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GRMC trustees make cost-cutting decisions

An emergency meeting of the Gila Regional Medical Center Board of Trustees was held Tuesday afternoon, April 30, to continue a discussion on the financial situation, due to the Centers for Medicare and Medicaid having frozen funds to sole community providers in New Mexico.

It was learned that the former chairman, Jim Leidich, had given his resignation following a Friday afternoon meeting on the issue. Charles Kelly, vice chairman, is temporarily assuming the duties of chairman.

Kelly read the mission, vision and values of GRMC.

Trustee Robert Morales Sr., said the group needed to take the mission, vision and values to heart.


During public input, Christine De Bolt, a department director, said: "We all come together to do out best for everyone. We're working hard on cost containment. Our caregivers are scared for their jobs. We're hearing no layoffs, but there will be attrition. Caregivers are frightened, and we need clear communication. Please move slowly to support all caregivers."

"This is my home and my hospital," Tami Bates, RN, said. "I'm mad because there has been a recent letting down of the community, caregivers and patients. I implore you to take a look at what's going on. Do the hard thing. Make decisions to keep this hospital. The spiral has been going on for four years."

"We're all going to do the best to do what you say," Kelly said. "I'm eternally hopeful."

The next item of business on the agenda was consideration of a write off of 50 percent of the Sole Community Provider receivable beginning with the April financial statements.

Elizabeth Allred, GRMC assistant vice president of finance and controller, handed out the financial statements.

Several board and staff members and a county commissioner were on a conference call earlier that day with the state Human Services Department in a follow up call to one held the Thursday prior with the Hospital Association.

"The latest information is that the New Mexico Association of Counties had a conference call with all the counties and Kelly and Pam Archibald (trustee)," Chief Financial Officer Craig Stewart said.

Trustee Dr. Roberto Carreón protested that he had not been invited to the call. "We couldn't go if we didn't know about it."

Trustee Dr. Darrick Nelson said it was primarily the officers who attended.

"We need better communication among board members," Morales said. "We need to be advised of what's going on before it happens. Have transparency as a courtesy."

Stewart noted that if more than three had attended, it would have had to be noticed as a meeting. "Brian (Bentley, GRMC chief executive officer) and I didn't go."

Kelly had earlier handed out thumb drives, which held the contents of the call, he said.

Stewart gave a summary of what was going on. "This morning, we got more current information. The HSD Deputy Secretary said we would get 75 percent of what we were owed. So our recommendation on the write off is that we write off 25 percent at this point. It would be a total write off of $3.375 million by year end. If we get the 75 percent, it will be more than $10 million. If we do not receive the 75 percent by the end of July, we will have to write off the whole $10 million, because the auditors won't let us carry over a receivable past the end of the fiscal year."

He also pointed out that gross revenues for the hospital are off more than $1 million for the year. "If we lose everything, which I don't think will happen, it would be a $13.5 million loss, but if we get the 75 percent, it would be a $3.5 million loss for the year."

Carreón pointed out that even in the best case, that was still a $3.5 million loss.

"That's why we have teams working to cut costs," Stewart said. "In 2014, I think we will receive only 25 percent, maybe 50 percent, best case."

Once Centennial Care, the New Mexico managed health plan, goes into effect Jan. 1, 2014, it is expected the hospital will receive 50 percent of what it has been receiving.

"If every hospital gets a proportional share," Bentley said, "with Centennial Care, our numbers would be 63 percent. We think it will not be proportional. We get more now, so we may get only 25 percent to 50 percent. We're talking about two pots of money, with checks to the hospitals and the rest to Medicaid providers. It becomes murky, because there are still a fair amount of mechanics on how the state wants to make it work."

"So we're being penalized for doing a good job?" Morales asked.

"About right," Bentley concurred.

"They have made statements that they may give more to the smaller hospitals to assure their survival," he continued. "There is no formula, no details. I don't think they know how they can do it. It has to be approved by the Centers for Medicare and Medicaid and the Saluds. We have to have their cooperation. What happens after 2014, we don't know. It may be a one-time payment or every year."

"We have more questions than answers," Stewart said.

A motion was made to write off 25 percent of the sole community provider fund. Trustees approved the write off.

Discussion continued on notification of board members. Nelson suggested the members be notified and the first three to reply could attend a call to avoid a quorum.

Allred said call-in numbers could be used from one's office, and the person could be muted, so unable to participate, but could hear what was being said.

Trustee Jeremiah Garcia asked if the hospital was going to challenge for "our match money."

Allred said new information during the call that day was that "we should put in our match. If it is unused, it will be returned, we heard today. HSD is willing to return our match, but not the federal match. We should get back what we put in."

Bentley said: "But it sounds like we won't get more than 75 percent back."

"We will challenge on putting in our fourth quarter match," Stewart said.

Allred explained that the county dedicated a one-quarter gross receipts tax and had added a one-sixteenth to the sole community provider fund.

"We always put in the whole amount," Stewart said.

"Some counties don't have their full amount of gross receipts tax any more," Allred said. "We work well with the county, and the county is good to us."

Carreón said the Leidich having resigned was a great loss to the board.

Bentley said Leidich had sent his resignation Friday. "It's the county's choice to fill the position. Leidich's term is up the end of June. There will be two positions open in June."

County Chairman Brett Kasten said the terms are staggered. "Because of the short time frame, we will appoint a replacement in June. You will be a six-person board for two months."

Bentley said the vice chairman will be in acting capacity for the chairmanship.  "The nominating committee will put forth nominations for the chair and vice chair."

"I can do it now or wait until June," Kelly said.

The board went into executive session, and after a lengthy discussion, came out of the session with ideas on how to help the hospital.

Nelson presented the ideas, which include the termination of the strategic facility expansion and repayment of the already encumbered debt; a one-year postponement of an information technology upgrade; cutting of positions, through attrition and restructuring of hours, with no layoffs; the termination of home health; and having the restructuring teams continue to find ways to save $1.5 million. The board approved them.

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