By Mary Alice Murphy

The Gila Regional Medical Center Board of Trustees members recognized Debra Manning for her 15-year service in the delivery room.

Robert Morales Sr., board member, asked Chief Nursing Officer Pat Sheyka to relay thanks to Manning.

Pam Archibald of the Finance Committee asked for corrections to the committee meetings changing a negative -$271,000 to a negative -$180,000.

Liz Beilue, Auxiliary president, asked that the bylaws changes be approved to make them more workable. "Most are just clarifications," she said before the board approved them.

Holley Hudgins of the Marketing Department gave the foundation report on behalf of Joe Kellerman, who was not present. "The report is in the packet. I would like to note that the board usually buys a hole at the upcoming golf tournament."

In the chief executive officer report, CEO Brian Cunningham gave updates. "We have completed the general surgeon interviews and are in negotiations with the person. I thank the board members for their mini-retreat input. We screened and did WebEx for five candidates and have chosen a chief financial officer—Omaira Heakin."

Archibald asked if there were any news on the residency program.

Chief of Staff Dr. Victor Nwachuku said: "We met with Dr. (Darrick) Nelson and made a few changes. Residents have to work directly with physicians when in the hospital. We want an HMS physicians in house when the residents are here."

Nelson explained that Medicare has terms and good definitions for in-house and in-proximity. "I ask Mr. (Dan) Otero (chief operations officer) to look at the definitions to made sure we are in compliance with Medicare."

Archibald noted the request for proposals for the emergency room practitioners had closed that day.

"Five will go to review, and we will make the decision in late June or early July," Otero said. "There is one local applicant and the others are regional or national."

CNO Pat Sheyka said she had one addition to her report. "Salary concerns have been an issue. I will bring a proposal next month."

Board member Jereniah Garcia asked about the stipulations for graduate nurses from Western New Mexico University.

"We require that they have taken the boards before we hire them," Sheyka said. "I have talked to the dean of the nursing school, Joe Heidrick, and he said the boards will be done by mid-June. Last time, three or four had to take the boards again and had to be retained as nurse techs."

"What about recruitment of a maternal and child director?" Garcia asked.

"We are doing recruitment internally and with a recruitment firm for the director position," Sheyka said.

Board Chairman Charles Kelly asked if Sheyka could give a rough estimate of how many nurses have been lost since the first of the year.

"We lost six to wanting to do home insurance," Sheyka said. "One came back. Others may come back. We lost another six and have applicants to replace them."

Archibald asked why they were leaving.

"A couple of husbands relocated," Sheyka said. "For some it is salary. We are not just retaining nurses if they are not doing their jobs."

Morales asked about more experienced nurses.

"At least three young more experienced nurses went to the home insurance work," Sheyka said. "There is such severe nursing shortages, recruiters are having trouble finding new nurses. With our changes we will be one of the best in the nation. We did a data search around here and big cities."

"We are not far behind, but we need some adjustments," Cunningham said.

"If we were more competitive, would we keep them here?" Morales asked.

"No one received an increase last year," Sheyka said.

Wanda True, nursing director, said it's about retention to keep qualified nurses.

"I really like to work here," Roberta Veseley, ER nurse, said. "It would be nice to have higher pay, but I like working as a team and where you're appreciated. It's nice to see the bosses on night shift, which I work, to show that we're appreciated and to work in a place where we're appreciated.

"I look for the positive," Veseley said. "I tell those who complain to shut up. We're much farther along, making a lot of progress and have come a long way from where we were. Nurses' Week is in May. I hope you're putting thought into a meaningful gift, such as one night a month, a midnight dinner. It's the little things that count. Dan is having forums. It's a great thing where we can come and be heard. It means we matter."

Otero gave updates on the patient financial assistance policy, which is 95 percent ready. "I will bring it to the May meeting and it will go into effect July 1. The second thing is the outsourcing in the business office being greater than 60 days. I am working with Marie Stailey and her staff. We decided not to do more outsourcing. We are looking at the revenue daily. Marie is increasing oversight."

"Are we still contracting coders?" Archibald asked.

"Yes, we have one," Otero said. "We are still recruiting. We have been remaining between $4 million and $5 million in unbilled services. We haven't slipped above $5 million. "

"I think the new CFO has experience and will help the hospital get more revenue," Morales said.

"Today we are at 7.03 days coding backlog," Garcia noted.

"It remains between six and eight," Otero said. "It moves every day. If we have a busy day, it increases."

Controller Beth Allred said the number is based out of the business office, but there are additional pieces, such as cardiology and pain management added into the monthly and end-of-year reports.

"Marie sends me a daily flash," Otero said. "The national standard is $5 million or less."

Chief of Clinical Services Ray Goellner said he had updated the dashboard for the imaging department.

Garcia noted the salaries for 2013-14 showed a difference in full-time employees.

"The imaging director position was cut last year, so the manager and I manage it jointly, which amount to a savings of about $100,000."

Garcia asked about the different numbers in mammograms and MRIs from last year.

"Revenues are up, even though volumes are down," Goellner said. "We increased costs, and are up 190 mammograms, but down in MRIs."

Nelson requested the color of the font for the numbers be changed. "Red usually means negative." Goellner said he would change them.

Allred said for the month of March, the hospital lost about $448,000, with the total for the year almost $1.9 million in losses, due to the loss of sole community provider funding.

