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GRMC board recognizes long-time employees and hears good news on finances

The Gila Regional Medical Center Board of Trustees at its regular monthly meeting recognized three employees for their years of service to the hospital—Barbara Youngs for 30 years at the hospital; Sara Montoya for 25 years; and Tami Bates for 15 years.

Chief Financial Officer Craig Stewart gave the best news of the meeting: "The good news is the hospital is starting to receive Salud payments. "We received $1.1 million for sole community provider funding from Molina Salud, and another $1.193 million from Lovelace Salud. We had to sign an agreement with Presbyterian, and we expect to receive $2.2 million by Tuesday, about $4.5 million all together. This gives us 109 workdays of cash, the first time we have gone above 106 since November. It is likely to go up again in July. We have to send $2.4 million to the state, which will send back $958,000. We hope to be a lot closer to 120 days. We were down as low as 96 days of cash."

He said the bond issue for construction, which had been canceled, was paid off in May, with all bond accounts being zeroed out. "For the fiscal year-end, we will have no bond debt. There is still bond escrow sitting in Albuquerque, and each month the bond holder pulls the interest money, but it's no longer in our hands. We have no long-term debt. Not many hospitals across the country can say that. Most are 40 percent to 60 percent in debt."

During public input, Trish Heck, diabetes educator, said she was present as a representative of hospital employees and the elderly of the area to say she hoped the board and new members, with their hard work, would benefit everyone.

Chris DeBolt, director of education and health reach, said her department is trying to maintain the bare bones. "In the education department, for the first time, we will have revenue, projected at $35,000 annually. We needed to have a nominal fee for the certifications we offer. For advanced education, the fee will be $40 for a two-year certification and $20 for shorter classes."  She reported the education department was the only American Diabetes Association-accredited program in the area. Many hundreds of people have come through the program as outpatients, as well as inpatients. "We have a pre-diabetes and diabetes epidemic here, in the state and across the county. We have seen children as young as four-years old diagnosed with diabetes by a doctor. In the Mining District the rate is frightening."

She said the prevalence of pre-diabetes and diabetes stands at about 45 percent of the adults locally and 65 percent for those aged 65 years and older.

"We will look for more opportunities for funding the program," DeBolt said. "Our best practices are recognized by the state." She said the ethnicities locally, with populations of about 50 percent Caucasian and 50 percent Hispanic are mirrored in the rates.

Brian Cunningham, GRMC assistant vice president of operations, said the GRMC strategic plan is tracking well, with only one item not yet completed.

GRMC Chief Executive Officer Brian Bentley reported on behalf of the GRMC Foundation and said the recent golf tournament was "the best ever for organization and financial outcome." He said the hospital stood to net "well north of $8,000." Board of Trustees member Robert "Bobby" Morales Sr. asked that the board send a letter thanking and recognizing Ashleigh Garcia for her work. A foundation member told the Beat she agreed that it was the best organized and most successful tournament ever, thanks to Garcia.

Bentley, in his CEO report, said the state of New Mexico has launched an investigation into several mental health providers, including Border Area Mental Health Services. He noted the agencies have not been given details on what they did wrong. "A number of places did not meet requirements. The government always calls it fraud, but it could be as simple as they didn't know any better or requirements changed."

Another behavioral health issue is the transition in the hospital's mental health area. Dr. Maria Elena Arizaga was continuing to work part-time at GRMC even after her move to Albuquerque. "We have been able to hire Dr. Alan Berkowitz, who used to work at BAHMS," Bentley said. "We have great cooperation between Dr. Teresa Arizaga-Morales, who will move from part-time to full-time and Berkowitz on how to work together and cover calls. I hope the board will look favorably on the contracts."

Bentley said the Veterans' Administration put out a request for proposals last January, but had continued to modify it. "Finally someone can respond. Once the V.A. announces the provider, we will volunteer to be the local provider at rates lower than Medicaid, so we may lose money, but we will help the veterans get services locally."

He said the hospital has had a busy two months, with 40 babies delivered, including eight earlier this week. The hospital has seen a lot of surgery and many high-acuity patients coming to the emergency room. "One day we had no beds. We are well over budget on our charges. We've been hustling. I commend the caregivers."

Pam Fulks, chief nursing officer and chief operations officers, commented some patients had been discharged from the emergency room without ever getting to a bed on the hospital floor.

Bentley said the hospital is converting from BoardBooks to Go Daddy to save about $30,000 annually. "We are ready to make the transition, but want board support. There are minimal differences, and we will have trainings over the next month."

Fulks said the hospital has hired five recently graduated nurses, who have completed "boot camp. We put them in MedSurge for the first year to get practice." She announced the director of surgery, Joan Dewbre, had retired. "Others will take over some of her duties, and we will try to do without a peri-op director. We will try it for 90 days, with 30-day reviews, to see how it is working. We are trying to cut by not filling the position. We are also doing the same thing in imaging and not replacing the director. We are expecting Dr. (Frederick) Wendler to be joining the surgical team later this summer."

She reported the restructuring teams are making significant progress. "We are developing our own in-house productivity systems." She said a few employees who had been cut back had returned to full time, with the most recent being the patient liaison. Fulks talked about the phase out of the Luna County home health, which has been completed. "We successfully transferred all but a few patients and most of the providers have found full to part-time work. "We are beginning an assessment of the Grant County home health program. Lordsburg is very busy."

Morales asked about the equipment and furniture. Fulks said David Furnas, chief information officer, had taken over the computers and desks and would be distributing them. She said the furniture primarily consisted of chairs, which might be donated to Habitat for Humanity.

Stewart noted that the furniture was fully depreciated, not capitalized or was minor equipment. Fulks said she had heard no complaints on the transition.

