off the county-owned model. I've talked to a friend on the east side of the state, and we talked about taxing a hospital board district. We want to know how counties interact with their hospitals." He also told the Beat that he had asked the county manager to develop a study on how to run a hospital from a county standpoint. "The RFP deadline is Tuesday for consultants to reply to help us. I keep thinking: 'Why are we the only ones left?'"

Trujillo said Kasten's comments at the special meeting with Gila Regional on the Cancer Center "starting vicious rumors that the country was trying again to sell the hospital. You vividly remember last time." Kasten nodded yes, because at that time, he was serving as a hospital board trustee.

"I don't anticipate a sale," Kasten said, "but we didn't want to limit the scope of their (the consultant's) job."

"I encourage you to include the trustees if we have any role to play or if we can provide input," Trujillo said.

Kasten said the hospital "has to have a role. I encourage you to pass a resolution to work with whatever consultant is chosen."

Trustee Dr. Victor Nwachuku said he knows the CEO talks to the commissioners. "We want interaction with the Commission where we are constantly informing the commissioners of what we're doing."

"I would suggest Mrs. Arias get with (County Manager) Mrs. (Charlene) Webb to determine some way for us to work together," Kasten said. "There might be a lot of legal wrangling we would have to do. My new board is rambunctious. I'm shocked at how well we get along personality-wise. We won't always vote together and we debate in meetings. I'm very happy with the five-person Commission."

Martha Stuart from the audience commended Kasten on getting the RFP out.

"I'm working on the committee," Kasten said. "I know each of the board members wants to have the best hospital for the community and region. Right now health care is a moving target."

During public input, two people spoke. The first was Ron Henry, who described himself as a cancer patient "standing here in remission because of the world class care I received here at the Gila Regional Cancer Center. Imagine reading a news release saying the hospital would soon have 'world-class cancer care.' It is misleading that this was only a recommendation. We're told the hospital is in negotiations. We're told it's not about dollars. We're told the negotiations with the New Mexico Cancer Center didn't agree on market value. That sounds like dollars to me. We're told the last day of New Mexico Oncology is July 16. You told us there would be a transition plan. We've seen no viable transition plan. Does anyone know the anxiety cancer patients are feeling? Why were patients left out of the process? No one talked to us. The trustees came to a meeting and said: 'We're listening to you,' but their minds were already made up. I've very involved with the oncologists and the caregivers. These are the ones who built the Cancer Center and made it possible over the past 22 years."

"If you vote in favor of this contract, you will be throwing all of us under the bus," Henry said. "Our Cancer Center runs as smooth as glass and makes a profit. Please vote against this contract. How will we be informed of the Cancer Center update with it being at the end of the agenda after your executive session?"

[Editor's Note: After the meeting, Garcia told the Beat that negotiations were continuing in a positive manner.]

Nancy Thomas thanked Ron Henry and welcomed Mrs. Arias. "I've never been a public speaker until now. I feel very strongly about this Cancer Center. My husband died here in October. We spent three months for him to be treated in Tucson, but the trips alone took their toll. When his doctor learned that Karen DeGenevieve was here at our Cancer Center, he said my husband would have the best of care. We were welcomed here from the front door. Now I'm speaking about my sister, who was diagnosed with cancer in February. Dr. Nwachuku is her doctor. He sent her to Albuquerque for her surgery. The surgeon told us if the new provider of cancer services here is the University of New Mexico, he would not recommend my sister stay here for treatment, but rather she should go to Las Cruces or El Paso."

She then talked about how at the last meeting, cancer patients were crammed into the small room "like cattle. Eighty plus years ago, I was taught that if a lady came into the room, a man would give her a seat. One woman here had just come from the Cancer Center. She leaned up against the wall, but no man gave her a seat. It really irritated me. When I feel passionately about something like this, I will rant and come across strongly. I feel like Jeremiah should recuse himself, because of his wife's connection to the Cancer Center."

Under hospital reports and updates, Frances Day of the Gila Regional Auxiliary said the auxilians are concerned, too, is for the safety of the patients. "We work as volunteers for the hospital, but we also raise money. We have made $27,000 to $28,000 for the hospital this month. I was just re-elected president of the Auxiliary."

Arias said the CEO report in the trustees' packets was done by the interim CEO Alfredo Ontiveros. "But I can say that the Meditech 6 upgrade was implemented June 1. We're been told it was one of the smoothest transitions ever, but we're still working on issues, especially ones that address safety."

Trujillo said he appreciates Ken Stone and thanked him for the job he has done with Meditech 6, since he took it over in January. "I was in for a sleep study right after the go live date, and it took 45 minutes just to get me registered. It's never easy with such changes, but we will get it done."

Arias said she wanted to recognize the service of Mr. Ontiveros. "It's not easy being interim, because sometimes, they just let things slide by until the permanent CEO comes on board. He didn't let things slide. He took the job seriously."

Assistant Vice President of Administration Liana Ryan commented on the service line initiatives in her report. "We have an update on the ENT Dr. Patricia Murphy. She is having challenges with getting paperwork done and getting her licensure completed, so we are still actively recruiting for an ENT. We are also actively recruiting for urology, pediatrics and family practice. We also no longer have weekend psychiatric coverage and need to find someone. We currently have a $90,000 contract for EKG readings. We brought it in-house for about $45,000 to $50,000. So that is an immediate savings. We want to continue to refine the model. We have had a few pediatricians come visit. We are hopeful they will come to stay."

