By Mary Alice Murphy

"We are the last county-owned hospital in the state," Gila Regional Medical Center Chief Executive Officer Brian Cunningham told the Beat. "We have a county-appointed board of trustees. We are tax exempt and all our revenue surpluses go to services."

He explained that GRMC, as a rural hospital, tries to provide as many services as it can, so residents get their care close to home, without having to travel long distances.

Some of the services that Gila Regional provides include an adult behavioral health unit; in-patient acute care; imaging, lab, cardiopulmonary services; a cancer center; an outpatient surgical center; emergency medical and ambulance services; a rehab center; GRMC fitness/wellness center; infusion services; and four primary and specialty care clinics, including a primary care family practice, a cardiology clinic, pain management and surgical services.

Recently Gila Regional Medical achieved a 4-Star Quality of Care rating by the Centers for Medicare and Medicaid Services, as one of only three hospitals in New Mexico to receive the 4-Star rating, putting them into the top 20 percent of hospitals across the country. "This is real for us. We always put quality first."

The medical center is a 68-bed acute care hospital, which serves Grant County, as well as Hidalgo, Catron and Luna counties, a service area encompassing 1,700 square miles. It has rural and frontier designations and employs 640 caregivers, making it the second largest employer in Grant county. It has an annual payroll of about $42 million and net revenue in fiscal year 2016 of $72 million.

"In 2013, the state cut funding to hospitals," Cunningham said. "That put us in the hole by $9 million at the end of the fiscal year. But by the end of fiscal year 2014, we had climbed out to a positive bottom line of $1,252 million."

A graph shows that at the end of FY 2015, the hospital had a positive bottom line of $734,000, but by the end of FY 2016, the number had dropped to a negative $3,356 million. The state-approved budget projects a $37,000 positive bottom line for FY 2017.

Cunningham said capital needs every year cost about $4 million to $5 million.

"We have zero debt, but we've been living off cash reserves to upgrade equipment," he said.

In a graph of trended state supplemental Medicaid payments, the highest amount since 2011 was in 2013, in which the hospital received $18,075 million, but with payments cut that year, receipts for 2014 were down to $4.7 million, when the new Safety Care Net Pool went into effect. 2015 saw the number jump slightly to $7.06 million, but drop again in 2016 to $4.8 million.

"For us, it's quality first and the finances follow," Cunningham said. "Days cash on hand is another fiscal health indicator. The industry average, for hospitals of a similar size in the country, is 108 days of cash. We dipped to 97 in 2013, came back up to 151 in the summer of 2014, and have bounced around since then, with, at the end of July 2016, 113 days of cash."

Cunningham said Taos County passed a mill levy when its days of cash had dropped to the teens. "As days of cash go down, we can't replace equipment. Doctors, if they don't have the equipment they need, will leave. Their priority is to treat their patients. We already have challenges nationwide recruiting physicians and nurses. We want to avoid the downward spiral."

He noted that 14 New Mexico counties currently provide some form of tax support to their hospitals. Some counties have private hospitals and six counties have no hospitals.

The New Mexico Hospital Association estimates that $96 million in economic activity is generated by Gila Regional expenditures.

Cunningham said the Board of Trustees unanimously approved putting a 4-mill levy on the General Election ballot and the County Commission also approved the initiative. Four mills equates to $4 per $1,000 of net taxable value. Taxable value is about one-third the sales value of a property.

For example, a property that is worth on the market about $100,000 would see its taxable value at $33,000, which, if the mill levy is approved by voters, would equal 36 cents a day or $11 a month increase in property taxes for four years starting in 2017. The approved mill levy would sunset or end at the end of the four years.

The mill levy would generate about $3.3 million a year for the hospital and would be used only for capital equipment and building upgrades to the 33-year-old building.

"We will give regular detailed reports at the Board of Trustees meetings and to the County Commission," Cunningham said. "The expenditures will be transparent and easily measurable."

Without the ability to financially support some of the current basic services of GRMC, the impact to citizens would be unnecessary travel and expenses for care. Travel to Las Cruces for care, not including lost time from work, would cost a patient approximately $50 to $70 per visit, including gas and meals. A trip to Albuquerque would cost about $165, plus an optional hotel stay up to a total of $260 per visit.

He noted more and more communities are taking on the responsibility for what they care about.

"We are asking the people of Grant County to consider supporting the mill levy to keep your 4-Start Quality Patient Care close to home," Cunningham said.

Cunningham said he is willing to go over the Health Hospital, Healthy Community initiative with any individual or to give presentations to groups. Contact him at 575-538-4000 or visit grmc.org to see the presentation.