By Mary Alice Murphy

At the beginning of the meeting of the Grant County Commission regular session on Nov. 9, 2017, after the approval of the agenda, Taffy Arias, Gila Regional Medical Center chief executive officer, approached the podium to give her report. She asked first that Dr. Tariq Ibrahim introduce himself, as the hospital's newest general surgeon.

"I was born in Dallas, grew up in Dubai in the United Arab Emirates and returned to Dallas to attend the University of Texas Southwestern Medical School," Ibrahim said. "I began my career in New Mexico. I started with the Indian Services in Gallup, went to Ruidoso, then to Mountain View in Las Cruces. I do bread-and-butter surgery and endoscopy, and ultimately I want to build a trauma center here, whether level 3 or 4, I don't know."

Arias said the hospital is looking for a larger space for the two surgeons that work for the hospital and a new urologist when one is recruited. "If you know of any buildings, let us know."

She thanked Commissioner Billy Billings for reaching out to her with a couple of questions. "He was questioning the amount of time the previous provider of cancer care had spent in Silver City. I was under the impression that it was only once a week. But I found out that when Dr. Clark retired from his trips to Silver City, the former provider started bringing in someone twice a week, on Tuesdays and Thursdays. The previous group saw a need to get patients in and taken care of. It was an appropriate service. In reaction, we have reached out to UNM to increase coverage, if possible."

"The other thing he asked me was about Molina insurance and what we are offering," Arias said. "What we are offering is an extension of a Molina product. As a hospital, we are having issues with getting reimbursement from Molina."

Billings said he was told that Molina is the most affordable carrier in New Mexico for the Affordable Care Act. "I was told, with Molina, they can't get service at Gila Regional."

JoBeth Vance, interim chief financial officer, said: "We and others statewide are having trouble getting bills paid by Molina. Here you can get coverage at Molina out of network, but at a higher rate. We are looking into it out of network for some products. It's getting a contract done."

Commission Chairman Brett Kasten said he saw two issues. "Contractual and not getting paid."

Vance said the main problem is trying to get paid. "Their product, we may not be signed up with for some service. What we offer is a product at the plan level that a person may not be part of."

Arias said October is looking better financially. "A lot has to do with cleaning up of processes. We've been dealing with an inadequate financial process."

Vance presented the end of September report, as the October report has not yet been approved by the Board of Trustees.

"We are in line with last year's admissions," Vance said. "We have had 838 outpatient visits and zero cancer visits the first quarter of the fiscal year. Last year we had 147 admissions and have had 149 this year, so inpatient is comparable. We took in during the month of September last year $18 million and $14 million this September. Net revenue in September 2016 was $5.5 million and $4.0 million this year. Our total expenses have dropped year-over year. Last year expenses were $6.1 million and this year $4.9 million. So we are going in the right direction. Most loss was due to the Cancer Center not operating. Our loss in September was $1.3 million. Days in cash have dropped from 97 last year to 52.8 at the end of September 2017. Our average daily expenses have dropped from $199,000 last year to $187,000 a day this year." She noted that although the days in cash have dropped, they have held steady in the 50s over the past few months.

Commissioner Gabriel Ramos asked what the hospital was doing proactively.

"We are working to capture more revenue," Vance said. "We are getting bills out more quickly and we now have people dealing just with denials to get them turned around quickly."

About the hospital's collection rate on amounts billed, Vance said: "We have a 30 percent collection rate, which is about what Medicare and Medicaid pay. We are in the process of closing out October, and there will be a loss, but less of a loss."

"It gives me hope that when the Cancer Center is fully up and running, our revenue will go up," Billings said.

"Our volumes and revenues will go up," Vance agreed. "We will be in better shape."

Billings asked how much it cost Gila Regional not to have the cancer center transition in place.

"I can't give you dollar amounts," Vance said. "The bulk of our losses this past quarter were due to the Cancer Center being closed, so the system was not capturing billing."

"You weren't here and Taffy wasn't here," Billings said. "This doesn't reflect on you. Dr. Willman at the chamber meeting said the process should have taken 12 to 18 months, and it's been four months, so you have done a lot."

Kasten asked in some surprise: "What you're billing for and for every dollar you get 30 cents?"

Vance said everyone gets billed the same amount and "30 percent collection isn't bad."

Kasten noted that for a recent hospital bill a member of his family received, "it was a plain bill, with no itemization. I would like more information on the invoices."

Arias said she has spoken about the individual town halls she is holding with hospital departments. "So far we've held 15 for an hour to an hour-and-a-half each. We hold them at various times of day, morning, afternoon, evening, night, whatever is most convenient for the department members. It has been helpful for me to solicit input on issues. We use Survey Monkey to get input from staff. We will adjust as we get information."

Kasten said he would like to know what percentage the hospital is getting on surveys.

"People have shared a lot of information," Arias said. "We have a sense of where we need adjustments."

The following article will begin with public input and get into the agenda items at the regular session.