Chief of Staff Dr. Gregory Koury said Dr. Liu would definitely be coming and "Dr. Gomez sounds solid, too."

Chief Nursing Officer Peggy White said her department is till working out the bugs of Meditech. "Then we will be reprioritizing our projects and working with Mrs. Arias."

In answer to a question from Trujillo, White said: "We are down to three traveling nurses and they will leave by mid-July. They are training their replacements. We will have accomplished our goal of zero travelers."

Chief of Clinical Services Ray Goellner said his department updated its scheduling report.

Garcia asked if the department had streamlined the process to make sure physicians' order were correct.

"We are making progress," Goellner said.

Koury said everything was working fine.

Goellner said the throughput of scheduling was better and volumes were slightly up.

Interim Chief Financial Office JoBeth Vance said, in spite of May having good volumes, with 174 admissions, and revenue being good, "a problem came with our contractuals. We couldn't get everything out in April, so they went into May. It's the issue of contract labor. We had to catch up invoices from April that came in May. We had a loss of $830,000. It look bad, but it's not really. It's just May. Revenues were good. We are on the right track. It was the timing of what hit in one month. It will also be tricky for June because of continuing costs of Meditech. We held expenses down, but the contract timing hit. We collected $5.6 million, so everything looks good except for the bottom line. The one-time snapshot of May doesn't look good."

"How does this happen?" Trujillo asked, "How do you get behind on invoices?"

"We need to improve the process," Vance said. "Jacobus (consultants) are working on accounts receivable, not this part of the process. Part of the problem is when we get invoices and we have a question. We have to hold it until we have the answer. It is the process and we're fixing it."

Garcia said he asked Vance about denials and she said the goal is zero.

"It was not really a Meditech problem," Vance said. "We have people looking at denials. We have processes to keep things out of the invoice before it is issued. We expect the number of denials to keep coming down. We have a lot to get straightened out before the end of the fiscal year on June 30."

Nwachuku said the hospital has one person looking at denials. "Do we need another person? We will talk about it in the Financial Committee. We need processes in place working on denials. My opinion is that before, we were not going after denials and trying to get paid."

Trustee Mike Morones said historically, invoices were manual processes. "Now with Meditech 6, we should be able to squeeze denials better."

Vance said her goal by October is to have more items automated.

Nwachuku said Jacobus was trying to make sure that every bill is clean before it goes out so the chance of denial is less. He said problems could arise if the diagnosis is not clear, if the coding is not correct. "So many things insurance companies can deny for. Hopefully Jacobus can look at the invoices so the bill is clean."

Koury said the upgrade to Meditech should help, because it queries the physician before the bill is issued. "We can put in the code in real time. Utilization review looks at admissions as they occur. For instance, you have 10 bills. Insurance can refuse four of them because the physician didn't sign it or put the date on it. That will stop with Meditech."

Nwachuku said insurance doesn't want to pay or will not pay, so the bill has to go back and forth.

"It's a game," Koury concurred. "We had a case of pre-authorization from the insurance company, but when we sent the claim, they denied the claim."

Arias said she and Vance are looking at refining the financial processes. "She has found many that are antiquated. Every expenditure must be approved by one of us before it goes forward."

Koury in his report said he had appointed Dr. Donna Bornmann to the Credentialing Committee and she was pleased.

Nwachuku asked that part of the bylaws section 3.06 be tabled for further clarification.

Arias thanked Dr. Koury "for being so cooperative in smoothing out issues."

"The medical staff is doing well with Meditech," Koury said. "I will attribute that to Ken Stone and his staff. Antonio Medina has been key. They are fixing problems as they come up. I like Meditech, but everyone is on a learning curve."

Trustee Joel Schram, who attended by phone, was asked by Garcia if he had any questions or comment. "Just the contractuals still continue to be an issue," Schram said.

In board committee reports, Garcia said the Executive Committee met and set the agenda for this meeting.

Trujillo said the Quality and Improvement Committee continues to address issues. Arias said: "Quality is paramount. We are entering the phase of 'No excuses.'"

Manzanares said the Plant and Facility Committee was where Arias introduced her philosophy of safety. "She was emphatic that one or two inuries are too many. She wants to improve our already good score."

Morones concurred that every injury is too many.

Nwachuku gave the Finance Committee report and asked for individual approvals for Dr. Tsering Sherpa to be named to the Pharmacy and Therapeutics Committee; for Dr. Ronald Dalton to be approved for the Utilization Review Committee; Dalton, Dr. David Friedman, and Dr. Mark Donnell to be named to the Ongoing professional practice evaluation committee (OPPE-Peer review); Dalton to be approved for liability insurance as a hospital employee; and Drs. John Stanley, Donna Bornmann, Norman Ratliff and Dalton to be EKG readers."

Trujillo said the Human Resources Committee still has issues with increases in contract costs. "We've spent time today talking about that. Full-time employees are down. We spent time discussing the turnover rate in housekeeping."

Arias said she wants to make sure "we have the right people in the right jobs. We want to make sure we are living up to our value of accountability."

After the executive session, Garcia was re-elected as chairman, Nwachuku will serve as vice-chairman and Morones as secretary-treasurer.