[Editor's Note: This meeting was recorded and photographed by Sandra Michaud. This author has taken notes from the recording.]

By Mary Alice Murphy

Silver City-Grant County Chamber of Commerce Board President Derek Ratcliff opened the meeting and introduced Ray Davis of American Legion Allingham-Golding Post 18. Davis said, before Chamber President and Director Scott Terry came back into the room: "I see (Gila Regional Medical Center) hospital people here. I want to say it's an amazing place. We at the American Legion support the community, youth, veterans and veterans in need."

Davis presented Terry with a certificate of appreciation for the work the chamber does in promoting businesses and the community.

District 4 County Commissioner Billy Billings was the featured speaker. Ratcliff introduced Billings by saying he finds it refreshing when politicians speak truthfully. "Thanks to all you people who work hard for the future of Grant County."

Billings said he is a native of the area. "My second great-grandfather and his brother were in the mining industry in Colorado. They came to New Mexico and logged north of Pinos Altos. Then they started a ranch and had a butcher shop in town. Before the shop, they butchered cattle at the ranch. They stopped in 1894. They would deliver a beef a day every day, even Christmas, fresh in the morning while it was cool, because people didn't have refrigeration. I try to keep the balls in the air for my and my wife's ranching business."

He said Terry asked him to talk about several issues and Billings chose to bring in the experts on them. The first issue was the senior centers. "The county had the centers and had problems with them. One of the things I like is when government can contract out with someone to do the job better than the government can. I'm not sure how County Manager Charlene Webb and Hidalgo Medical Services Chief Executive Officer Dan Otero made a connection for HMS to take over, but they did last year. I asked an expert on the issue, HMS's Edith Lee, to talk about the senior centers."

"On July 1, 2017, we agreed to take over the four centers – one each in Silver City, Santa Clara, Mimbres and Gila," Lee said. "It's been a year of transition. We had a rocky start. We didn't have a full picture of what we were walking into. The centers are funded by federal and state funding through the New Mexico Area Agency on Aging in the Long-Term Services Department, through local support and through seniors' contributions. Anyone 60 years of age or older can use the services. We served 609 seniors last year. We did a survey and 91.75 percent said the senior centers have had a positive impact on their lives."

HMS serves congregate meals, as well as hot, home-delivered meals to those who qualify. "We also provide transportation to get them to the centers, to any medical appointment, to pick up prescriptions or go to the grocery store."

"Last year we served in Grant County 23,026 congregate meals, which was a 24 percent increase in the numbers at the centers," Lee reported. "We delivered 30,227 meals to homes and we provided 10,581 rides. We've been working hard to get other programs and educational opportunities into the centers. ICAN, ideas for cooking and nutrition, comes to the centers. The AARP provides free tax return help, we bring in legal experts, representatives of Senior Olympics visit the centers, and the WNMU nursing students continue to do screening at the centers."

She read excerpts from a letter from the NMAAA after their annual assessment. "We have to follow a lot of regulations and processes. The summary came out in June and the letter said they were impressed by the accomplishments over the past year. They commended the cohesiveness of the team, the cleanliness of the centers and the evidence of accomplished compliance."

Melanie Goodman of U.S. Sen. Tom Udall's office said she had two questions. "Do you have a sense of how many grandparents are raising their grandchildren? And are you aware of two federal programs that could bring in funding. They are the Retired Senior Volunteer Program and the Foster Grandparent Program."

Lee said HMS was interested in pursuing the issue of grandparents raising their grandchildren and it is being researched at the state level. "The county runs a senior volunteer program, and I'm familiar with the foster grandparent program. I will pass the information along to April Hunter, who is in charge of the senior centers."

Billings said he was sorry HMS didn't know what they were getting into. "I did." And then he posed a question: "Do you know what one-third of county taxes go toward?"

A guess from the audience was roads, but Billings said it's the jail. Many of the inmates have mental illness or addiction to drugs and alcohol or both. He invited Amanda Frost from HMS to talk about Tu Casa, the newly constructed treatment center for substance abuse, which is managed by HMS.

