By Mary Alice Murphy

Gila Regional Medical Center Board of Trustees, while hearing reports and updates, later in the meeting got into a discussion on the need for a special committee to promote dialogue among area physicians and the hospital.

In addition to the special recognition given to Barbara Guber for her more than 39 years of service to Gila Regional Medical Center, which can be seen at http://www.grantcountybeat.com/news/news-articles/21989-barbara-guber-recognized-by-gila-regional-medical-center-for-years-of-service , other long-time employees of GRMC were recognized.

Kathy Madrid has worked in Medical Surgical for 35 years; Kay Beeman for 15 years in the Special Care Unit; and Susan Walsh, 15 years in the Operating Room.

During reports and updates, GRMC Auxiliary President Elizabeth Beilue, who was not present, had asked Holley Hudgins, GRMC marketing director, to report to the board that the auxiliary had elected new officers, and Frances Day would be the new president.

GRMC Chief Executive Officer Brian Cunningham said the hospital is putting a lot of work into collaborating with Southwest Bone & Joint Institute to bring in an additional orthopedic surgeon to cover while Dr. Brian Robinson recuperates from injuries sustained when a vehicle hit him and his bicycle.

The hospital will visit next week with Dr. Don Hughes, who has been practicing orthopedic surgery in New Mexico for many years. He is interested in the position.

"We will see if he is a good fit, and we all hope for a speedy recovery for Dr. Robinson," Cunningham said.

He said the Bylaws Committee is moving forward and will likely present the new bylaws next month or the month after for the board's consideration.

"However, we have an issue now, relating to signing contracts," Cunningham said. "In our bylaws, it says the CEO, and, in his absence, the Chief Financial Officer may sign contracts. Sometimes, both of us are not here. I am recommending you modify the language to grant the CEO or a senior level administrator to sign contracts. If none is available, the Chairman of the Board may sign the contract." The change in language was approved.

He also spoke to a request from Board Member Jeremiah Garcia to set out the relationship among the hospital and area physicians.

Kari Lane, director of medical staff affairs, developed a list, and said the number depended on how many physicians were rotating, and who was contracted with other companies, with which the hospital contracts.

"It was eye-opening to see the collaboration," Garcia said.

"And many of them, who also serve on hospital committees, do a lot," Cunningham confirmed.

Chief Nursing Officer Pat Sheyka highlighted additions to her report. "Gila Regional was chosen to represent New Mexico at the national Rural Health Conference in Denver. We will send three representatives. Also I want to report we hired 14 new nursing graduates, 10 from Western New Mexico University. All are contingent on their passing their boards."

Garcia asked if the national conference would be an opportunity to recruit for the hospital.

"It's a wonderful opportunity for us," Sheyka said. "We have pamphlets we can hand out. The conference is a combination of educational institutions and rural hospitals to help us meet community needs."

Chief Administrative Officer Dan Otero highlighted clinical integration networks. "We are meeting next week with all physicians and talking about future clinical relationships. We want a lot of dialogue. So far, we have 36 RSVPs, so we want to limit it to providers and administrative staff."

Garcia asked Otero about Emergency Medical Service transports versus air transports. "Do we have new policies?"

"Not new policies, but we are putting more focus on interagency transports, and making sure that motor transports are used when appropriate," Otero said. "We brought EMS back in-house. We are having a dialogue on keeping those patients we can appropriately treat locally."

Chief Operations Officer Jed Rudd said his department is working on a software suite to support Dr. Lash's urology work. He also reported improvements in the operating room.

"For Meditech 6 (technology upgrade), we are putting a big resource effort together," Rudd said. "We are collaborating to develop the build. We are choosing what to call things and considering discarding things that aren't working. We are moving into the test environment. We will make sure to test everything in Meditech 6. In July, we will begin the Centers of Medicaid and Medicare collaboration to transition from ICD-9 to ICD-10 and how to work with the community. It tests our billing processes."

Board Member Dr. Victor Nwachuku said the most important is to make sure that caregivers code correctly.

"We will reach out to key providers to let them know how coding will change," Rudd said.

Chief of Clinical Services Ray Goellner answered Garcia's question about rehabilitating the hospital's swimming pools.

"It will affect all pools," Goellner confirmed. "We will drain them and replaster them, starting in June. They will be out of service for six to eight weeks."

"Make sure you are communicating with the users," Garcia said. "They are all in a panic about it."

Nwachuku said when he was in the lab the previous night, he didn't know anyone and they didn't know him, until he pulled out his badge. Goellner said most are travelers, and they are phasing out.

Cunningham introduced Jerry Hammond of Jacobus Healthcare Consultants. "He is a revenue cycle expert," Cunningham said.

"I've already spent a week here, and there is a lot to work with," Hammond said. ""That's good. I'm excited about being here."

Interim Chief Financial Officer Michael Rolph said the past month had been challenging, due to volume decline. "The budget you approved last week has gone to the state. We have some real opportunities with Jerry."

GRMC Controller Elizabeth Allred said the hospital lost $637,000 last month, bringing the hospital to a negative $1.2 million for the year. "But it was better than we expected. We looked back in past years, and our volume has never been as low. We had 187 admissions and surgeries were flat."

Trustee Joe Ramirez asked if the decline was due to people realizing the costs of insurance and choosing not to seek care.

