Editor's Note: This article about the GRMC Board of Trustees Meeting of March 28, 2014, was written from the draft minutes, which have not yet been approved by the board.

Gila Regional Medical Center Board of Trustees Chairman Charles Kelly recognized Lisa Laws for her 25 years of service to GRMC. Her daughter, Jennifer Melon, accepted a plaque and a service pin on her mother's behalf.

Liz Beilue, Auxiliary president, reported that additional hours had been added to the volunteer number presented in her report, which was in the board's packer.

Chief Executive Officer Brian Cunningham said the hospital has sent a letter to EMCare, the Emergency Department medical provider group, stating GRMC would use its termination by either party without cause option to end the contract effective Dec. 31, 2014. GRMC has also put out a request for proposals to ER groups, local and across the country, soliciting proposals for the next 30 days. A review committee, consisting of GRMC leadership and the physician community, would begin the process of choosing the next ER group.

Cunningham noted that historically hospitals survived and thrived within their own four walls, but today it does not suffice. Good relationships between the GRMC leadership with county commissioners and local legislators help in the current climate.

A recent kick-off meeting, with the GRMC executive committee, Grant County Commission Chairman Brett Kasten, County Manager Jon Paul Saari, state Rep. Rodolpho "Rudy" Martinez and Sen. Howie Morales, helped all to become "grounded" in the current condition of healthcare reimbursement, related to Senate Bill 268.

Board member Jeremiah Garcia asked if Bernalillo County had been included in the bill, to which Cunningham said he did not believe so.

Board member Pam Archibald asked about the interviews for a general surgeon. Cunningham said he was awaiting physician input, but "it is clear we have one well-qualified candidate," so the process should conclude quickly.

Garcia asked about the date and time frame for the ER RFP. Following the 30-day response period, GRMC would consider the proposals for at least a couple of weeks. By mid- to late-April, the first round of interviews should be completed. By May or June, the choices should be narrowed down enough to make a decision and begin the transition period.

Chief Nursing Officer Pat Sheyka said, as part of developing Gila Nursing Excellence, through interviews, six strong candidates, including one external candidate, had been identified. At first, they will fill night position, as that is the greatest need. Day shift nurses will then be hired. For nursing recruitments, Sheyka said GRMC hosted a pizza luncheon for Western New Mexico University nursing students. Afterward, Sheyka met with the Nursing School Dean Joe Heidrick. They have put together a bachelor's degree program and are looking to add a master's degree program, consisting of three semesters.

Sheyka noted the title of Health Reach would be changed to Health Management and Education. She said the department will continue to work with inpatients and will work with Utilization Review during the transition. The department will also work closely with physician offices and patients to make sure they have what they need, including follow through with prescriptions. "We are focused on preventing readmissions, since the 30-day window with Medicare reimbursements are specific. If patients are readmitted within the 30 days, their stay will be bundled with the original admission."

Chief Operations Officer Dan Otero said the linear accelerator is in the third construction phase and the project was on task until this week. An electrical inspection might require the hospital to make an appeal to the state for a conduit that runs between the power source and the linear accelerator. Worst-case scenario, the hospital will have to run new conduit. Board member Robert Morales, Sr., asked for more information on the issue.

Otero said the conduit is PVC, and a regulation change in past years now requires the conduit to be galvanized. He noted the state had previously signed off on the original plan, which showed the PVC pipe.

During the meeting, the board received information that the current conduit was approved, which would eliminate any further delays.

Otero said the hospital is partnering with a third-party group, Citadel, which was doing an assessment and analysis in Patient Financial Services. The group already did a first assessment virtually from Nashville and looked at $3.2 million worth of accounts, with 35 percent of them collectable. Sixty-five percent of the accounts, worth about $2.1 million are at risk, with more already lost due to not filing on time. Otero said the hospital continues to receive a small amount back from VA accounts. Citadel, that week, had been onsite looking at work processes and workflows to make them more efficient and effective. He expected the phase 2 report the following week. Phase 3 involves Citadel returning to look at patient access, involving registration and the up-front processes to make sure patients are being registered in a timely manner and that authorizations are being processed before an appointment is scheduled.

