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Category: Front Page News Front Page News
Published: 25 July 2018 25 July 2018

By Mary Alice Murphy

Before the press conference began on Thursday afternoon July 19, 2018, Gila Regional Medical Center Board of Trustees Chairman Mike Morones said the hospital was already stepping down the strategic plan. They were celebrating the Grant County Commission's unanimous decision to let the hospital remain county-owned and independent.

"Because we're smaller, we can move faster," Morones said.

Chief Executive Officer Taffy Arias formally opened the session by thanking the Beat and three members of the Silver City Daily Press staff for being present "at a most eventful time in the history of this hospital. It's interesting that years ago, under the same scrutiny, the community prevailed in keeping the hospital county-owned and not sold because they felt it was a most important part of the community."

"Without health care services, a town ceases to be a community," she continued. "What secures us as a community is not just the beautiful surroundings, good business, good health care, industries, but also the prevailing economy and what the hospital has to offer and the jobs it creates."

Arias said the recent ads for the hospital have a common theme about life and "the community we are here for. It's not just lip service. It's a true commitment by the caregivers, the physicians, the Board of Trustees. We're all here for you, not as a monetary generator, but for each as a human being, with a family, a mortgage, a job, a dog and a life. Those things are valued by Gila Regional and everyone who works here. It is a blessing and an honor to serve everyone who enters our doors."

She said she believed the community realized with tremendous appreciation what the hospital offers. "They rallied around us. We could not have asked for a better, true validation of what we offer. We couldn't do it without the Board of Trustees. I am constantly reminded of their level of commitment to this hospital. One of the toughest decisions we had to make was the change of the Cancer Center provider. I will tell you, it had to be done. Being out there, taking the criticism that occurred was because of a lack of understanding. We couldn't give all the information because it was protected. The Board was strong enough to make the tough decision in spite of the backlash. The Board members have a thankless job. Few in the community have a true understanding of the role and responsibility of the Trustees. They are affecting the lives of everyone."

"I am so fortunate to have been interviewed, hired and supported by this group," Arias continued. "I am elated by the results of the vote today. The total support of the community, for [the commissioners] to have gone against it would have been going against their being a voice of the community.

"They pointed out we have obstacles, but we have support and commitment," she said. "We have people committed to this organization. Even people coming from outside the community, they came, they saw, and they fell in love. We have administrators and leaders (who are) 100 percent dedicated to the success of this hospital. That will never waiver. We ask the commissioners to rally around us and support us. Health care is not for the faint of heart. It's only for those who are focused and know the strategy and recognize the outcomes years from now, based on the strategy of now. We have a strong, detailed strategy that we have already initiated even in the light of the controversy and indecisiveness of the Commission. We know where we need to be. You have leaders who will get the hospital fiscally sound unquestionably."

Daily Press Publisher Nick Seibel asked if Arias would give a preview of what she would have said had the vote gone the other way.

"We would have expressed our deep disappointment," Arias said. "We would have offered very little thanks to the Commission and great thanks to the Board of Trustees, the community and the people who work in this hospital. We had a press release for both outcomes. We would have said the work of the Trustees, the physicians and the caregivers cannot be minimized."

Seibel asked Arias if she was surprised at the unanimous vote.

"I was surprised and very, very glad it went the way it did," Arias replied. "I was almost speechless because I knew the gravity of the other way would have been devastating. How could I come back to 600 people to tell them their commissioners voted against the hospital? It was something so terrible to consider that I could not have delivered the message."

Daily Press Editor Christine Steele asked if Arias would give a sneak peek at the strategic plan.

"Absolutely," Arias said. "It is expand, expand, expand and recruit, recruit, recruit. We want to open more clinics. It's the only way to bring good solid revenue. We will do all of them as we can afford them. We can't afford to stop. It's paramount to get new physicians opening up new sites. One strategy is to expand a pulmonary rehab/cardiac rehab. We're already started it. We have the groundwork built; now we will exploit it."

She said this administration looks at what needs to be done, weighs the problems and "we act. We don't have to go through the layers of bureaucracy before we can act on what we know is best. When Richard comes and says; 'Can I do this?' I say: 'Go for it. Can you do it by Friday?' And it's Thursday."

Seibel asked how the hospital plans to expand clash with the Hidalgo Medical Services expansion.

