By Mary Alice Murphy

The first order of business for the Gila Regional Medical Center Board of Trustees is usually to recognize employees who have served the hospital for long periods of time.

At Friday's meeting, the total number of years by the three employees equaled 70 years of service. Rita Alvarez, who works in information systems, has served the hospital for 35 years. Ruth Jurado, in dietary, has worked at GRMC for 20 years, and Jenny Shurtz, who was on hand to receive the recognition, has spent 15 years in the Behavioral Health Unit.

In reports and updates, Liz Beilue, GRMC Auxiliary president, said the group has gotten a couple of new members, but is still looking for more.

Chief Executive Officer Brian Cunningham, highlighted in his report that based on ongoing financial challenges, the hospital continues to implement part of the work plan to make the hospital more efficient.

"The interim Chief Financial Officer (Michael Rolph) is helping us, so I expect over the next few months that we will see the finances level off," Cunningham said.

Chief Nursing Officer Pat Sheyka said she had some good news, which Chairman Charles Kelly said he liked to hear.

She said the hospital had no traveling nurses in Special Care Unit, with only one in maternity and one the Emergency Room.

"We hope to be able to eliminate all travelers by October," Sheyka said, "if we have no surprises."

Chief Administrative Officer Dan Otero said he also had good news. "Gila Family Medicine had a very strong month for its first month in March."

He said the hospital also saw net revenue rises for the Gila Multi-Specialty Network.

Chief Operations Officer Jed Rudd said his department would be deploying advanced essentials of execution. "We are working to be truly leading edge in managing costs. We are undergoing a critical IT upgrade, and will move into testing. We have finished the assessment of community preparedness and will be doing all medical-section meetings."

Trustee Dr. Victor Nwachuku asked if hospital-affiliated medical practices had been assessed. "All practices need to be ready, because it will impact the hospital."

Rudd agreed that the practices and the hospital are highly interdependent for the shift in IT.

Chief of Clinical Services Ray Goellner was not present, so Cunningham gave a highlight of Goellner's report.

"The new fluoroscopy unit should be ready by the end of May," Cunningham said. "They got the old machine out in a day. It will take a couple of days to install and then, at least a couple of weeks for calibration."

For the Chief Financial Officer report, GRMC Controller Beth Allred did the narrative.

"At the end of March, we had a $737,000 loss, which makes us about $400,000 lower than budget for the year to date," Allred said. "Decreasing Medicaid reimbursements and contract salaries being up impacted the bottom line. Unbilled accounts remain steady at about $5.7 million.

"For the good news, we got a payment for the safety net care pool of $1.7 million," Allred continues. "That will improve the bottom line. Yesterday we had 145 days of cash, then we had payroll, so today we have about 140 days of cash. We are good in that respect."

Rolph said one of the deliverables he had been tasked with was to determine contractual adjustments that were needed and to make them. "Contractuals are based on paid claims history. We have increasing unpaid accounts receivable, and I continue to monitor them."

He recommended the hospital explore contractual payment software, which would monitor payments over time.

Another deliverable he is developing is how much to reserve for potential bad debt on self-pay accounts. "We assume that co-insurances and deductibles not paid in over 121 days are uncollectible. I am suggesting we determine what our collection experience has been and migrate to a more conservative approach. Those uncollected in under 121 days, I recommend we study them to evaluate them relative to current accounts. We can improve to best practices. I see a possibility for improvement in unbilled accounts. Contractual adjustments increased and bad debt grew to 4 percent from 3.7 percent. We had a big increase in accounts receivable with a 38 percent increase. If they are incomplete in terms of non-payment, it leads to more denials from insurers."

He also suggested the hospital look for talent to outsource some components to.

"We are immediately engaging to put people on the ground in the business office to get more collections," Cunningham said. "We will throw resources at it to stabilize it."

Rolph said the upgrade to the new Meditech for IT also offers revenue cycle management applications and they are good programs.

In board committee reports, Kelly said the executive committee determined the agendas for committee and board meetings.

Trustee Jeremiah Garcia presented the Quality Improvement Committee report. "We're ahead of our curve. I compliment the team. In quality, we are doing an exceptional job."

Garcia also gave the Finance Committee report, which included recommendations for contracts, all of which were approved by the board. The include a membership renewal agreement for Dr. Brian Etheridge for the Medical Executive Committee and an agreement with Dr. Nathan Williams for the Pharmacy and Therapeutics Committee, both for terms from May 1, 2015-April 31, 2017.

A first amendment to the Family Practice lease agreement in the Fowler Development was from February 1, 2015-January 31, 2017. Two more renewals at the price are allowed by 2019.

The last approved agreement was a first amendment for a four-year contract to the Emergency Department Medical Services agreement with Innova. Otero explained the amendment allowed the group to provide care at events, such as the Tour of the Gila bicycle race.

Kelly gave the Plant and Facility Committee report. "We have Native Air back on board and things are going well. A group will assess our space to make needed changes in the facility. We completed a mock survey, so when we really get surveyed, we will be ahead."

The Human Resources Committee did not meet due to lack of a quorum.

Cunningham said the Bylaws Committee met and will meet at least a few more times before presenting the complete revision.

"We want to address the section about delegating authority from the CEO to the CFO," Cunningham said. "Because our interim CFO is not here all the time and sometimes I have to be gone, we want to amend the item to the CEO can name a designated chief-level officer to sign contracts in his absence."

Nwachuku noted that most major contracts come to the board level for approval, but smaller contracts are signed by the CEO or CFO.

Kelly asked, as a point or order, that because the item was not on the agenda that it be placed for a vote at the next Board of Trustees meeting.