In the coding backlog update, Otero said he did an analysis of average cash collections from January to November 2013. About $4.2 million was coming back into the system. To a question from Garcia about $2 million in denials and whether it could be returned, Otero said the money was lost to the hospital. Otero said the billing department has been able to keep the coding total at about $5.4 million, with two contract coders on staff. He noted that once the backlog is caught up, one coder might be dropped.

Otero said the hospital put together a team and created a process in Patient Financial Services to provide financial counselors, especially to those who do not have insurance. Those patients who do not pursue insurance would receive an advanced bill notice, which states the patient is responsible to pay the bill if they do not have insurance coverage.

The first week of April, the new pain management provider, Dr. Leicht, who already has patients scheduled, was due to start work.

Otero noted that Varian would not charge additional money for any delay with the linear accelerator process.

Chief of Clinical Services Ray Goellner said, as a result of Dr. Darrick Nelson's question at the previous board meeting about why the number of mammograms fell, an analysis was done and inaccuracies were found. A chart he handed out to the board members indicated that the number of mammograms had actually increased. He noted the inaccuracies were due to billable items being listed separately, rather than as part of the procedure. The item on the financial report is listed as a procedure and will include all billable items in this month's and future reports.

Controller Elizabeth Allred said there was no change to her report since the Finance Committee had met earlier that week.

Cunningham said one of the ways the hospital was tracking expenses is the statement of a daily average spend. In the month of June 2013, the hospital hit a high of $207,000 a day, which has dropped to $180,000 in February 2014. Decreasing the daily spend allows the number of days of cash to increase. To a question from Garcia, Archibald said the rolling average of expenses does not include denials, but is more on a cash basis of what the operating expenses were. Allred pointed out that the hospital is paying its bills on time, and it no longer has a backlog of bills that were overdue.

Chief of Staff Dr. Victor Nwachuku said, starting in June, patients will have access to their own patient records electronically, without having to go to their physician's office to access them. GRMC is working out issues with this as part of the Affordable Care Act requirements. Silver HealthCare and HMS are already doing this. Also starting in June, physicians will be using a system to write orders electronically. Dr. Nwachuku suggested making hospital IT staff available to physicians as they make the transition.

Under committee reports, Archibald made a motion to approve a fourth amendment to the chief of staff agreement with GRMC. Morales seconded it, and it was approved.

Archibald also made a motion to approve the Professional Services Agreement for the Linear Accelerator Commissioning Agreement with New Mexico Oncology Hematology Consultants. Garcia seconded and it was approved. Otero explained that during the commissioning physicians come to the hospital and perform high-tech calibrations for radiation therapy in the Cancer Center.

Garcia reported on the Plant and Facility Committee, which discussed IT changes that have been made, including contracts involving software and hardware. The IT team, under Ken Stone's leadership, has eliminated some contracts that were being paid for, but not used. A change to a back up center in Albuquerque for $3600 a month was a huge savings over the $35,000 a month that was being paid to a backup center in Dallas. Investing in high-tech wiring and hardware and server costs would have an eight-month payback period, but would offer a return on investment of $2 million over the next five years. Otero said the changes would be completed by June.

Although the Human Resources Committee did not have a quorum, Garcia said contract labor for the hospital had dropped in February from January. Cunningham said the hospital uses "travelers" only as a last resort and for a specific time period. Garcia said succession-planning interviews took place for the CEO candidate. Otero interviewed. He was nominated and has begun the process of shadowing Cunningham. "I appreciate having this opportunity," Otero said.

After the executive session, several medical staff appointments and reappointments were made including for Joyce Troxler, MD, Pediatrics; David Ficklen, MD, Internal Medicine (Hospitalist); Samuel Moses, MD, Radiology; Robert Garrett, MD, Psychiatry; Shauna McCosh, Certified Nurse Practitioner; Laura Hotchkiss, MD, TeleRadiology; Karen Phillips, MD, TeleRadiology; Michael Smith, MD, TeleRadiology; and Donna Bornmann, Certified Nurse Practitioner.