"There's room for everyone," Arias said. "We receive different types of funding. We should be able to work together. I think the vote said: 'You will work together.' The hospital will work with the community. I know we had a little rift with HMS on LifePoint. It will not happen again."

Stokes noted that recruitment and service line recruiting are the CEO wheelhouse. The CFO optimizes "what we have today; identifies the opportunities outside, but also recognizes and optimizes the opportunities inside."

Arias said the hospital will be doing the residency program in conjunction with HMS. "We train the attitude, the compassion and the human spirit of the physician. It's not just the skilled physician, but the one who cares about you, your child and your wife."

Daily Press reporter Ben Fisher noted that several physicians the hospital had recruited had been hesitant about coming amid the uncertainly of the status of the hospital. He asked if any were still available.

"They are all gone, except for a general surgeon," Arias replied. "I need to call him after this press conference. We do a have a physician coming in August to interview for the full-time oncologist position."

Seibel said the issue of the Cancer Center lay at the roots of the situation that got the Commission involved. "Do you foresee any changes, because the decision was allowed out of the public eye just because you could keep it out of the public eye? But should you?"

Morones said the Trustees will have to live with and juggle the exceptions in the Open Meetings Act. "We are accountable to the Commission, which also has to follow the OMA. We want to follow the spirit of the OMA. If we do not, the commissioners can choose not to reappoint us. Regardless of the exception, we have to move toward more accountability. We will rely on the spirit of the OMA and are working toward doing business in front of the public."

He noted in the former way of doing things, there had been utilization of the exceptions without following the spirit of the OMA. "(Trustee) Tony Trujillo, at the time of the Cancer Center change, said it was a flawed process. I think this board moving forward believes in the spirit of open government and the OMA. We will rely on the exceptions, when it is extremely important to the hospital, but we will be working within the spirit of the OMA."

Fisher said the commissioners mentioned going to a ballot issue for the hospital, but that the board preferred to wait a year.

"We haven't made a preference," Morones said. "We want the taxpayers to feel good about what we're doing. It should take a good year to articulate to the public that their taxpayer dollars are going to a good purpose. I can't imagine being able to do it sooner."

Seibel asked if the hospital could wait that long.

Arias said it was never part of the strategic plan. "What we have been doing is making the financial cleaning up of what was neglected for, I believe, decades. We are finding so many opportunities that will have a direct impact to our bottom line. Everything else is on top. It will cost to open clinics and recruit physicians. We will have to make sure to make financially sound investments. We have to determine the potential volume that specialists can sustain."

This author noted that during the rest of the commissioners' meeting they discussed a bond issue that will be on the ballot in November. "Today they talked about adding money to that bond for the hospital."

"Speaking for myself," Arias said, "I think we have some hurdles of trust with the County Commission, even on validating data. We have to get through this as a body working together. We can't work with people who are against us. In the spirit of working together, we have to have a common understanding of the goal. Sometimes, revenue will be not good; other times, it will be good. Trust, once you lose it, it's hard to get back, but I'm a business woman. As long as we understand that it is for the good of the whole."

Morones said: "If we were to articulate this, we don't have any plans for county bond money. But in many cases, money comes first. If we do get money, we would work with them for the appropriate uses of the money."

"We have never gone to the county and asked them for anything," Arias said.

Seibel said he appreciated the statement of properly planning for a future bond issue. "The Commission handed you the opportunity for community support with comments that the public needs to support the hospital. How will you capitalize on that good will?"

"We have to continue to do our due diligence and clean up our processes internally before we go asking anyone for help," Arias said. "We owe it to the community to clean up the hospital first before we ask the community to help us. We have to say; 'We've done this. We show you this, but we need a new hospital at some point. Eventually the community will need a new hospital, but not yet. I would rather say we've done everything we could."

"We will perform, and we will build on that good will," Morones said.

Trujillo an election like this takes on a life of its own. "We want to make sure we have our ducks in a row before we ask. We will manage the good will."

Seibel said it was interesting to him to see from some of the loudest critics of the Cancer Center issue, the loudest voices this time were being the hospital's biggest supporters. "It was a head-turning turnaround."

"I've been here my whole life," Morones said. "The Cancer Center was a piece of the whole. It's like your pinky finger. You don't want to cut it off, but if it's the hand, the pinky doesn't matter as much. We had a number of people rooting for us saying we needed to keep the hospital. They are still mad about the Cancer Center, but they understand this is macro. We will continue to make people unhappy over a piece. We will make hard decisions that are not popular, but I think we're doing well. But they won't forgive us for some issues."