Board Chairman Charles Kelly asked about ambulance service. Fulks said the hospital had gone to two trucks around the clock, with an additional one in Bayard during the day. "We are trying to put a third crew on call. We are also talking to the air transport or Elite out of Deming for transfers. By attrition we are taking substantial reductions. The new Emergency Medical Services Director James Marshall, who is spending 75 percent of his time at EMS and 25 percent in his former position of project development, is implementing stringent cuts. We are looking for a paramedic director and have three good in-house applicants."

Bentley noted that Marshall is looking at better coordination of services with the fire departments, so only one ambulance is dispatched to a scene. "I think there are some economies to be realized."

Fulks said the EMS is also looking for ways to cut down on canceled calls. "James has taken that on. Some people call the ambulance out every week. James is talking to places that have reduced their canceled call percentage."

Cunningham said in his report that wound care is still being considered to determine if there is enough population and physicians to implement the program.

Furnas said phase 2 of narrow banding is complete. "We renegotiated with CenturyLink and will save $212,000 over the 60-month agreement and will have better bandwidth." Kelly asked how narrow banding helps the hospital.

Furnas explained that it was federally mandated, but "it will enable us to interface our public safety radio system with the state and federal systems, giving better coordination for disasters."

Chief of Staff Dr. Victor Nwachuku said the cardiology department is concerned about getting medical records as fast as it can. Furnas said the problem is being routed for approval and "we will work for implementation as soon as possible."

Clinical Services Assistant Vice President Ray Goellner said imaging volume has increased by 25 percent. "We are at our lowest point of 28.65 full-time employees, with the director leaving. The cardiologist volume is going through the roof. He (Dr. Norman Ratliff) told me he is getting too old to work like this and is burning out."

Fulks said the hospital hired a nurse practitioner and a registered nurse immediately  to help him. He has received a lot of referrals, some direct and is also doing some in-house consultations. "We're doing our part to see he doesn't burn out."

Bentley said once the cardiologist office is more automated, it would make the paperwork less onerous. "We have to work with him and get the nurse practitioner, Donna Bornmann and the RN to take on more to help make him more productive. He told me he knows a cardiologist in Las Cruces, who may be lured here. The office we picked for him can hold two cardiologists."

Board member Jeremiah Garcia said the board needs plans B and C. Fulks said a mid-July meeting would be looking ahead. Garcia also asked about the pacemaker program, and Nwachuku said everything is in place to begin it. Fulks said the hospital has trained 80 caregivers.

In a continuation of Stewart's financial report, he said the budget would reflect adjustments of operator indicators. He also explained the budget the board members had in their packets shows where the hospital would have been, adjusted with or without sole community provider funds. "I'm glad our cash situation is getting better."

Under committee reports, Dr. Darrick Nelson, said much of the quality improvement data runs six months behind. "I think we will have better data in terms of timeliness, so we can do rapid changes and determine whether they are working or not." He said that after the meeting, two caregivers volunteered to meet with residents to interact with them to improve core measures from the start. Nwachuku said physicians need to understand what needs to be done.

"For instance, a surgery patient is getting antibiotics before surgery, but it is not getting documented," Nelson said. "We know we are giving quality care."

Bentley said the hospital is trying to get core measures done as the treatment is ongoing.

Board member Pam Archibald presented the Financial Committee report. The first item was to approve a resolution to purchase a linear accelerator. Bentley explained the law says the hospital must show a validated need through the resolution. Then the New Mexico Finance Authority must do a resolution and then work on issuing bonds, expected by the end of September. "We get a letter saying our expenses are reimbursable, so we can pick a machine and put a deposit on it. We can try doing it as quickly as possible using our cash flow or wait until NMFA gets the money and can pay the manufacturer directly. The big issue is to make it as easy on the patients as possible."

Bentley said he has heard of a company that works 24-hours a day on installation to cut the downtime. The machine is concreted in, so the current machine has to be jackhammered out, a new concrete floor put in and then the alignment of the machine has to be exactly right to measure out the radiation required."

Archibald said the committee did a charge comparison with other hospitals to see where GRMC stands.  "We're under Alamogordo, Deming, Las Cruces and Presbyterian in Albuquerque. This is information for the budget next month."

The committee also did a comparison of rate increases for services, comparing an increase of 12 percent with 15 percent, also for consideration on the budget next month. "The difference is about $400,000 additional revenue with the 15 percent increase over the 12 percent," Archibald reported.

She recommended approval for Dr. Ratliff to order, review and approve his own tests. It was approved.

Archibald also recommended approval to add peritoneal dialysis to Dialysis Inc.'s acute dialysis services. It, too, was approved.

Also approved was a perpetual software license to MediTech. Furnas said it includes software to meet federal government mandates. "We will receive about $7 million when we meet the Phase 2 mandates."

Board members approved a contact for Dr. Alan Berkowitz at $114,639 for part-time and weekend coverage to replace Dr. Maria Elena Arizaga. An amendment to Dr. Teresa Arizaga-Morales' contract will increase her workload from part-time to full time, with commensurate increase in pay.

A contract for locum tenens services for one year from the University of New Mexico was approved. Bentley explained it has no amount charged, because the charges would be based on the physician and the amount of time spent at GRMC. "It is mostly used for specialists, and it is ideal not to use it. Having the agreement lets us use the locum tenens if we need it, if we can't find another acceptable solution without using the agreement." He noted that GRMC wants to strike one paragraph that is "poorly written and seems to indicate double billing of the hospital and the patient." Rather than table the issue for next month, the board approved with the section 5, paragraph E removed.

The only report from the Plant and Facilities Committee was already addressed with the discussion on the linear accelerator.

The members then went into executive session.

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