By Mary Alice Murphy

Gila Regional Medical Center Board of Trustees members didn't get great news, but it was better than in the recent past.

The meeting on Friday, Nov. 17, 2017, began with a safety moment. Chief Nursing Officer Peggy White said her department had identified some trip hazards. "Maintenance will take up the carpet and replace it with tile this weekend. We appreciate any staff members bringing such things to their director who brings it to the safety huddle we hold every morning. Patients and their families are welcome to let us know, too."

Trustee Tony Trujillo asked if the hospital has a safety officer. White said it is under security and is part of a monthly meeting on safety and security. "We are creating a culture of safety," White said.

Three long-time employees of Gila Regional, with a total of 100 years of service to the hospital were recognized at the meeting. They include Paul Donet, with 40 years of service in the laboratory; Dora Romero, with 40 years of service in patient financial services; and LuAnn Wittrock, with 20 years of service in the behavioral health unit. None was able to attend the meeting.

"One hundred years of service among them," Trujillo said. "That says a lot about our organization and a lot about their commitment. I think recognizing these caregivers is one of the most important things we do every month."

Linda Nichols gave public input. She said under the University of New Mexico professional services agreement, it says that medical and radiological services will be provided to cancer patients every day, excluding holidays. "I called and asked when the first appointment available to see a doctor is and she told me Jan. 19, 2018. I also asked about if the person needs chemo or radiology would it be fair to say, after evaluation by the doctor, it might be as long as 90 days from now. And she said: 'Every bit of that.' I would like to see you push for someone down here so patients wouldn't have to wait so long. When I was first diagnosed with cancer, I saw Dr. Clark 14 days out. To generate more dollars for the hospital, you need to have physicians here."

She said she had requested through the Inspection of Public Records Act, the salary and benefits for Interim Chief Executive Officer JoBeth Vance. "I’m concerned about the dollars going out for her services. She's great and doing a good job, but she was paid $233,000 from March to September and it will cost another $167,000 through next February. She also gets $38,311 in benefits, plus $90 a day for housing and a rental car for $17,000. She has travel benefits, which she has not used. But I hope she gets to spend time with her family over the holidays. At the end of the day, I don't see how you can justify a half million dollars. I suggest you negotiate a salary and keep her on. Cash on hand is down to 52 days. Please make an effort to get the salary lowered or get someone on board."

"With all due respect," Trujillo said, "and I know public input does not receive answers, but when you are comparing numbers, it's apples to oranges. What we're paying JoBeth is well below the standards of what she's worth. I ask you to look at the salaries of CFOs at similar-sized hospitals, like Deming, Lovington and Artesia. I think you'll be surprised. I'm all for being competitive. I don't think we pay nurses enough. We are losing them to other hospitals. For professionals, we have to be competitive."

Board Chairman Jeremiah Garcia said what the hospital is paying Vance is not even close to what past CFOs have been paid. "She has done an outstanding job. If we had not had her here, we might be closed. We still have days of cash on hand and no debt. We knew we would have a loss with the cancer center transition. We've had CFOs in the past who have not found the problems she has found. She has ethics, morals and a work ethic. I want to personally thank Mrs. Vance. She understands the compliance and regulations that go into hospital finances. It's not just balancing a checkbook."

Trustee Mike Morones said: "She's finding every problem. That's how we fix it. I'm an accountant, but she has given us 10 years of education in just a few months."

Administrative Assistant to CEO Arias Joann Holguin added: "JoBeth also proofreads my minutes on top of everything else she's doing."

Auxiliary Vice President Jennifer Yost was available to answer questions about the Auxiliary report, but none was asked. "We always like to thank the auxiliary for what they do for the hospital," Garcia said.

Chief Executive Officer Taffy Arias said the new surgeon, Dr. Tariq Ibrahim, is already seeing patients and is also going to other communities soliciting patients for Gila Regional.

"We have seen 35 patients in the Cancer Center," Arias said. "And yes, the schedule is booked. It was brought to my attention that the previous cancer center provider had two providers come every week because they wanted to see as many patients as possible." She said Commissioner Billings had told her about it. He was present and she thanked him.

