By Mary Alice Murphy

At the Gila Regional Medical Center Board of Trustees meeting on Friday, March 27, one of the first items of business is often to recognize long-serving employees of the hospital. Karla Hall received recognition for her 15 years in health information management.

Reports began with that of the Chief Executive Officer Brian Cunningham, who announced the resignation "for personal reasons" of Omaira Heakin from her position as chief executive officer for the past ten months. A search for a new CFO began immediately.

Cunningham highlighted recent government relations' efforts at the legislative session, which ended March 21. "There were multiple bills impacting the hospital. We were able to give input. I would like to recognize Sen. Howie Morales for his help. Capital outlay died, but Rep. John Zimmerman helped with $200,000 in capital outlay for the hospital. Capital outlay died on the House floor as the session expired."

Trustee Jeremiah Garcia asked about the tax credit. Cunningham said it died on the House floor, but impacted only private hospitals, not public ones. "It wouldn't have impacted Gila Regional."

Cunningham updated the board on the financial challenges Gila Regional has faced over the past couple of months. He cited the shifting healthcare environment and some key processes for the hospital seeing a negative $1.5 million bottom line for the month of February, which puts GRMC at a negative $400,000 for the year. "However, this reflects a positive $600,000 ahead of budget. This obviously represents another significant call-to-action for GRMC," he said. " I want you all to know that we have been developing a very specific plan to correct for this latest challenge and have already begun implementing several of the key elements of the plan. We have also invited a third-party, state approved Healthcare Financial Auditing firm to come on site to verify what we are seeing from a financial perspective and to help identify any other opportunities for improvement."

Garcia also asked about the Veterans' Choice Card, which will give veterans that meet certain criteria the opportunity to get health care at a facility closer to their homes than a trip to a Veterans Administration hospital. Cunningham said the VA has had problems in implementing it, but "we are monitoring it."

Chief Nursing Officer Pat Sheyka said the department would be mentoring 11 new applicants for first year nursing. "We held a pizza lunch for senior nursing students. We will be down on the number of travelers."

Garcia inquired what was being done about readmissions to the hospital.

"We are working on addressing the problem," Sheyka said. "Two nurses are working closely on the issue."

Chief Administrative Officer Dan Otero said his department is doing ongoing research on a clinical integration network. "We will bring a report to the board in April on the process."

"I would like to update you on the Gila Family Practice," Otero continued. "It has been open since March 2 and has seen 537 patients. The grand opening was well attended with about 100 community members in attendance. They are even busier this week. The start-up costs were a bit higher than we expected."

He also said a workshop was held on streamlining processes. To a question about a proposed survey, Otero said the hospital had a "robust response to the mock survey. We found no deficiencies, but potential deficiencies. Each department is reporting monthly on survey readiness."

Chief Operations Officer Jed Rudd reported "great success with the deployment of the Operation Excellence Model. We will take the waste out of the system." He said he had met with every physician's office, except for Silver Care. "We will tabulate and report to the community on our levels of preparedness. We plan to soon move into double coding."

Trustee Dr. Victor Nwachuku said he knew most of the physicians were not ready for coding. "I wonder about workshops."

"We are looking at a resource for physician education," Rudd replied.

"It helps the hospital when physicians are prepared," Nwachuku said.

No questions on his reporter were posed for Chief of Clinical Services Ray Goellner.

In the good news part of the financial report, Gila Regional has 135 days of cash.

In the Chief of Staff report, Dr. Koury said the Medical Executive Committee had discussed residents and medical students and whether they could write orders. "The attendings will take the responsibility of writing orders," he said. "As of now, residents cannot write orders, but we will likely give them more responsibility. The attending physician has to be there to write the orders."

Garcia noted it impacts billing and patients.

"We weren't prepared to be a residency program," Koury said, "but it's improving."

He also talked about rules and regulation changes needed. "We are looking at software to encrypt, as well as texting. The pager system is archaic."

Trustee Dr. Donald Stinar said recertification should be required every 10 years, but Advanced Cardiac Life Support requires recertification every two years.

Koury said the argument for emergency physicians not to have to recertify as often is because they are practicing the ACLS more often.

Stinar said the issue with ACLS needs to be reviewed. "It is forcing doctors to put out money to recertify. They took the rules and changed them. I don't think there should be exemptions. Either we do it or not."

"We are the only hospital in the region requiring ACLS," Koury said.

Nwachuku asked about new bylaws. Koury said the committee had tweaked them, but plans to meet again in April for "our last vote. You get it in May."

Trustees approved the changes in rules and regulations.

Garcia gave the Quality and Improvement Committee report. "We looked at value-based measures. We were educated on quality. I ask for a presentation to the board, so we're all on the same page. I'm pleased with where we're going."

Garcia, in the absence of Trustee Pam Archibald, also gave the Finance Committee report. Trustees approved the agreement between Gila Regional and Dr. Stephen Sherick for the Ongoing Professional Practice Committee. Approved for the Medical Executive Committee Professional Service were between the hospital and Dr. Tsering Sherpa, Dr. Mark Donnell, Dr. Okay Odocha, Dr. Brian Robinson, and Dr. Michelle Diaz, all for terms from April 1, 2015 to March 31, 2017.

In the Human Resources Committee report, the biggest factor was contract labor, which year-to-date has cost $1.4 million. "We have put a lot of money into contract labor, with 75 percent of it nursing," Garcia commented.

Cunningham said: "These are just the clinical contracts."

Sheyka said she hopes to hire 14 nurses in July. "We hired a couple this week. My goal is to have no travelers. The new nurses will hopefully be trained by the end of the calendar year. The maximum we can hire is 12 to 14, because of a lack of places to get them training."

Koury noted that the board needs to talk to the commissioners to make sure a whole family can be retained in the community.

Stinar said the school systems have an impact. "It's harder to get doctors, when the schools aren't good overall. One of the reasons doctors don't stay is the schools. We need an emphasis on having nurses qualified in places like the ICU."

The board went into executive session, where some of the financial problems were discussed.

Financial opportunities and quality of care initiatives remain as key focus areas for GRMC, according to a news release. Since 2012, the hospital's score on six core measures of publicly reported quality indicators, ranging from heart attacks to surgical care to pneumonia, has risen from 80 percent of the top 10 levels in the U.S. to 98 percent, according to GRMC publicly reported data. At the same time, GRMC has been on an intensive push to bring costs down. Average daily cost for running the hospital is now $182,912.00, a new low. One key, Cunningham says, is an aggressive push toward greater collaboration between the physicians who serve the hospital and the hospital administration.

"These are challenging and rapidly changing times in health care," Cunningham said in the news release. "Today, our facility provides high quality patient care and has a plan for navigating the road ahead."