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Published: 01 August 2017 01 August 2017

[Editor's Note: this is part 3 and the final article of a multi-part series on the Gila Regional Medical Center Board of Trustees meeting on July 28, 2017.]

By Mary Alice Murphy

On Friday, July 28, 2017, the first regular meeting of the Gila Regional Medical Center Board of Trustees, since the approval of the University of New Mexico to take over the Cancer Center, took place in the hospital boardroom.

After public input, and some of the leadership reports, the Chief of Clinic Services Ray Goellner gave his report. He said his report in the packet was in error, because housekeeping had lost two people.

Trustee Jeannie Miller asked about the department replacing its PACS (picture arching and communication system) software, which is used for imaging solutions.

"It collects images and allows physicians to see them," Goellner said.

Miller asked about where the lymphedema services were housed. Goellner said they were in the rehab center at Billy Casper Wellness Center, where they offer massage to enhance proper drainage of excess fluid.

Trustee Joel Schram asked about the savings on EKG reads being brought in-house, as mentioned in http://www.grantcountybeat.com/news/news-articles/38405-grmc-board-of-trustees-hears-leadership-reports-072817 . The contracts were approved at the special meeting held to approve UNM coming to the Cancer Center.

GRMC Chief Executive Officer Taffy Arias said total savings from the change would be $90,000.

Interim Chief Financial Officer JoBeth Vance said admissions for June were 164. The hospital received $7.7 million in revenue for the month and had $5.5 million in expenditures, for a positive bottom line for the month of $332,042. "However, the not as good news is that for the fiscal year, the hospital had more than $6 million to the negative. We have 56.91 days in cash. Throughout the month of July we have been addressing hiccups in the Meditech upgrade, but even so, most claims are going out and more quickly. June was tough. In July, we're on the right track."

Schram noted that unbilled is $10.2 million. "Is it all related to Meditech?"

Vance said, as of last Wednesday, it was down to $5 million. "The unbilled will come down as the bugs are worked out."

Schram also asked about the $6.7 million in claims that are more than 150 days unpaid. "What are the chances of their getting paid?

Vance said some claims are two to three years old. "Those we are looking at as charity. We will collect some, but not much. It requires some policy changes."

Schram also asked if the $268,000 in contract labor for the month would shrink.

"We had a lot of contract labor in June connected to Meditech," Vance said. "By the end of July we will be down to only two on contract. We are still working to get rid of Meditech labor."

Miller asked if there were a statute of limitations on bills.

"It's not good PR to send out a three-year-old bill," Vance said. "For insurance to pay, we only have a certain amount of time. We track the time of denials or we have to write them off."

Schram asked about the amount of indigent write offs, which seemed to be about $6 million.

"We are getting from the safety net care pool about $6.2 million," Vance said. "The bad debt is what we are having to write off."

Garcia said, when he looked at volumes, pain management had no volume. "I understand he's gone. What do we do with his staff when he's out of town?"

Assistant Vice President of Administration Liana Ryan said his RN took time off. "We are cross-training, so she can do fill in. We are flexing appropriately."

Vance noted that the pain management physician had gone to Iraq to help the military there.

She said auditors would be coming to the hospital in two weeks. "It all comes down to processes in place. We have to make sure they're in place and we're getting there."

Miller questioned the drop in ER visits. "Are we seeing a difference because of urgent care, for instance at Silver Health Care?"

"In this case, it is not an impact from urgent care," Vance said. "It's seasonal and part of the Meditech changeover, which might not have captured everything. We had quite a few surgeons out in June. They cut back in June because of Meditech."

Trustee Dr. Victor Nwachuku said the hospital is always looking at the losses, with a negative $6 million at the end of the fiscal year. "Within the next few weeks, we are hoping to have a strategic meeting to address it. As the vice president of this board, I've been working with Mr. Garcia. The Cancer Center is an integral part of this hospital, and I think the comments against him are unfair. His focus has been care. There was no financial benefit to changing the Cancer Center. The intent was always to make the hospital better. Mr. Garcia has spent a lot of time; more than I. We're not perfect. All of us have made an incredible commitment to make this hospital better. When UNM comes, it may be better. Mr. Garcia has done everything he can. We have respect for his time."

Trustee Michael Morones said he appreciates the CFO. "Our past one, I, as a CPA, was struggling to figure out what he was talking about. Since JoBeth has been here, it has been much more clear and will help us make better decisions."

"That's the beauty of a great CFO," Garcia acknowledged. "She puts it on the table. We must honor your for your ethics and morals to present this. I pass the compliment on to Beth Allred, too. We are looking for a permanent CFO, but JoBeth has given us the opportunity for her to stay until December. We have to depend on the CEO and CFO to work together."