"I work for HMS as the senior mental health program director," Frost introduced herself. "The Tu Casa building is up. It's an 8,000 square-foot facility recently completed." She reported the recent rains have brought to light some leaks that will have to be addressed.

"The services HMS is going to provide include basic outpatient treatment, which is being handled by Tranquil Skies right now, and they will do the services at Tu Casa. We will also provide intensive substance abuse outpatient treatments, as well as medically assisted treatments, by telehealth from a contractor in Florida. My boss, Dr. Neil Bowen, emphasizes therapy, so those who receive medications will also receive therapy. We will have a peer-support service by those with limited experience of receiving treatments, but the providers will be certified to help individuals because of their experience. We will also do motivational intervening."

She described the social detox section as a room with chairs. "Those coming down or withdrawing from addiction will come together in a social setting. We ultimately will serve 24/7, but not until later. There are only three such treatment centers in the state. Silver City's will be the first to open, because we're a little ahead of the ones in Albuquerque and Santa Fe. The hold up in opening has been because of the Department of Health having never licensed such community detox centers before, so there have been snags. After the licensure, which we hope to get on Monday (Aug. 6), then comes the credentialing, which will take about 30 more days. We need a crisis triage center, which will come later. At the beginning, we will be open regular business hours from Monday through Friday. Once we get the crisis triage set up, we can be open 24/7."

Billings asked how many employees will be in the facility.

"We need nursing staff and therapists," Frost said. "When we are open 24/7, we will have peer support certified personnel in the facility, including overnight. We will get medical screening, with medical staff on call. We will have at least 20 to start and then ramping up to about 31."

Billings asked about the expected number of patients.

"We expect to be very busy," Frost said. "We have an idea, but don't want to commit to a number at this time."

Billings said another topic that Terry asked him to address was the hospital, Gila Regional Medical Center, so, Billings asked the Board of Trustees chairman, Mike Morones to attend the luncheon. "I want to thank the trustees for all the work they do in their non-paid positions. I speak for the community and the Commissioners as the number of hours of service is incredible. I also ask the new Chief Financial Officer to come up." Billings also introduced Doug Oakes, the new hospital marketing director."

"As trustees, we truly appreciate what the county has researched on health care today," Morones said. "The commissioners want to make sure we're a quality hospital. We have developed a plan and we have to execute it. This will lead to other areas pertinent to the community. We are not willing at this time to ask for public money. This whole process plan is developed for Gila Regional to be sustainable on its own. In a year or two, we may then go to the public for money when they trust us. We'll be able to do beautiful things. We want a positive bottom line, and we want to recruit and retain specialists. The balance sheet and the days of cash on hand are important so we can move forward. We plan to go forward on critical access."

Richard Stokes, the CFO, said Billings made a statement at the county meeting that the process the county did was based on finances, "so, why are we here working so hard on patient care? Because that's what brings people into the hospital. I had zero hesitation at taking my wife to this ER when she broke her elbow. I haven't felt that way with other hospitals."

He noted that the Centers for Medicare and Medicaid (CMS) gave Gila Regional Medical Center a 4-star quality rating. "There are a lot of other quality agencies. I like to look at Leapfrog, because it's an industry-based organization. Gila Regional received an A rating from Leapfrog. And in 2018, Gila Regional was recognized as the only hospital in New Mexico to be rated in the 100 Rural and Community Top Hospitals by the Chartis Group and iVantage."

"I hear people say they are going to Las Cruces," Stokes said. "It's a big building, so they must know more than Silver City. Well, Memorial Medical Center in Deming has a 2-star rating and a B by Leapfrog. Mountain View in Las Cruces has a 2-star rating and a B by Leapfrog. Memorial in Las Cruces has a 1-star rating and a B from Leapfrog. University Medical Center in El Paso has a 1-star rating and a C from Leapfrog.

"When we have patients leave here to go to another facility, they spend their dollars there," Stokes continued. "When they spend their dollars here, each dollar returns 2.3 dollars to the local economy. Going to Las Cruces, they are going to an organization with a lower quality rating than we have. The damage comes when they spend their money in Las Cruces and it makes Las Cruces richer and Silver City poorer."