"This has been happening for the past two years," Cunningham said. "We have seen a shift from in-patient to out-patient services. So we've seen these trends."

Allred said the hospital was down 25 full-time employees, matching the decrease in volume. "Wednesday, we had 145 days of cash, then we did a heavy check load yesterday (Thursday), because of the holiday next week, and today we are down to 137 days of cash. We expect to be around 140 at the end of May."

"We hope to turn that around with the additional help of Jacobus Consulting in billing," Cunningham said. "The rest of the team is coming June 1."

Chief of Staff Dr. Greg Koury said Dr. Robinson is awake and his medical team is working on rehabilitation placement. "I told Dr. (Roberto) Carreon, who has been working hard to keep up with the patient load, not to burn out."

Koury said he is establishing some formal "black-and-white" agreements for transfers from Gila Regional.

He said University Medical Center in El Paso, which used to be called Thomason, has a no-refuse policy for hospital transfers.

Koury also said two pediatricians are leaving, so the area will "need a couple of pediatricians soon, sooner than expected."

He noted that two physicians had been in danger of suspension for being delinquent in medical records, but "they caught up."

Board member Dr. Donald Stinar said automatic transfers to other hospitals concern him. "We need someone to look at where we are sending people."

"We are on top of that and visiting them," Koury said. "We will create affiliate agreements."

"We should consider the place (the hospital to which people are being transferred) as part of our hospital so we know what it's like," Stinar said. "I send people to Las Cruces, and I think most physicians have relationships with other physicians."

Cunningham noted that, even with affiliate agreements in place, "it won't be automatic to send people there. Transfers are a challenge."

"I have had patients come back to me and say: 'Don't send me back there,'" Stinar reported.

"We're working on it," Koury assured him.

Board Chairman Charles Kelly suggested sending physicians to check out other hospitals.

"If someone tells them I'm coming, I'll be happy to do that," Stinar said.

Under the report for the Executive Committee, Cunningham said the idea for a Healthcare Environment Committee was discussed. "We had lots of extensive dialogue, but we didn't feel we needed a standard board committee. I recommend a special short-term committee to handle the issues among physicians and the hospital, so time outside of the board meeting can be dialogue on the issues."

Nwachuku said some issues have come up on insurances. "If we can have all the physicians and the hospital to get together, maybe we can develop common insurance. We must move into working together. Dr. (James) Skee (of Silver Health Care) has been talking about an ACO (accountable care organization). We need to have dialogue. I think a committee working on that and reporting every month is a good thing."

"It's a best practice," Otero said. "It's a really good structure for physicians, so they realize the dialogue is happening at the board level."

Stinar said he has a private practice, works two days a week at Hidalgo Medical Services and also at the hospital. "They all have different cultures. It's the same at HMS-everyone is pro HMS. I think private practices are the same and also the hospital. It's not a team effort like it should be. I think all the community would be more profitable if there weren't these walls. Where I work, I never see the team approach."

Cunnningham said the meeting among physicians and administrators next week would start to break down the walls.

To a comment Stinar made about advertisements from the hospital showing only the hospital-affiliated physicians, Hudgins said, because of the regulations in the Stark Law, which places restrictions on physicians and hospitals, especially on referrals, she cannot advertise for other physicians.

Garcia said many of the local physicians have GRMC privileges. "But we are wanting to collaborate, and we need to break down the walls."

"This committee could look at these issues and do the legwork," Cunningham said.

"We could present ourselves better and maintain the collaboration," Nwachuku said.

Cunningham noted the committee did not require three board members and would include administration representatives.

Drs. Nwachuku, Stinar and Koury all volunteered to be part of the committee.

In the Quality Improvement Committee, Garcia said the group is mostly doing education.

Pam Archibald, board vice chairwoman and head of the Finance Committee, recommended and made motions to approve several contracts and agreements.

Approved were a first amendment to a management and oncology services agreement between New Mexico Oncology Hematology Consultants and Gila Regional for a six-month contract for an additional $400,000, while work continues on a final contract.

A renewal of a contract for four years between GRMC and Dr. Stinar to continue as Special Care Unit Medical Director, not to exceed $5,000 a month, was approved.

A no-charge agreement for pediatric telemedicine between the University of New Mexico Health Science Center and GRMC was approved for one year. The cost is covered by a grant.

Nwachuku asked how it worked. "Does a doctor call UNM with questions?" to which Otero replied: "Yes, sir."

The last agreement approved was for an architectural contract with Kevin Robinson to estimate the cost and design of turning an office into an interventional radiology room.

Kelly said, this past month, the Plant and Facility Committee determined that no offices had moved. "The hospital will work on old pipes and maintenance."

"We also started to broach the topic of growth around physicians and space," Cunningham said. "We need to determine whether we want to continue to rent space or look at construction. This was a very preliminary discussion."

Garcia said the highlights of the Human Resources Committee showed that applications to work at GRMC are low. "We need to streamline the expectations of caregivers. The good news is that we were down on overtime, as well as on contract labor."

Nwachuku said he was glad the trends are down on overtime and contract labor, "but they are still fairly high."

"With the new nurses coming on, that will help," Cunningham said.

"It seems we are really managing the business," Garcia said.

The board members went into executive session.