Arias chuckled: "Notoriously, they say that CFOs are CF-Nos. It's important for the CEO to have a CFO with seasoned experience beside her. Running a hospital is intricate with interwoven detail. It's not like selling shoes or scooping ice cream."

Chief of Staff Dr. Gregory Koury was absent, but Ryan presented items from his report. "Dr. Preston Maxim will be the new ER director, and the board will get the contract today."

Joint Commission regulations require more input in the hiring of directors, according to the report. Koury commented in his report that physicians don't want to fill out surveys; they want to be involved in recruiting, and the medical staff would like ongoing information on the Cancer Center transition. He also expressed concerns about shadowing and students doing so. The medical staff has asked to get a legal opinion on whether students not in a certified program should be able to observe. Is there a liability issue with high school students?

Ryan said a change was made to the delinquency in medical records policy, which includes bylaw changes and changes in rules and regulations.

Trustee Dr. Tsering Sherpa said everything in records would be on Meditech, with queries in messages. "After 30 days, the records will be delinquent if not properly recorded."

Nwachuku asked to table the changes. Vance said she believes it would have to go to the policy committee.

"I want to complete my records," Nwachuku said, "but I'm having problems with Meditech. Dr. Koury and I talked about it and some have become delinquent."

Garcia said he agreed on keeping the conversation going on the Cancer Center.

Arias acknowledged that Dr. Nwachuku had given her names to call immediately about the Cancer Center. "It takes the medical staff to point us to the right people."

During board committee reports, Garcia said the Executive Committee had worked on the agenda.

Trustee Tony Trujillo presented the Quality Improvement Committee report. "We met in June and went through the dashboard items."

Morones gave the Plant and Facility Committee report. "Ms. Miller asked lots of questions. We talked about the state of the facility. We need to get air handlers repaired and replaced over the next few years. We talked about lockdowns and about injuries and safety. It was interesting getting an idea of how departments are staffed. We could handle almost any maintenance issue, with our highly certified personnel. Many of our security officers are retired law enforcement personnel. We have a high quality staff. What goes into running this hospital involves so much. We have an amazing crew."

Arias pointed out that the hospital chef had prepared outstanding food for the board members and invited them to partake.

Trujillo said the Human Resources Committee was glad to see a great reduction in contract labor, with it cut in half last month. "We also looked at filling vacancies."

Schram asked about the number of full-time employees having gone up.

"I think it was the reporting structure," Vance said. "It didn't go up that much."

Garcia clarified that some work half-time, so the numbers of employees is not the same as the full-time employees.

Nwachuku said the Board Bylaws Committee was meeting as needed. "Let me know if we need changes."

He also presented the Finance Committee report. "We recommend a three-month extension at $15,000 a month for Gila Pathology. Hopefully we will soon have a final contract." It was approved after comments.

Chief of Clinical Services Ray Goellner said the sticking point is the need for a memorandum of agreement between Dr. Pavel Capek and Tri-Core to provide coverage.

"We are still working on getting a nurse midwife for the Behavioral Health Unit," Nwachuku said.

Also approved was a professional services agreement with Dr. Donna Bornmann to serve two years on the medical staff credentialing committee at $110 an hour.

The software for storing images in the cloud has a cost of $829,500 for a term of six years.

Goellner said one of the hard drives failed two days ago. It had historic images, so they could not compare them. "We were able to put in a new drive this time, but we're on borrowed time."

The new software includes new hardware, with three parts, Care Stream, the hardware and data migration.

Arias said the cost would be for the software, the maintenance agreement and cloud storage. "This is an upgrade, bringing in a system that will replace what we have from General Electric. Rolling everything into one piece is cheaper than our buying and paying for maintenance."

Vance said the capital piece is hardware, costing $1.3 million over six years.

Sherpa asked if it would interface with Meditech, which the current system does. She was assured it will.

Nwachuku noted it should streamline issues.

Miller asked if outside physicians could access the information, and Sherpa replied that they could, if they were credentialed at the hospital.

Miller asked about the retention policy for images and records. Vance said the hospital has guidelines for how long it has to keep them.

Schram said: "In the banking industry, we have to maintain a robust vendor system. Do we have that? And do we have firewalls to prevent hacking?"

Vance said she asked the same question. "According to the IT people, the company has the responsibility for the firewalls."

Schram urged the hospital not to assume the company has strong firewalls.

Vance said the statement of work lays out what the company will do for its managed service. The proposal states what they will do and the service agreements.

Arias said the upfront costs for the hardware are $275,000.

"Everything else will be monthly or annual," Vance said. "The capital piece was in the budget. Our current cost will be replaced with this. We are paying General Electric now, and we won't pay Care Stream until it's active. Except for the hardware."

The board members approved the software, hardware and licensing.

Vance said the present server is dying. "The images will be transitioned."

The board members went into a break before going into executive session.