He said the strategic plan the board has created has initiatives for the hospital to follow. "Our main strategy right now is getting the Cancer Center at full operation. We had a full-time oncologist willing to come to Silver City, but he was not willing to commit while the status of the hospital was up in the air. We are interviewing another one on Aug. 23. If the applicant accepts, the oncologist will be a full-time employee of the University of New Mexico Cancer Center, which is what we prefer."

Stokes talked about the major update to Meditech, the electronic records system that runs in the hospital. "Our No. 1 safety issue is how will the system work? We are in the process and have spent many hours optimizing Meditech, the update of which will go live Aug. 22."

"Our biggest issue is finance," Stokes said in his southern drawl. "I told them I was originally from southern New Mexico. They saw right through that. I'm from South Carolina and I have spent the vast majority of my career in South Carolina with a bit in Texas. But I'm happy to be in New Mexico.

"The revenue cycle has been a struggle," Stokes continued, "but we are in the process of correcting it. During this time of sending out thousands of old statements, we are granting anyone 30 percent discount for paying their bill in full. We sent out 3,000 statements recently. If you find problems in the bill, we won't know about them unless you call us and give us a chance to fix them."

The revenue cycle is the major project for the year, according to Stokes. "It centers around optimization and Meditech."

"We are also improving and expanding our clinics," he said. "And we are implementing a marketing strategy with Doug."

In public meetings, it was stated that Gila Regional collects about 30 percent of what it charges. "It has bounced around from about 26 percent, but never got over 30 percent. At every hospital where I've worked, and this is my fifth, when the collection rate was low, we looked at the charge structure. Our charges are lower than Las Cruces, Deming and Albuquerque, but in May we hit 30 percent."

To address the billing issues and the revenue cycle, Stokes said he recognized the need to transition to an outside entity to help fix the billing. "My goal is to get to a consistent 35 percent collection rate. I'm confident we can maintain that rate. Self-pay statements are going out."

An audience member asked what the norm is for collection rates in hospitals.

"Well, first of all, when you've seen one hospital, you've seen one hospital," Stokes replied. "Each one is different. The charge percentage is based on the charge structure. In South Carolina, I saw percentages from 35 to 38 percent. I'm confident we can get to 35 percent and more. Each percentage point is $650,000 to the hospital instead of leaving it with insurance companies."

Terry asked if the company outsourced to this time for the financial side of things was different from the previous consultants used.

"Yes, it's a different consultant. This is the first time I have outsourced a billing office," Stokes said. "We made a two-year agreement with HRG, but I fully intend to start pulling billing back internally when we get the processes fixed."

Billings said: " It was a breath of fresh air when Richard came to us and told us what we knew was broken and had a plan to fix it."

Billings went on to say the Commission has proposed an $8 million continuing bond issue to be placed on the ballot in November. "I've been hearing and seeing erroneous information. We are fixing things, like roads, that need to be fixed without raising taxes."

Ratcliff thanked the volunteers who helped put on the recent Wine Festival. He announced the Chamber-sponsored golf tournament to be held Aug. 18. "We serve our members by promoting commerce and tourism."

Terry said a Small Business Expo would take place in October. "We will have a speaker on how to reduce stress for small business people at a luncheon, followed by the Small Business Expo."

"The September meeting of the Silver City-Grant County Chamber of Commerce will take place at Bear Mountain Lodge, with WNMU President Joseph Shepard talking about the GO bond," Terry said. (It has since been announced that County Manager Charlene Webb will also speak on the proposed County bond issue.)

Terry said because the venue is smaller, it is imperative that members register for the luncheon as soon as they can.

Cecilia Bell of the Fort Bayard Historic Preservation Society announced Fort Bayard's 152nd birthday on Aug. 18, and Fort Bayard Days to take place Sept. 21, 22 and 23.

Trent Bohl announced that Cactus Jack's medical cannabis dispensary is open seven days a week.