By Mary Alice Murphy

The first item of business on the Gila Regional Medical Center's Board of Trustees meeting was to recognize Frances Montes for her 15 years of service to medical surgery 1. Montes said: "I want to thank everyone for this honor. I work with a bunch of great people."

The GRMC auxiliary president's report was in the packet, but no questions were asked. Board Chairman Charles Kelly said: "The auxiliary members do a great service for the hospital."

GRMC Marketing Director Holley Hudgins noted the auxiliary would be preparing six Thanksgiving baskets for six caregiver families.

The main item of business was hearing a report from Mike Trostel of Discovery Health Care, a consulting firm the hospital uses to "true up its payments over the year. We've been using them for a long time," Beth Allred, GRMC controller, told the Beat after the meeting.

Trostel highlighted items in the report summary, which, according to Allred, came down to the hospital owing Medicare $320,000 net. "We have $350,000 set aside for this purpose," Allred said.

This includes some items where Medicare owed the hospital certain amounts and the hospital owed Medicare larger amounts.

"As for federal sequestration, tell your congressional representatives what's happening to you," Trostel recommended. "The federal government is taking 2 percent off every payment to you. That is $276,000 this year alone. The government said the sequestration would end March 1, 2014. It didn't and it won't anytime soon. The low volume extension is good for you. In bad debt, the federal government paid you more than it should have. That is the biggest piece. Medicare in-patients don't have to pay what Medicare doesn't cover, but if you try to collect that money and can't, the federal government will pay you 65 cents on the dollar. For Medicare out-patients, you submitted more than they paid you for. In Medicaid what you get is what you get. They owe you $10,000."

Chief Financial Officer Omaira Heakin said her department would be looking at bad debt monies that might be available. "We have six to eight weeks to resubmit. We are developing a plan to streamline the process. If we miss the window to resubmit, we won't be able to collect the bad debt, so we are making all efforts to make it happen."

Chief Executive Officer Brian Cunningham said the board would need to hold a special meeting to accept the report and sign it. The meeting is set for 9 a.m., Wednesday, Nov. 26.

Trostel commended the hospital's staff for "being very helpful."

In the continuation of her report, Heakin said the hospital is $929,000 ahead of budget year-to-date. Cunningham said the hospital has an $891,632 positive bottom line year-to-date.

Cunningham, in his CEO report, highlighted that GRMC has completed its community needs assessment. "We will bring it to you next month. We need anesthesiologist help and will move forward on formal recruiting. We have two anesthesiologists and four certified registered nurse anesthesiologists. One of the anesthesiologists wants to cut back on his hours. We will replace the hours by recruiting for another anesthesiologist."

Pat Sheyka, chief nursing officer, said she would entertain questions on her report. Pam Archibald, board member, asked how the visit went at the University of New Mexico and Grant Canyon University.

"Very well," Sheyka replied. "UNM wants to develop a nursing practicum for rural areas. Grand Canyon University's Albuquerque branch wants to send student nurses here by the end of this year. Grand Canyon has a very professional program. They assured us they would send those who would be interesting in working here after they graduate."

Board Member Jeremiah Garcia said the members of the Human Resources Committee talked about incentives.

Sheyka said housing would be needed for the student nurses. "And in January we will have orientation and then training for all nurses who have not had acute-care experience."

Board Member Dr. John Stanley asked about the $11,000 for recruits. Sheyka said the hospital uses traveling nurses and has to pay recruiting costs.

"UNM wants to build rural service into its program," Hudgins noted. "Tamera Ahner also accompanied Sheyka."

Ahner added: "A report states that only 1.6 percent of UNM's nurse graduates leave Albuquerque. A report is going to the Legislature to recommend sending UNM graduates to rural areas. UNM was receptive, so I think a year from now, there will be more than 1.6 percent leaving Albuquerque."

Sheyka said Grand Canyon University, a Christian school, cultivates nurses to provide service. "I'm having dialogues with seven students graduating in April, who want to come here before they graduate."

Chief Operations Officer Dan Otero highlighted the annual leadership progress plan. "I will bring the core measurements to the meeting next month."

Stanley asked about the agreement with other emergency evacuation providers now that a helicopter is stationed at the hospital. "What if someone requests another provider?"

Otero said the hospital has an agreement between the companies to provide space to land and take off.

The Chief of Clinical Services Ray Goellner was not present and no questions were asked about his report.

Chief of Staff Dr. Victor Nwachuku said at the beginning of next month, on a date to be determined, a meeting would take place between GRMC's and Hidalgo Medical Services' medical staff on the residency program. Board members would also be invited.

He asked for a slight adjustment to the bylaws, which are being rewritten.

Stanley said he had received a call from Dr. Mark Donnell asking that general medical staff be able to approve minor bylaws changes in a general staff meeting. "It would still have to come before the board, so there is a safety mechanism built in."

Dr. Donald Stinar said he didn't like words like "minor. It may not be minor to me."

Stanley said that was the way he felt.

Kelly asked why the change was proposed.

"We don't know if it's minor until we see it," Nwachuku concurred. "It's been almost a year that we have been working on rewriting the bylaws. We can wait on this until everything comes at one time. I expect it will be done around the beginning of the year."

Stanley said maybe the reason why Donnell was pushing for the change is that once it comes before the board, the information might not get back to the general medical staff.

Kelly said he preferred the idea of having it all at one time. Nwachuku said there would be a lot of "back and forth, so it will likely be six months before the rewritten bylaws are approved." The item to make a "slight adjustment" was tabled.

Kelly reported the Executive Committee met, set the agenda, had coffee and went home.

Garcia asked Otero to discuss the Quality Improvement Committee meeting. Otero said the hospital has made significant improvements in the quality of care, especially in nursing medical care. "It is not happening as quickly as we wanted it to, so we will be ramping up our efforts, but almost everything is headed in the right direction. Mortality is down; that's good. It's good that medical complications are down. Experience of care dropped a bit. We are putting in lots of work and increasing our efforts."

Archibald presented the Finance Committee report. The first item, family practice pro-forma, was to be discussed in executive session.

Contracts were approved for a revised physician sublease agreement with Surgical Associates for Dr. Friedman to increase his days of use from one-and-a-half days to two days; for an on-call anesthesia services agreement for Dennis Gutierrez, CRNA; a third amendment to computerized physician-order entry for Dr. Greg Koury; and to add physician health computer information systems advisory committee members, Koury, Dr. Brian Robinson, Dr. Tsering Sherpa, Dr. Brian Etheridge, and Dr. Darrick Nelson.

Kelly said the Plant and Facility Committee met. Cunningham said the hospital would be seeing some upcoming activity, as "we backtrack and pick up space we have needed for a while."

Garcia presented the HR report and noted that contract labor was continuing to rise. "We will hold a celebration for all caregivers on Dec. 6 at the Brown Derby."

Hudgins noted the committee would be planning the Light Up a Life program at 5:30 p.m. Wednesday, Dec. 3, for the community to honor its deceased members.

Cunningham noted that Howie Morales, who was absent, is working on a roll-out of a hospital-wide customer service orientation and on-going training.

"That's needed everywhere," Kelly said.

The next regular meeting of the GRMC Board of Trustees will be held at noon, Friday, Dec. 19.