By Mary Alice Murphy
Dr. Darrick Nelson, Gila Regional Medical Center Board of Trustees vice chairman, led the meeting on Friday, Feb. 28, in the absence of Chairman Charles Kelly.
The board recognized Mary Ann Aguirre for her 35 years of service in the GRMC operating room, and Gilbert Jauriqui for his 20 years of service in the maintenance department.
Chief Operations Officer Dan Otero gave a brief report on the Annual Leadership Action Plan Report: "We are 30 percent complete with this year's activities," he reported. The Quality Improvement Committee has been asked to give the report next month."
No one from the GRMC Auxiliary or Foundation was present to give reports, although the reports were in the board packets.
Chief Executive Officer Brian Cunningham asked for questions.
Board Member Jeremiah Garcia asked if the hospital had received any general surgeon applications.
"We have chosen four we will interview," Cunningham said. "We have completed one. We hope to have the surgeon named in a couple of weeks."
Garcia also asked for a legislative update on Senate Bill 268, its impact on the hospital and the three-year sunset for the bill.
Cunningham said counties would be assessed 1/12 of 1 percent to pay for a state compensation program to hospitals, as the sole community provider program had expired at the end of December.
"Sen. Howie Morales put an amendment into the bill to make sure the program was funded at the 1/8 of 1 percent level by the state, so that federal match funding would not be lost," Cunningham said.
Nelson reported that the Hidalgo Medical Services residency program has approved six residents, with two new ones a year. "We had more than 500 applicants for the two positions. HMS is also recruiting for second-year residents. First-year medical residents will spend the year at the University of New Mexico Medical School. The second- and third-year residents will be able to serve here. We have the opportunity to have four residents starting July 1."
Chief Nursing Officer Pat Sheyka said the use of cell phones by nurses has never been enforced. "They will now be required to keep their cell phones in their locker and can check them on breaks. They are told that if it's an emergency, the call should go to the desk."
After complaints from physicians who couldn't tell who the new nurses were, Sheyka said, beginning Sept. 1, all nurses will wear royal blue tops for uniformity, so everyone knows who the news nurses are.
Board Member Robert Morales Sr. said he did a walk around the hospital. "Nurses told me they were happy to see you around and to know who you are."
Sheyka thanked him, but said she knew some nurses aren't happy about the uniforms, "but they need to look professional and be professional."
"Another plus is that the staff is seeing you around the hospital, too, Brian," Morales said to Cunningham.
Otero, during his COO report, said the old linear acceleration went out of the hospital that day and construction would begin on Monday, March 3.
"Our primary first step is to meet quarterly and look at the balance sheet and the pharmacy," Otero said. "We want to get volumes up and keep high quality care for everyone."
As for the billing process, which was once behind by $16 million, Otero reported it is now $4.6 million behind, but being caught up. "We'll watch and see when the funding comes back to us."
Ray Goellner, Clinical Services director, said his report was in the packet and he would entertain questions.
Nelson said he noticed mammograms were down.
"For a period of time, we had only one mammography tech, so only one could be done at a time," Goellner said.
A question was asked about whether the hospital sends out reminders. The women in the room confirmed that it indeed does send out notices.
Dr. Victor Nwachuku, Chief of Staff, said doctors also receive alerts for their patients if a mammogram is not scheduled.
Holley Hudgins, marketing director, noted that if it has been more than two years since a mammogram was scheduled, the woman is considered a new patient. "We are looking at a fix for that."
Garcia commended Goellner for the new dashboard, which made it easier to see the numbers and costs, so the board can determine where things need to be worked on.
Chief Financial Officer Beth Allred was not present, so Cunningham presented her report. "There was an extensive discussion in the Finance Committee on Senate Bill 268. January is the first month when the hospital did not receive supplemental funding from the state, so our bottom line was $870,000 in the red. We have 119.6 days of cash. We have positioned ourselves well, because there will be a lag time before payments come in in May or June. We have many plans on managing the finances, and all are focused on quality care."
He said with three to four months with nothing coming from the state, "we expect the days of cash to drop four or five days of cash a month. We will continue to work on efficiencies, cost reduction and improving our revenue streams, as well as creating new revenue streams. We should get a lump sum back to January in May or June."
Garcia said he appreciated Allred's efforts "to tell us what we need to hear. Will we need cuts?"