Arias said the piece about accountability is critical. "We should all be held accountable for our actions and decisions. It a necessary part of all of our lives. We cannot pick and choose accountability. When I came here, I started holding people accountable, some who held important positions. I'm held accountable by the Board of Trustees, the Commission, and every single person of the community. I have so many bosses, I can't keep up, but I welcome accountability. It makes me better; it makes me stronger; I know it makes me a better leader. I think our Commission is being held accountable now."

Seibel asked about capital needs and deferred maintenance on the physical plant. "There must be some study?"

Arias said the hospital does a capital assessment annually, and "we do a five-year plan. Nothing at this point needs to be done now. Equipment may be at the date of end of life, be we have good people taking care of it and it still works fine. We would never say no to money, but we are not at the point where we need to ask for a new roof or a new this or a new that."

Seibel said when Brian Bentley was the CEO, several CEOs ago, he did a roadshow of changes he envisioned were needed at the hospital.

"To spend money, we have to make money," Arias said. "When we have reimbursement for the critical access designation, we won't need as many beds. The industry standard now is to minimize space, but keep it full, through maximum use. Larger hospitals are going smaller. This hospital was inefficiently built for our needs today. There are too many steps for caregivers, which makes them tired. What we have to do is determine where is our waste. What can I change to operate more efficiently operationally and financially where we are now? Yes, the labor and delivery area needs help, but how many births do we have? Labor and delivery is generally a happy place, where the mothers need a cheerful environment and one of serenity and happiness, but we have to be efficient. We are not there yet."

Stokes said when the hospital was designed it was for a world where acute care was the driver of health care. "That's not the case these days. The majority of services are moving to outpatient. It's a good building. We might have a few leaks, but so do others in town. Critical access will allow us 25 beds. It's a reimbursement methodology. We are already a critical access hospital by definition, but we're not being paid for it. We very rarely go above 25 full beds. The designation will have virtually no impact on services. I am completely confident it will bring more dollars. Yes, Congress can change the model to restrict it or even make it sweeter. A lot of the representative represent rural hospitals, so it likely will change."

This author said she had heard from some that the critical access designation would mean more people being transported out of the hospital.

"That is not correct," Stokes said. "We are a $200 million gross hospital. There are critical access hospitals with $200 million net."

Arias said the community would be totally unaware of it, "unless we tell you."

She also said the hospital is looking at restarting the home health and hospice services. Stokes added that as the hospital moves to more outpatient services, "we have to have the ability to manage and provide care after discharge. It's another of our obligations to provide treatment beyond discharge for the patient and the family. There is no reason not to extend some type of care through home health. I don't know why they stopped home health and hospice, but this is a different time and a different team."

Seibel asked about legislation brought up in the last 60-day session of the New Mexico Legislature that would have changed billing for hospitals. "The governor vetoed it. Would it have been helpful for Gila Regional?"

Arias she didn't know the details. "Our stance is to be prepared, like a good Girl Scout or Boy Scout, for the unknown, because it's coming."

Trujillo said the bill would have been very beneficial to Gila Regional.

Stokes talked about the Medicaid 1115 waiver. "New Mexico is following on the heels of Texas on how to treat uncompensated care. It has been put into place on how to qualify for the 1115 waiver in the 2020 fiscal year. New Mexico didn't technically expand Medicaid, but petitioned CMS (Centers for Medicare and Medicaid) for a waiver. Federal funds continue to flow into the state, but rules are being developed that will change for 202o. We watch these things and start acting before they kick in. CMS accelerated the changes in Texas, which didn't let the hospitals know. It severely hurt a number of rural hospitals. New Mexico is taking slower steps toward it."

When asked when the celebration would take place, Arias said: "Tomorrow (Friday, July 20). We're having a lunch cook-off for all the employees. You're invited, too."

Seibel said a couple of commissioners expressed their concern about the challenges faced by the hospital and the "unqualified board." He said it seemed they thought corporations could figure it out better than "our little community hospital. Will we do better than a corporation?"

"I say, Yes," Arias said.