"As a result, I reached out to UNM, and asked for another physician to come to Silver City," Arias said. "We had a boom in referrals starting in January. One of UNM's physicians is scheduled for jury duty, but if she is not chosen, she will be here for the rest of the first week. We have started capturing charges from the center. We will send out the first bills at the end of the month."

She said the hospital has purchased the radiological software. "Some of our equipment was inadvertently taken when the prior provider left. We have asked for it to be returned. The software has begun to be implemented."

On the issue of the hospital supplying and replacing drugs for the Silver City Fire Department ambulances, "Mr. Brown and I and the EMS director had a lengthy meeting. We have jointly come to an agreement. We are currently paying thousands for oxygen. We have housed it in our department and we will replace their oxygen, too. We have created an account to track and monitor the expenditures. There must be a run sheet that tracks back to specific patients."

Gila Regional is preparing for the Joint Commission on Accreditation of Healthcare Organizations (JACHO) to visit sometime between January and May.

The active shooter drill has been rescheduled. And due to growth in the number of surgeons and with the recruitment efforts for another urologist, the hospital is looking for larger spaces to house them.

Trustee Jeannie Miller said it sounds like things have improved with the fire department.

"The best way to communicate is in person," Arias agreed.

Miller asked about the patient tracer item. Arias said the hospital is looking for the specific person that is given the drugs. "Where do we find it? We trace it back to the beginning where the patient entered the process. Through the tracer, we can see the gaps, whether it's in nursing or somewhere else. We create a plan of action to eliminate the gaps. Hospitals need to be accreditation-ready at all times, because it's the right thing to do."

"Who initiates the tracer?" Miller asked. "It can be anyone," Arias said. "Nursing or I or compliance."

Miller asked: "So it will be embedded in our culture?" Arias agreed.

Trustee Joel Schram asked how many hours are spent on public information requests. "It's staggering," Arias said. "Because we work with two law firms. Lawyers charge by the second. We get bills by the minute for phone calls, emails, texts. We want to make sure we get the correct information every time. We are a business and we are taking away from someone's job. It causes confusion and uncertainty. It causes a sense of uncertainty about self. Am I doing something wrong? It sets up a tone of distrust. It's deeper than just a financial cost. We have nothing to hide. We are here for you."

Morones noted: "There are legally things we can't say. We are transparent as far as legally possible."

Trujillo asked about the issue of equipment that was removed and what the cost would be.

"Yes, it's a cost," Arias said. "That's why the attorneys are working out the details."

White added to her report with an update on the New Mexico requirement for an NM nursing license or an enhanced nursing license for those coming from outside the state. "I thank Tony Trujillo for his help. Sen. Howie Morales and Sen. Gay Kernan will sponsor the bill. All but 15 of our nurses have applied for New Mexico licenses, and should receive them by the first of the year. All but two travelers, we will replace with others who have New Mexico licenses."

Trujillo said there has been a lot of bi-partisan support for the effort in the Legislature. "It has to be done in four days to meet the deadline. Otherwise, hospitals, especially rural ones will be significantly impacted."

White agreed that it was predominantly the border hospitals that would be impacted because they have nurses who commute across the borders.

Miller asked about the potential for a pediatric affiliation with UNM. White said the hospital wants to get some in depth training. "Several UNM doctors have a huge focus on pediatric patients. It will be a formal agreement. We hope to set up a consultation agreement for physicians here to be able to talk to them about specific cases. It will start in the emergency room, go next to surgery, the med surg unit and the behavioral health unit. This has been driven by our local pediatrician, Dr. Brian Etheridge. He will work closely with us."

Vance gave her CFO report. "Our volume in outpatients is still down, likely due to cancer center care not being fully operational. Our inpatient volume is up over last year. Our gross revenue for October was $14.3 million. Our loss was significantly better than the past three months at $445,000. We have a negative of $4.4 million year to date. We have 55.24 days of cash and 44.3 days in accounts receivable."

Miller asked about recurring patient revenue. Vance said it refers to patients who come in multiple times, such as for physical therapy, to the cancer center and some lab tests.