"We spent $1.8 million in salaries less than last year, and $4.5 million less in operating expenses," Allred said. "For the safety net care pool, we are working with the Centers for Medicare and Medicaid to get the template approved. I think they are moving more quickly. We will not collect any checks from the program until June or July. In the cost report for fiscal year 2013, we expected $183,000, but got an additional $30,000. I signed the contract for the audit and they will report to you in September. The auditor will do preliminary work here in July.

"The budget is 98.5 percent complete," she said. "The Financial Committee will review it May 14, and the full board on May 16.

"Comparing this year's budget to last year's is a challenge," Allred said. "The hospital never got a handle on what the Human Services Department was going to do, so we did not prepare an interim budget. We don't pay attention to the comparison, because last year's budget was not based in reality. Typically we look at historical analyses and annualize the numbers, but not this year. Frankly, last year's budget was not real."

"When we are looking at the score card, we see the average daily spend going down, but efficiencies going up," Archibald said.

"How do we fix the situation?" Kelly asked.

"We have to go deeper; we have to cut the budget or we will use up our reserves," Archibald said.

Nwachuku asked for approval of changes to the SCLS policy.

Dr. Donald Stinar asked why surgeons are not included.

"If a surgeon has to talk to a hospitalist or another physician, he may go out of scope," Nwachuku said. "If someone is late with medical records, and continues to be late, there may be a suspension, and then reporting to the New Mexico Medical Board. I usually call them if they're late and most catch up."

Stinar requested a call before a physician is suspended.

"The policy requires a letter within seven days, and if the records are not done, then they receive a call about a suspension to go into effect in another seven days," Otero said.

"They have to take care of medical records," Nwachuku said. "I don't want to suspend them, but records are important, too."

Stinar noted that he thinks the hospital goes out of its way to help physicians. Nwachuku said he had never suspended a physician.

Nwachuku said he had a meeting with the anesthesiologists the day before. "Cases cannot be canceled because of the lack of an anesthesiologist. We need to have systems in place to have someone available. Elective cases need to be done on time."

Otero noted that the utilization of the GRMC operation room is 60 percent, and the industry standard if 85 percent. "That's good for the surgeons, the anesthesiologists and the hospital. An architect is looking at post-op to improve the flow of patients."

The Executive Committee met and created the agenda.

The Quality Improvement Committee has made 146 improvements, according to Garcia. "We are creating a dashboard, with a main item having lots of items under it. Our target is to be among the top 10 hospitals. We have improved in categories. I want to come up with a report.

"The composite score of inpatient improvements is trending up," Otero said. "Under each subcategory, we are identifying what we can improve. Inpatient measures are improving. The amount of change we're bringing in creates chaos as we continue to work on improvement. The big picture is with the composite score."

Nwachuku suggested identifying the problems and then looking back after the change to show results.

The Finance Committee had a list of on-call contract renewals, all of which were approved. Stinar noted that internal medicine physicians are not being paid to be on call, because hospitalists are internists. Most of the contracts stipulated the number of required on-call shifts and how much the physician would be paid for extra shifts, not to exceed a set amount for a year and for four years.

Cunningham said he met with the Independent Physicians Association and is recommending minor changes in the invoice with on-call agreements. "We are crossing out a section with the list of rates, because it is impossible to update. They will just give the dollar amount."
For the Plant and Facilities Committee report, Otero said the new linear accelerator was being installed. "It is 75 percent complete and is significantly larger. Commissioning will take 32 days, so there will be a slight delay in using it again."

Garcia said Information Technology contracts had been changed for cost-savings. The pool at the Billy Casper Wellness Center is on schedule to be complete by the end of May.

Archibald asked about the Bayard building HMS is renting.

"We toured it, because we own the building," Otero said. "The lease expired and we moved on it quickly. We are getting a price quote for repairs. We will work with a realtor to get a new fair amount lease payment. It is definitely in disrepair."

"My concern was that HMS might move out and leave us with an unused building," Archibald said.

"We are working as fast as possible," Otero said.

"Make sure maintenance is in place to keep that building and others in good shape," Garcia cautioned.

"Also the labor and delivery section is horrible," Archibald said. "Have there been any discussions on it?

"Just discussion on egress, which is a problem," Otero said. "A place that was used as storage will be used for Dr. Leicht for pain-management."

Nwachuku said labor and delivery needs windows.

"It's on our radar," Cunnigham said. "When we can look at construction again, it's our No. 1 priority."

Morales of the Human Resources Committee said it has big goals. "I am grateful for the caregivers and all their hard work. I feel we're moving in the right direction."

Cunningham said the hospital is working on its own version of a survey for caregiver satisfaction to get feedback on improvements and what the leadership could be doing better.

"Corrective actions are being taken," Garcia said. "There are impacts when someone is not doing his or her job or working as a team. I hope actions are being taken in those cases."

"We are looking at unexcused absences," Sheyka said. "It may result in disciplinary actions. We're trying to address the issue."

"One of the biggest concerns is the work force is coming out with different attitudes about work," Garcia said. "Most of us were brought up to be professionals. The newer generation is looking at it differently. If we don't prepare, we will not have the staff we need and so quality nurses don't get burned out."

Hudgins said the Human Interaction Team is focusing on retention.

The board members went into executive session and adjourned after approving contracts.