By Mary Alice Murphy
In a lengthy meeting, with a divided executive session, Gila Regional Medical Center Board of Trustees, at its regular monthly meeting for September that was rescheduled to Oct. 6, 2017, heard good news on the reopening of the Cancer Center and not as good news on the financial front.
The first item of business was the monthly safety moment, offered by GRMC Chief Executive Officer Taffy Arias. "This week we were supposed to have a drill to prepare for active shooters, which have become almost commonplace. The drill was pre-empted by an active shooter situation that tied up law enforcement. We will reschedule the drill."
Before approving the agenda for the meeting, Trustee Mike Morones moved to amend it and requested the executive session be split with the first portion coming right after public input, so the auditor could present his report and leave to catch a plane in Tucson, AZ.
Leticia Obar, who has worked in registration for 40 years was recognized for her service. "I'm honored to be part of this family. I met my husband at the hospital and had our son at Hillcrest."
The first to speak during public input was Linda Nichols, who has been a cancer patient at GRMC, when New Mexico Oncology was the provider.
"I had a call from Mrs. Arias telling me the cancer center is reopening soon," Nichols said. "That is good news. But I will drop off another records request. I would like to know how much of last month's $1.6 million loss can be attributed to the closing of the cancer center during the transition (to University of New Mexico). I also would like information on JoBeth's salary and benefits (JoBeth Vance is the interim chief financial officer)."
Martha Stuart, also a cancer patient with New Mexico Oncology, said she, as a retired banker, watches numbers. "As part of my treatment I have had to go into the center once a month for intravenous immuno-globulin infusions, as well as every six months I have chemotherapy treatments four times, once a week for four weeks. In February, here at GRMC Cancer Center, I had the chemo treatments. Each week cost $39,499.25 for a total of $157,997. Because I liked my doctor with New Mexico Oncology, I have chosen to travel to Albuquerque to receive treatment. I went to Dr. Fontaine and received my August four times treatment. This time, each treatment cost $10,901.01 for a total of $43,604.16. The treatments here cost not quite four times as much. I gave Taffy a heads up that I was going to talk about this. I have been treated wonderfully in Albuquerque and will continue to travel, so it won't look so bad on my Medicare bills."
Chris DeBolt, county resident and former 10-year GRMC employee, said: "Regarding time passing, the community continues to talk in the absence of factual information. We get lots of rumors and ongoing community conversation. Can we all agree that we absolutely need our hospital here to be intact and solvent? In light of all that is happening, I encourage all of us. We need facts. There are a lot of things we need. We need to come to the source and we have to be voices of reason about what is real and not what is gossip. When I came to GRMC, we were a Planetree hospital. We had therapy dogs, for instance. When things are taken away, it can leave a bitter taste."
She said some people have a desire to see the administration fail based on disgruntlement. She alleged they want to sell the hospital and have it managed by a company. "This isn't the last of the hard changes. Let's try to be as honest and transparent as possible."
"The second thing is discontent over the board not giving out information," DeBolt said. "I encourage the board to be as open as possible. We have to repair and move forward without getting the legal entities involved."
The board went into a two-hour executive session. When they came out, they said they had talked to the auditor and discussed the draft audit report, but had taken no action.
In reports and updates, Frances Day, the auxiliary president, said three auxiliary members, including herself, had attended the New Mexico Hospital Auxiliary conference. "One of the speakers talked on intergenerational employees working together."
She presented some minor bylaws changes for approval. "We want to raise our dues to $8 for the year or $5 for six months, because we have to send $5 each to NMHA. We buy our own uniforms and badges. Our gift store manager is approved by our board, but we don't want the manager to be an automatic signer of checks."
Trustee Tony Trujillo asked why the trustees were approving the bylaws for the auxiliary, which is a 501c3.
Vance said the auditor had said the item was not a material item for the audit.
Board President Jeremiah Garcia said the board is supervisory over the auxiliary.
Trujillo said he wanted to make sure the board is not putting the auxiliary in jeopardy of violating the anti-donation clause.
Morones said the thinks the reason why it is in the auxiliary bylaws is because the auxiliary reports were once upon a time filed with the Public Regulation Commission, but now reports to the Secretary of State. "Let's have them look at this further."
Next on the agenda was a report from the GRMC Foundation, but as no one has attended any meetings from the foundation to report on its activities over the past several months, it was recommended the foundation be removed from the agenda reports.
Arias presented her CEO report. "A physician's assistant has been hired by UNM to serve here at GRMC Cancer Center. As soon as his two-week training is over, we can start up the cancer center. We will host an open house on Oct. 19 from 10 a.m. to 12 noon in the Cancer Center. Physicians from UNM will be present. Starting Oct. 20, an oncologist from UNM will be here every Friday. We have started scheduling patients and will be seeing new ones."
"I know it has been stressful for our cancer center patients," Arias said. "UNM is actively recruiting a full-time oncologist to live here and work Monday through Friday. We need another radiation tech. We have interviewed one, but UNM did not feel like it was a good match. We have two other candidates."
Trustee Jeannie Miller asked if the radiation tech would be local. Arias said: "Yes, but the tech will not do radiation oncology."
Trustee Joel Schram noted that if the former provider at the cancer center had lived up to the contract to provide 90 days of transition, Oct. 20 would have been the 91st day.
Arias said a surprise fire inspection found numerous things, but "nothing huge. We have fixed everything. During the inspection, they noted we had accumulated copious amounts of records near where welding was happening. We will get a better rate on a provider to store our records. We had storage, 11 units full, but we didn't know what was in it. We got a shredding company to shred it and threw away all the broken things. We also found an empty locker that we had been paying for."
