The Gila Regional Medical Center board of trustees heard good news on the financial front during the chief financial officer's report about halfway through the meeting, as well as some concerns.
At the beginning of the meeting, the board members and the chief-level officers recognized two caregivers for their long-time service to the hospital. Rose Marie Obar has worked at Gila Regional for 40 years, and Yvonne Maxwell for 15 years.
Interim Chief Executive Officer Brian Cunningham said neither could make it to the meeting, but they would receive certificates of appreciation and gifts for their service.
During public input, Chris DeBolt, director of education and health outreach, said: "I believe I'm seeing the seeds of something special being sown here. I am feeling the difference. It's palpable. I thank you for your courage and leadership, and I include the board in my comments. Thank you."
No one was available to give the Auxiliary report, but it was in the board members' packets. Cunningham said he would take any questions, and wanted to highlight the patient-centered care. "I want to make you understand. After eight years of Planetree, we learned a lot, but we are now taking responsibility in house and will continue with patient-centered care, just as we have in the past before we affiliated with Planetree,"
Board member Pam Archibald asked Cunningham if he had any information on Southwest Eye that is coming in.
"All we know is that they just secured a building," he replied, "and that they are talking about eye surgery."
Chief Nursing Officer Pat Sheyka announced that interviews for a director of clinical services would begin on Tuesday.
"We have done some reorganizing with the chief operations officer and chief nursing officer," Cunningham told the board members. "We, in health care, talk about silos. The Operations Department is available to work with the entire organization. It opens up opportunities to break up silos. We are breaking down the silo by allowing joint work between departments."
Dan Otero, chief operations officer, said he wanted to highlight from his report, which was in the board packets, the operational restructuring, which he asked Cunningham to return to at the end of Otero's report.
"We have been re-evaluating the more urgent issues," Otero said. "I thank the team for their reorganization and process changes. We are getting waste out of the system and want to improve outcomes."
He said the Revenue Cycle Team has started work, and he thanked Chief Financial Officer Elizabeth Allred for taking leadership, along with Marie Stailey.
"We did an analysis of big portions of the revenue cycle," Otero continued. "In Indigent Care, we have a potential loss over the next 12 months. Total insurance company denials are also part of a potential loss." He explained that if a payer denies a claim, it kicks it back to the hospital with the reasons it was denied. "We hope to have estimates for annualized revenues with six-months of data."
Cunningham said: "By improving process, we can bring some of this revenue back in."
Otero said the hospital "is also up against the coding challenges. We are two coders short, and we are not getting qualified applicants. We are thinking of doing a contracth."
Cunningham said it was a big focal point. "We have the potential that a portion of the denials can be pulled back into the budget."
"If we don't change the process, we can lose $80,000," Otero said.
"We are also looking at centralized scheduling," he continued. "Phase I, we would make sure everyone is using the same process. Phase II, we would move scheduling into a centralized area."
Board member Jeremiah Garcia asked for a timeline.
"We had $16 million unbilled," Otero said. "The two coders worked the weekend and now we are down to $14 million unbilled."
"As soon as we can get the coding personnel, it will be a quick implementation," he said to Garcia, who asked if overtime were a possibility.
"Overtime and contracts, we need to look at strategically," Cunningham said. "This is a strategic opportunity."
Board of Trustees Chairman Charles Kelly asked in clarification: "There are a variety of reasons why this billing is not going out and why there are denials. Insurance company payments are not coming in because of coding?"
"There are bills sitting on the table that are not being sent out," Otero said. "We can't send them out sooner than four days after services, but we only have 60 days to receive payment."
Kelly asked where the bills go. Otero said the first stop is medical records. The coders often are doing quality checks on the coding and then the bills go to the Billing Department.
"There are so many opportunities to get some little detail wrong," Cunningham said. "When we tried to link bills to the operational structure, we found millions were still in process."
"When we were keeping up, we were at eight days average," Otero said. "Then, we had two coders resign in April."
Cunningham said the "denial windows are tight. We have only a certain time to correct the errors and still get them back to the payers within 60 days. Right now, we have $7.5 million permanently denied. We need to move that downward. There would be an impact for a quick turnaround. We need to standardize the processes."
Otero also said he wanted to make sure information technology support is in perfect alignment with what is needed by caregivers. "We re-established the physician orders process. We are looking at relocating the data processing center services, which would be a huge savings." He explained the service comes out of a group in Dallas, which charges $32,000 a month. "The industry standard is $6,000 to $8,000 a month."
"We want to make sure the new cardiology services are up and running efficiently," Otero said. "We are in the process of changing the office over from paperwork to electronic processes, and we are on target for the end of October."