"If we lose $1 million and can collect a new $1 million, we would rather do that than cut, but cost-cutting is still an option," Cunningham said.
Pam Archibald, Finance Committee chairwoman, said, with the catching up on billings, the hospital should see the payments coming in next month. "About $15 million in billing was sent out. We may see only 30 percent of that, but we should see something."
Morales said he was glad the leadership was being transparent with the employees, so they are aware of the situation.
Archibald asked about the revamping of the service line analysis.
"We are doing it monthly now, " Cunningham said. "We have refigured it, so the department heads get it month. We have to make sure the contractuals are correct, as they are different in each department. The analysis is woven into every department's monthly report."
"We are used to seeing them annually, and I would like for us to see them at least every six months," Archibald said. "I would like to see how the hospital has turned around."
Garcia asked if the hospital needed to look at outside contracts.
Cunningham said contracts were pulled through the Finance Committee.
Morales asked how long contract employees serve the hospital.
"We only use contracts as we need them, and only as long as we need them," Cunningham said. "Not having contractors is not necessarily a good thing, if we are not meeting a need. We always talk honesty in the Finance Committee, as we move through the most challenging time in health care.
"I thank the prior leadership because they positioned us much better than other facilities," Cunningham said. "That zero debt is huge—a gift from them."
Nwachuku, in his report, asked for a rules and regulations change and the addition of a ventilator management test.
Board Member Dr. Donald Stinar said hospitalists have variable talents. "They will take a test on how to use a ventilator before they get hired."
Sheyka said she was pleased that Stinar was doing rounds and providing education to the nurses in the Intensive Care Unit. "It's amazing how the ICU has changed. Dr. Stinar is training ICU nurses four hours every week. It really raises the quality."
Nelson said he felt that some of the rules and regulations were "a little gray," especially with acronyms, which should be explained. He said the certifications should be more specific that they are "current U.S. standard certifications."
He said the Executive Committee met and set agendas.
Garcia, who serves on the Quality Improvement Committee, said the group is striving for 100 percent and is at 93 percent.
Otero said he had asked the director of quality improvement to build composite metrics, "because some have to hit 99 percent to be in the top 10 percent. Others are in the top 10 percent at 83 percent. We are determining what process changes are having on quality improvement and showing which improvements are making the greatest impacts on quality. We will set strategic goals and we want zero adverse incidents."
Nwachuku suggested identifying the problem and what can be done and then revisiting it in a few months to determine the outcomes.
"We have to provide education and training to improve," Otero said. "We have to tell marketing to get the word out."
Archibald asked for approval of several contracts and recommendations, including:
- Two amendments to on-call agreements for Dr. Michelle Diaz and Dr. Nwachuku with GRMC for when the physicians exceed their required 10 shifts a month;
- A non-operative obstetric on-call coverage agreement with Dr. Joyce Troxler with GRMC and HMS;
- An amendment to the hospice medical director agreement to add Dr. Barbara Mora as a backup to Dr. Jennifer Agosta with GRMC and Silver Health Care. Archibald noted there are other backups, too;
- An amendment to the Special Care Unit Medical Director agreement with Dr. Stinar, who has taken on extra duties and increasing his overall amount of time in the SCU; A Credentials Committee member agreement with Dr. Troxler; and
- An ongoing professional practice evaluation member agreement with Dr. Leonore Herrera.
Garcia asked that Otero give the Plant and Facilities Committee report. Otero said the linear accelerator had been shut down the day before. "There will be a 30-day construction to make renovations to the vault, then three weeks to install the new unit and time to calibrate it. We expect commissioning of the new linear accelerator on June 1."
Garcia noted that the last patient had finished treatment. "We are not taking more until June 2. We also forecast the capital budget for 2015 on how to maintain the hospital and how much it will cost."
Morales of the Human Resources Committee said the members are working hard. "I am proud to say the caregivers are willing to be on board. We are working on a plan and a vision."
Cunningham said the focus is on caregivers. "Our focus on big projects right now is a succession plan. We have 30 percent covered with a mentee. We have updated the caregiver engagement survey. We used to use canned ones from other facilities that never gave us the information we needed."
Garcia clarified: "The updated survey is to show what is best for Gila Regional."
Cunningham said he expected the draft to be ready soon. He also noted that a couple of coders, and a few nurses and physical therapists had been moved to contract status.
The board went into executive session to talk about medical staff appointments and reappointments.