Editor's Note: This is the final article in a two-part series on the Gila Regional Medical Center Board of Trustees regular meeting held Friday, May 31. The article continues the senior management reports.

Wanda True, representing Pam Fulks, chief nursing and chief operations officer, said her department had changed emergency medical service shifts from 24 hours to 12 hours. "We also changed nurses' shifts. Most are 12-hour shifts. We have no more than four days in a row without a two-day break. We will have five positions for newly graduated nurses, who were already certified nurse assistants here. They will remain, but at a higher level."

Chief Information Officer David Furnas said information technology is pursuing working with eClinical Works for an electronic medical records solution. "We are waiting for a contract. We have no completed contracts with Information System. I have elected to take a 15 percent cut immediately."

True said that Fulks had taken a 20 percent cut, and "I will take a 15 percent cut with days off."

The clinical administrative vice president said the pharmacy revenues had increased by half a million dollars over the past month, due to cancer medications. Full-time employees had dropped further, with two part-time employees having left. "We are as low as we can go in cardiac and are not filling positions. We will be the lab provider for Fort Bayard. We are at rock bottom, and I don't recommend further cuts. In four years, we have cut the pharmacy by 12 percent. I'm not sure how much revenue we will receive from Fort Bayard. The Fort Bayard pharmacist is due to retire next year."

Bentley explained Fort Bayard had been phasing down its pharmacy. "We can provide lab services 24/7, which Silver Health Care could not, because its lab is closed on weekends. Dr. (James) Skee (of Silver Health Care) and I have been talking to mutual benefit. We have also talked to Hidalgo Medical Services. They want to have lab results electronically transferred. We are doing at pilot program at Dr. (Twana) Sparks' clinic, which is working, so we may increase it to HMS."

To a question about serving the Silver Care nursing home, Bentley said the hospital was formerly stiffed half a million, but "we are working with a new group there."

Dr. Victor Nwachuku, chief of staff, said the group had made changes to the rules and regulations. Dr. Roberto Carréon said the medical staff did not really know about the financial changes needed. "Quarterly meetings are not enough. It was my job to let them know. I'm willing to go to the Medical Executive Committee and give a report. Communication was not there."

Chief Financial Officer Craig Stewart said the financial report was in the packet and a considerable amount of time had been spent by the Financial Committee going over numbers. Acting Board Chairman Charles Kelly said the gist of it was that things were starting to look hopeful.

The hospital can expect to get about $3.7 million of sole community provider funding, with about $6.4 million that was promised last year having been cut retroactively back to July 2012. "Much of the $6.4 million had already been spent. Other hospitals across the state have the same problem.  Basically, the state and Centers for Medicare and Medicaid are taking away about $8 million we thought we were going to get through the end of the year."

Tom McCall, Quorum Health Resources vice president, discussed what will happen after the contract with the group runs out at the end of July. "Our purchasing comes through a health purchasing organization that negotiates with preferred vendors." He said $5.5 million was spent with preferred MCare for supplies and orthopedic implants; $2.7 million was spent on capital items, with a total of $13.7 million covered by discount programs. "We belong to purchasing organizations. No one pays retail. It used to be sliding feeds, where the smaller the hospital the smaller the cuts. Now smaller hospitals get the same rates as large urban hospitals. You have saved about $94,000, not counting capital expenditures."

He said GRMC spent a lot on supplies and equipment, which is second to salaries for most hospitals.

Kelly asked if the hospital purchased a "widget, would it be the same cost as say, M.D. Anderson?"  McCall said it would be the same cost at GRMC as at M.D. Anderson.

"QHR gets good rates, although the Veterans Administration probably gets the best deals," McCall said. "As of the end of July, our management assistance will go away, but you will keep the same purchasing deals. There is no comfort, I know, but your situation is being replicated across the country. QHR wants to educate people. With the Affordable Care Act, hospitals will have to change and can't be everything for everyone. It's more difficult in an area like here, because you are so far away from many services. In New Mexico, the circumstances are exacerbated by the sole community provider situation. Taos saw the same thing last year, with a different problem. Cuts are coming with the ACA."

Carréon asked if the QHR educational resources would go away with the end of the contract.

"We will have access to purchasing through the Healthtrust Purchasing Group," Bentley said. "We may have to pay a fee for service for training."

Addressing the financial statement, Stewart said the almost $10 million of capital remaining on a newly acquired bond had been paid back to the Bank of Nevada to save GRMC the monthly payments. "The county asked for the money so it could pay it off early to facilitate their getting a Department of Finance and Administration loan to replace the fairground building."

Stewart said part of the complexity of the budget was the cuts having to be made and how to institute rate increases. "We have assets and we have liabilities, which are offsetting each other." He explained that debt with the Bank of Albuquerque has already basically been paid off, with the funding having been put in an escrow account to pay it off monthly through August 2014. The money has been taken out of hospital funds and is no longer accessible to the hospital. "At that point, we will have no debt."

Also of financial interest was an amendment to the First Born agreement. Bentley explained the program was created by GRMC staff, when Victoria Johnson was part of the staff. The program was based on her research and thesis. "My predecessor gave full rights to Johnson. That was against the law. She has agreed to give us an eternal license for a fee. She has replicated the program successfully throughout the state. At the same time we've been able to use it here at GRMC." The amendment was approved.

A property lease with Fowler Development for $40,000 yearly includes the remodeling costs for the cardiology space. The board members approved the lease.

Right before the executive session, Stewart reported that full-time employees without grants had decreased, and overtime was held at 2.2 percent. "We've been doing a lot to cut costs."

After coming back into open session, board members approved the appointments and reappointments of several medical staff. There was no old business or new business, and the board adjourned.

Live from Silver City

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