Stokes said they should go to Georgia, Louisiana or Arkansas to see the hospitals spun off by LifePoint. "There are examples after examples. It goes to the leadership. There is no community hospital with hospital experts on the board. But this board asks some very good questions. It's our responsibility to help the board members understand why we are doing some things. We have recruited, well, Taffy has recruited some leaders with experience. Miss Taffy herself has years of experience. Tanya (Corrasco, chief quality officer), who was recruited from Banner Health, has lots of experience. I have a fair bit myself. We have tons of experience. Leadership is critical to lead people down the road now and knowing how to lead them. Miss Taffy has attracted people with experience. If I don't know the answer I know who to ask."

"The No. 1 threat to local health care is local politics," Stokes continued. "The second thing that is a threat is not attracting the right leadership. You have to have the right experience in rural health care."

Doug Oakes (marketing director) said: "It needs to be pointed out that it was this Board of Trustees that brought in this CEO, who has had successful for-profit hospital experience. Taffy has been able to attract Richard, Tanya and others. We have leadership with experience running a hospital like a business."

Morones said Gila Regional had tried a little experiment a few years back by using home-grown administrators. "They were smart people, but with only the experience of what they had seen here. We have people with talent here who could be employed and could perform at a large hospital."

Seibel said the County Commission felt that it was a flaw not to be able to hold the Board of Trustees accountable. "I'm not sure I see it as a flaw. Do you have any concern? Will this set a precedent for locally elected county commissioners to be involved in the hospital?"

"I think their desire is to know every single thing," Arias said, "but that can be too much. I was offended by Commissioner Browne. He showed his true lack of understanding of health care and what goes on. We've agreed to be as transparent and communicative as possible and to share on a more regular basis. What I need to see from them is a true desire to move forward. I need to see that people are not stuck on an agenda."

Morones said he found troubling the piece indicating the board is not accountable. "When I served as mayor, the accountability came with the public giving comments. Oddly enough, we also have public input. People give us negative comments. City councilors are difficult to recall. Their ultimate accountability is to be voted out of office. It's the same for the County Commission. For us, it's hard to take us out on a whim, but we have limited terms. Those who appoint us are held accountable and they hold us accountable by not reappointing us. For me, it's a head scratcher of where we lose accountability. The direction they're going could undermine the Hospital Funding Act. The setup of the act was well thought out and done for good reasons to separate the bodies. It's been well documented through Attorney General opinions. Where they're heading would break down the separation that protects the public, protects the Commission, protects the Board of Trustees. Yes, we need to follow the spirt of the OMA. We will work together when it's appropriate, but we need to balance it, so we don't endanger the protections of separation."

Trujillo said the classification of unqualified grated. "I think my job is to make sure the Taffys and the Richards do their job, what they are best at. We're here to do the politics of it. It was a difficult process and caused a loss of trust. We have to build it back by communicating better. My intent is to let Taffy and Richard do the work. We're committed to doing our work. My job and my intent are to deal with the politics and build trust back up. They made the right decision for the right reasons. I applaud them."

Trustee Joel Schram said it was unfair to say the members were not experienced. "I was a hospital board member for two years in Michigan and two years here. I appreciate the process that the commissioners are using to choose board members. They will be getting more qualified people. But we need a diverse group of people to bring more ideas to the table."

He said he had considered applying for a trustee position one year, but "when I saw the hospital lost $1 million one year and made $11 million the next, I recognized the administration did not have a good handle on the problems, so I did not apply. Then I applied and was appointed. I knew we had a problem, but we brought in a team that can fix things. Over the next 12 to 18 months, we will be the hospital generating revenue for capital needs without the need for tax dollars. I have that much faith in this administration."

Fisher asked if it would be possible for the board to put into writing ways they plan to follow the spirit of the Open Meetings Act. "Maybe in bylaws for more communication to make it more long-standing so the next board doesn't change it."

"That's a good question," Morones said, "but I don't know how to document it. We just have to start changing the culture of how things are done. We can do education on holding to the spirit of the OMA. When you put it in writing, you are starting to undermine the Hospital Funding Act and adding requirements that aren't there. If we put in restrictions, did we undermine and take away the protection from us, from the county commissioners, from the public? There could be ramifications. My gut feeling is that we should live within the law, not hide behind the technicalities."

Trujillo, at the end of the conference, thanked the members of the press for keeping the pressure on members of the public to support their county-owned hospital.