Garcia asked if fire drills are done regularly.
"Absolutely," Arias said. "They are part of our annual drills." She commented again that the active shooter drill would be rescheduled. "These types of activities are becoming prevalent, and medical centers have been increasingly targeted, so the best way to prevent them is numerous drills.
"We also have an offer out to a second surgeon," Arias continued. "He has been in constant communication and wants to come here. We are very hopeful. He will be a hospital employee. We are still recruiting for another urologist, an ENT and a pediatrician. We have an ENT from Corpus Christi, Texas, who is interested. The general surgeon's wife is an artist. Jeannie showed her around. The general surgeon wants to help turn this facility into a trauma center on some level."
She said the hospital has been successful in getting a nurse manager for the family practice, cardiology and surgery and pain clinics. "The manager will help the clinics grow. We are looking at expanding the clinics, especially the family practice clinic. We continue to look for a permanent CFO (chief financial officer), a chief quality manager and a clinical manager for the Cancer Center. The latter two will be R.N.s."
Miller asked if they would be nursing and managing, to which Arias replied: "Yes."
Chief Nursing Officer Peggy White said the competency checkoffs are at 60 percent. "We are also updating policy and procedures. We continue to work on lengths of stay."
Garcia asked why the wait times checkoff is at only 5 percent.
"That is one of our highest priorities," White said. "We have nine areas of focus. We have corrected three of them. Others are more difficult. The biggest impact is floor staffing. We are losing three or four to Las Cruces, because they are offering high bonuses. New Mexico is going to be impacted by the loss of multi-state compact licensures.
"We are sending and getting daily emails on the issue," White continued. "We are working on it to get the legislators on the issue, because it will impact many rural hospitals. We just found out that it happened at the state level and don't know all the specifics. JoBeth, Kelly (Rodriguez) and I have been addressing the issue."
Chief of Staff Dr. Greg Koury asked if any of the nurses are coming back from Las Cruces. "The hospitals there are offering bonuses through the roof, but the nurses aren't happy. The Legislature kept the licensure issue quiet. As for the wait time, MediTech is not giving us good data. It is not getting the latest data up. Patients are being seen more efficiently. Some doctors are not hitting the right button—nurses, doctors, everyone."
White said some complex issues are in the nine priorities.
Interim CFO Vance reported volume has been good, except that outpatient services have gone down. "Due to the Cancer Center not being at full capacity, we lose lab, pharmacy and imaging services."
She said admissions to the emergency department have been down, but surgeries up at 482 and 28 births. "Clinics are about the same as last year. The family clinic processing was down, because both of the family practice providers were offsite at the mines testing 30 to 40 people a day."
Gross revenue to the hospital for August was $15.4 million for the month, with net revenue at $1.5 million, salaries and benefits at about $3 million. "Contract labor invoices came in later. We are no longer on contract with Meditech, so now it's an expense. We have one person left. Expenses were down at $5.3 million, and the hospital has a loss for August of $1.2 million. It was expected. We collected $5.5 million and have 58.44 days of cash. Full-time employees stand at 519. The hospital average daily census is 16.2, with an average 3.28-day stay.
Schram asked when the hospital would see a decrease in salaries.
"We have backfilled three positions," Arias said. "We also had to pay out severance."
Koury said he was working with physicians on chart completion. "We are steadily seeing a bit of improvement. Thank you for Nancy, the Meditech consultant. She is very helpful and easy to work with. It is money well spent."
Miller asked if trustees were allowed to attend the Medical Executive Committee meetings. When she was told yes, "can I be assigned as a non-medical attendee?" Again a yes, and she was told the MEC meets every three months, with the next meeting set for Dec. 19. The departments of the medical staff include medical, which includes adults and non-surgery; surgical; perinatal; and maternal and children.
Koury asked for a change in rules to improve communications between the surgeons and the attending physicians.
Kari Lane said the communication has to go back and forth so each understands the patients they are co-managing.
Koury said the 2017 utilization management plan is a committee that reports only to the board. "It works diligently so Vance can collect money. It stays current on the 'game,' on changes in rules. It is vital to this institution. It might be better to call them translators on the criteria for payment."
Miller clarified that every patient has an R.N. case manager. Koury said there are all kinds of inpatient managers at in the hospital. "They help us make sure everything is in the records."
"The committee reviews every admission in real time," Miller said.
"Some get denied, reviewed, and resubmitted," Koury said. "They may get denied because a doctor didn't get the timing and date right. MediTech has helped with this. We have to submit the claim within a certain time. When the time runs out, we can't collect."
Next came committee reports. The Executive Committee set the agenda. The Quality Improvement Committee meeting was cancelled.
The Finance Committee asked for and received approval of a psychiatric on call/locum tenens agreement for inpatient and emergency room service by Dr. Alan Berkowitz, beginning Oct. 1, with automatic renewal. The initial payment is $50,000 and $7,200 for malpractice insurance.
The Plant and Facility Committee report was given by Schram. "Our discussion on IT got lengthy. We plan to circle around to get more information."
Morones said the person wasn't prepared "for our quantity of questions, but he was very competent."
Garcia gave the Human Resource Committee report, and said a contract was delayed because of billing issues. "We are moving to quarterly meetings."
Arias clarified that the dashboard would be updated monthly. "With quarterly meetings, we will see better the outliers and trends."
Trustee Dr. Victor Nwachuku of the Board Bylaws Committee said the committee had no changes.
The trustees after a short break went into the second part of the executive session.