Cunningham said the operational restructuring report, which Otero asked him to update, shows that some projects are coming to an end and others coming online. "Do you want to see the entire list, including T-shirts or just the high-level running report?" he asked members.
Kelly said he would like to see them for a couple more months, while the hospital is still in transition.
Pam Archibald, board of trustees member and financial committee member, said the spreadsheet showed expense reduction, but "we are not seeing new possible expenses. For example, you may cut a million, but then add a $900,000 expense. By my calculations, you really only cut $4 million. Look at what was spent last year. We need to account for the big chunks we are adding on."
Cunningham agreed it was a problem with the spreadsheet, and one of the reasons he would rather take it up a level. "So much is going on that it is impossible to track $10 in and $10 out."
Garcia suggested it be drilled down in the financial committee.
"We need a bigger gap between expenses and revenue," Cunningham said.
Chief of Staff Dr. Victor Nwachuku said at a recent meeting, the topic was improving relations between the medical practitioners and the hospital. Another issue was how to keep patients in town instead of going to Las Cruces or elsewhere for their medical needs.
Allred said she had good news. "Inpatient revenues are up by 34 admissions this year, but outpatient is lower. Bad debt is lower and expenses are controlled, although salaries went up a bit."
"We will likely redo the budget and resubmit it to the state after about six months," she continued. "Volumes are lower, but the curve is starting to bend upward. Cash in hand is not going up this month. About mid-October or toward the end of October, we are expecting to receive about $3.5 million in sole community provider funding. At a meeting on Tuesday with the Human Services Department, we learned nothing new about what might happen in January."
"We have around 108 or 109 cash days," Allred said. "It does fluctuate through the month. We watch it on a daily basis. We don't have details on how we will receive the sole community provider funding. HSD is not allowed to give it to us directly, but it should be in the bank by the end of October.
"HSD is looking at raising Medicaid payments 50 percent to 70 percent to try to hold us harmless, they said," Allred continued. "But it's not in writing. HSD gave a presentation, the Hospital Association presented, and so did the counties. I was surprised at what some of the hospitals are doing. Clayton will have no more obstetric services, so a woman has to drive to Tucumcari, about 200 miles, to deliver a baby.
"I presented for a few minutes," she said. "I reminded them that if they take out the county monies and keep them, that's funding we're dependent on to deliver babies and do medical transports. We're part of the conversation, and we're monitoring what is happening."
Kelly asked what contributed to the loss in volumes at the cancer center. He was told that many died. "I know some in Hurley who go to Las Cruces for chemo therapy." It was suggested that perhaps people were unaware of Gila Regional's services.
Kelly gave the executive committee report and said the members set goals for the committees.
Garcia, in the quality improvement committee report, said members thought the hospital is moving to address gaps and as well as determining where it does not need to focus.
After a brief executive session, the board members voted to accept the audit, which will now go to the state for acceptance.
Under contracts and agreements, the board approved an amendment to a one-year contract for computer physician order entry services to Dr. Greg Koury.
Contracts addressing the installation, architectural issues, and purchase agreement/grant agreement for a new linear accelerator were tabled to next month, because of the moving parts of the issue.
Also tabled to the next meeting was a facility commitment agreement with Cardinal Health for drug pricing, because needed information did not reach the finance committee before its meeting.
"In the past month, QHR (Quorum Health Resources) came to an agreement with Cardinal Health that would decrease costs by 1.5 percent to 1.8 percent a month," Cunningham said. "It would be a savings of about $3,000 a month. It would be the same contract we have with Cardinal, with additional incentives to save money, such as electronic paying. The representative told me if we need more time, it would be a loss of $3,000 in savings this month. Drug prices continue to go up."
"So we don't know what the additional costs would be," Archibald said. "Also this is a five-year contract. I thought we couldn't do one for longer than four years."
Cunningham said he would clarify the length of the contract. Although a motion was made and seconded, it did not pass, to give time to work out the details before the next board meeting.
Kelly said the most discussion in the plant and facility committee was about the linear accelerator and moving the housekeeping department. "Because of contracts and the need for state approval, what is realistic for installing the linear accelerator?"
Otero said the end of December is an unofficial date to close down the current linear accelerator. "There are too many moving parts, and we need to get the contracts in place. It will be three to four months to get the old one out and the new one installed and calibrated."
"We have to get the grant agreement from the Department of Finance and Administration first," Allred pointed out.
The board members then went into executive session again to discuss personnel and legal issues.
Other than medical staff appointments and reappointments, nothing else was discussed after the executive session, according to Kelly.