The one item of discussion that took up most of the long Grant County Commission meeting this morning, Thursday, May 9, 2013, was the commissioners hearing opinions before deciding to take a no-confidence vote against the Gila Regional Medical Center senior management.

Commission Chairman Brett Kasten asked those who opposed the no-confidence vote to speak first.

Craig Stewart, GRMC chief financial officer, stepped to the podium. He said he has 30 years in hospital administration.

"The financial reality is that we had to take action because of declining patient volumes and reductions in payments," Stewart said.

He said the hospital had absorbed the 30 percent Medicare payment cuts over the past two years, equaling $2.5 million. Sequestration gave GRMC a further $500,000 annual hit, and the Affordable Care Act was slated to hit the hospital with an addition $1.5 million loss.

"In late December 2012, the sole community provider fund of more than $9 million receivable was frozen," Stewart explained. "Even if we get 75 percent of what we are owed, it will still be a $3.5 million hit. In 2014, we have been told we are likely to receive 50 percent or less of what we had been receiving."

When the fund was frozen, the hospital had 152 days of cash, according to Stewart. "But we have lost $10 million in 90 days. If we continue this way, we will be bankrupt. We have to change the way we do business. You can shoot the messenger, but the problem will not go away.

Dave Furnas, chief technology officer, said the hospital has been cutting costs for several months. "In the past three months, our restructuring teams have figured out how to save us $5 million." Savings have come by reducing the capital budget and postponing the planned Meditech upgrade, deferring $1.8 million and $500,000 for training. "We have suspended the expansion of the hospital making us debt free. Cutting staff was the last consideration." As an accomplishment of the hospital Furnas said in cancer care, GRMC is a regional and national leader in technological advances. "I believe the cost savings and actions by the board were reasonable and appropriate, based on the long-term outlook."

Pam Fulks, chief nursing officer and chief operations officers, said she had taken over two former positions in clinical nursing and operations.

"When we heard the financial picture, not to take action was not a consideration," Fulks said. "Additional areas we have addressed include forming 14 teams in January to took at everything from contracts to services to determine where to cut, while maintaining the quality of care. We renegotiated health insurance for a $460,000 saving. A decision not to fill vacancies, if we could do without them, would save us $840,000 a year. Renegotiating the lease on the MRI machine was a $102,000 savings. Caregivers were suggesting savings, including too many printers in an office
and no food at meetings. Looking at costly services, we were trying to break even. We are looking to expand revenues, not just make cuts. Among new services are cardiology, wound care and stroke medicine, through telemedicine. Unfortunately, we had to reduce caregiver hours. We hoped to save $127 million through attrition. We decided to close Home Care in Luna County and are looking at the Home Helper program in Grant County. We have cut the hours for 10 percent of the employees, but you need to look at the 90 percent we are keeping to allow us to continue our work to maintain quality care."

Brian Bentley, who said he has been in Grant County five-and-a-half years, out of his 27 years as a chief executive officer. "You've heard the problem and the solutions. We are trying to stay ahead of the reimbursement cuts that are happening across the country. The Centers for Medicare and Medicaid just released regulations for more cuts in reimbursement. It will take continued restructuring.  In the year 2014, we can be smaller, and we can still continue to offer quality care. We may be suffering lower volumes. Focusing solely on paychecks means you are not focusing on the savings and the maintaining of quality health care."

Dr. Matt Williams, anesthesiologist, gave his perspective over the four years he was in Doña Ana County. "I have vivid memories.  The federal government is the biggest healthcare payer and they're broke.  Personally I think a continuing conversation would be better. Be involved in layered input into the process, instead of a single no-confidence vote."

Wanda True, vice president who oversees nursing and emergency medical services, said: "Our current leadership has focused upon aligned service and quality care. They have achieved it in the face of problems. They are engaged and visionary leaders. I ask the commissioners to engage with them and not go forward with the vote."

A man, whose name the Beat did not catch, said he has worked 37 years with multiple leaders. "Leaders have to consider offering quality service, while maintaining a fiscally sound facility. We have strong, competent leaders who demonstrate the commitment even though difficult decisions have been made. Work with us rather than saying they are wrong."

Marie Stailey, 22 years in the financial office, said her office processes claims and receipts. "2013 was always going to be a pivotal year as we prepare for the implementation of the Affordable Care Act. New Mexico is revamping its Centennial Care and insurance companies will contract with it. Centennial Care is not finalized. The Medicaid population will increase, because the Affordable Care Act will require every American to be enrolled. New Mexico will have a health exchange. Insurance companies are proposing reimbursement rates similar to Medicare and Medicaid. Rural hospitals will be significantly impacted. Reimbursements will be reduced. Insurance companies are already doing everything they can not to pay claims. Payments are being capped. In these uncertain times, it is critical we have strong leaders."

Another person said the cuts began with the fiscal cliff negotiations. "We've done everything we could do. If there is new leadership, there will be further cuts."

Chris Jepson of the First Born program said when she heard Bentley speak at the hospital town hall on Wednesday, "I felt he was honest. Yes, it's a painful cut from 40 to 20 hours a week, and it's a scary situation. I would ask you to stick with this administration leading us through this difficult situation. It's not wise to ditch the leadership and bring on chaos. I worry programs will be worse hit, if we try to protect jobs above all else."

Dr. Mark Donnell, anesthesiologist, said he came to Silver City 20 years ago because of the university and the excellent Gila Regional Medical Center. "I was very impressed. I have stayed at the hospital because it has maintained that level of quality. I am not an employee of the hospital. I am an independent practitioner. I know the difference between bad and good administration. John Rossfeld will live in infamy. He was incompetent. I believe you are never more stable than when you have more qualified leadership. Hidalgo Medical Services has also lost its sole community provider funds."

"We are not looking at bad administrators; we are looking at a loss of reimbursement," Donnell said. "Replacing them may worsen the situation. It's not mismanagement. These are all changes thrust upon us. I ask you to come work with us. I'm afraid that what is happening is you are getting complaints from constituents, which you rightly should deal with. I think the leadership is taking responsibility to address a difficult situation."

Kasten next asked for those who wanted the no confidence vote to give their opinions. These comments will be covered in a subsequent article.