Trujillo noted the 3.6 million in unbilled accounts out of the 16 million sent out.

Vance said that is how many claims are sent out. The unbilled are those that have documentation or coding issues. "That number came down, which is good. That's why health care is different from other businesses, which bill and receive what the invoice says. We run at a 30 percent return. A lot of things have to happen to get the payments in. We're trying to get it smoother. Of course, insurance makes money by not paying our bills. We send out the same invoices to everyone. We get it back in different percentages."

Trujillo said 26 percent are beyond 180 days. "Getting paid is a tough issue."

"Getting the bill out the door is the first step," Vance said.

Miller asked if the hospital budgets on what it gets in or what it expects to get in.

"Both," Vance said. "We budget using the gross revenue, the contractuals and bad debt."

Miller asked about the monthly report where it says family practice providers expect 2,200 visits. "Is the 2018 budget expecting 2,200 visits?"

"That was an error," Vance said. "We will never meet that number."

Miller noted that net-net revenue for October was ahead of September. "So we're moving ahead."

Morones said the report shows the hospital grew in days of cash over September, by one day. "Last year, we projected that we would have no cash on hand by now. It is significant in the details of the work and how highly controlled our expenses are. We are doing very, very well. The 2015 data talked about getting down to 16 days in cash. It's significant that we're maintaining in the 50 plus days of cash. We have just changed how we operate to make it more clean and efficient."

"This is huge for people to know," Morones continued. "Without these ladies (Arias and Vance) we would look significantly different."

"I will tell you, I, for one, based on the way things were happening, we had seats set up for the Titanic," Trujillo said. "Now, I think we can put them away."

Vance introduced the Interim Controller, Alfredo Pacheco. "He is doing a great job."

"I'm from Alamogordo," Pacheco said. "I've been in health care since my second job, which was in home care and hospice. The bulk of my professional career is in health care finances. I am enjoying working with this staff and being here."

Miller noted the graph showing last year in October to this year. "We were in bad shape. Something happened, then it fell apart again and now we're on the way up."

Chief of Staff Greg Koury was not present, but Trustee Dr. Tsering Sherpa said she would be happy to answer any questions.

Trustee Dr. Victor Nwachuku said the proposed change in bylaws would allow only certain people to vote on an issue.

"JoBeth and I have grave concerns about this," Arias said.

Sherpa said she would take it to the Medical Executive Committee for clarification and bring it back next month. She added that quality checks are being done in the lab.

Kari Lane said the labs are doing everything in house except for LDH (lactate dehydrogenase) tests which test for signs of damage to body tissues.

Sherpa reported that patients are seen in the cancer center every day, but by an oncologist only on Fridays.

On the board committee reports, Garcia said the executive committee met to approve the agenda.

Schram said he was the only attendee at the Quality Improvement Committee, "so we didn't meet."

The Finance Committee had a couple of contracts to approve. They included a physician member agreement for Dr. Laura Davenport-Reed to serve on the Ongoing Professional Practice Evaluation at an hourly rate of $150 from Dec. 1, 2017 to Nov. 30, 2018. An additional agreement for the same rates and time was a physician consulting agreement for Dr. John B. Whitaker to serve on the OPPE Committee.

Schram gave the Plant and Facility Committee report. "We were introduced to Emory Coleman as the new director. We have seen a large uptick in stand-by hours because of violent patients and other issues. Security was very active over the past month."

Trujillo said the next Human Resources Committee meeting was set for December, as it meets quarterly. He noted contract labor had moved up.

Vance said: "We do have an interim controller and an interim supervisor. We have help for IT (information technology). Dec. 9 is the last day for HIM (health information management) and IT help."

Garcia noted that overtime was staying below 3 percent. "That means we are managing operations as we should be. We have had to bring in a couple of travelers in surgery."

White said: "We have plans to offset that, fingers crossed."

Nwachuku asked board members to read the Board of Trustees bylaws and review them in case of questions. "We have to constantly review and correct and bring them to the Bylaws Committee."

Before the trustees had a 15-minute break and then went into executive session, Trujillo wished all the guests a Happy Thanksgiving.