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[Editor's Note: This is part 2 and the final article of the GRMC Board meeting on Jan. 25, 2019.]

The safety moment, recognitions, public input and Board of Trustees' members' input at the Gila Regional Medical Center board meeting on Jan. 25, 2019, may be read at http://www.grantcountybeat.com/news/news-articles/49048-grmc-board-of-trustees-holds-regular-meeting-012519-part-1 

In reports and updates, no one was present from the GRMC Auxiliary and no one had questions about the report in the packet.

Allen Townsend, a member of the Gila Regional Foundation, said the group is coming up with new ideas to support its mission of providing extra funding to the hospital. "We held an open house meet and greet with the new doctors. We will hold our golf tournament in June. We have a new member and three or four more prospects to join in February. We are open to ideas for us to support the hospital. We will possibly do a blood drive. We want to get out into the public and make them aware of what we're doing. We plan to start getting flyers out and will work with the (Silver City-Grant County) Chamber of Commerce. We will try to be more involved in ribbon cuttings, with Foundation members trying to attend."

Board of Trustees Chairman Mike Morones said he appreciated the report. "It has been a strained relationship with the Foundation that we have been trying to fix. There has been little communication in this forum. It's nice to hear about it and freshen it in our minds."

Chief Executive Officer Taffy Arias, during her report, said she wanted to say that the recently held consortium of medical facilities concerning the immigrant influx into area medical centers would not have happened without (Chief Quality Officer) Tanya Carroccio and her team.

She said surgeon Dr. Lamour had left Silver City to join his wife in Santa Fe. "We have put considerable efforts into replacing him. Our finances depend on surgeries and radiology. I've been able to make offers to three who have accepted. One will be joining us in May, one in July and one within a month.

"It is even more important for the hospital to create service lines that impact the ones we already have," Arias said. "In our strategic plan, the big opportunity was the cancer center. We didn't want just a cancer center, we wanted oncology service lines. One of the physicians we have hired does a lot of cancer surgery – breast, colorectal, and full mastectomies. Another surgeon does none of these, but does gastro-intestinal, heartburn and such. When we look at expansion, we are looking at hiring the right people the first time and getting people who are absolutely dedicated to our community. No one has signed a contract yet, so I don't count on them until they walk in the door, but we are in a better position. In family medicine, Emory Coleman went with us on a walk-through on the Bayard Clinic, so we know what we face when it comes back to us from HMS. We have hired two nurse practitioners for the facility and have an offer out for a third that we're waiting to hear from. We're very excited about that. Renny (Mariscal), our physician practice administrator, has already started his new role. He has started setting up monthly meetings one-on-one with physicians and administration to go over the finances of the clinics and the physicians' practices to see what we can do to boost revenues in each practice. We need to be totally accessible to our patients. We closed down the pain practice and sent letters to all the patients and put public notice out. On our outpatient therapy, we hired Frank Grammer to take over the practice at the Wellness Center. He is doing an outstanding job. We had lymphedema services, but when Grammer took it over it jumped from 5,700 in January 2018 to 21,000 in December 2018. It shows that just by hiring the right individual and doing the right marketing plan, how we can grow. Therapy at the facility has jumped from 48,000 in January 2018 to 68,000 in December. He hired a specialist for women's health and pelvic floor services. It went from 1,500 in September to 7,500 in December, and they're just getting started. He is already making a positive impact."

She said they had reported to the Prospectors, the group that lobbies for the county at the legislative sessions. "(Chief Financial Officer) Richard (Stokes) led the effort. He did all the preparation for the presentation."

Trustee Jeannie Miller said she was excited to see the women's health and pelvic floor therapy services. She said a family member had prostate problems that were solved by the therapy. "I'm happy the services are now available in Silver City."

Arias also gave an update on the oncologist application. "We're almost there. It will go to credentialing and the medical executive committee."

Miller asked about the PET mobile unit.

"It was one of our requests at Prospectors," Arias said. "If we cannot get a unit, we will bring the mobile one more often."

Miller also asked about the cancer support group.

"Participants are not coming as often as we would like," Arias said. "Once we have a full-time oncologist, I think they will come more. We also want it for children in the future."

Trustee Ed Wilmot asked about how Santa Fe views the hospital's projects.

Arias laughed and said last year she was "like a fish out of water. It's such a dynamic place. I was so impressed with it. The more information we get out to the legislators, I think they will realize how important our requests are."

Trustee Tony Trujillo who spends most of the session in Santa Fe said Arias would visit with our local legislators. "Our new senator (Gabriel Ramos) is looking for numbers and information, so he can pass it on, on the immigration issue. They are our ambassadors, and we need to make ourselves available to them and bring them up to date. The Legislature will have more requests than there is money, so absolutely visibility is the issue."

"I was impressed with their knowledge and have respect for what they do," Arias said.

Kelly Rodriguez stood in for Chief Nursing Officer Peggy White for the report. "We have taken over leadership for the ER. We're still going after the Level 1 Trauma designation. The Regional Trauma Advisory Committee will be meeting here in March. We interviewed and hired eight of our graduate nurses from Western New Mexico University. They are onboarding today and will start with the educator next week."

Arias addressed Gail Stamler's earlier comment about the nurses coming in from the Philippines. "I wanted you to know that if the nurses were here, we would grab them. We really would. One of the most dynamic pieces Nursing has begun is the internship program to help the nurses to look at patients in a more expanded way than from classes. You have didactic and then the real world. When you have an R.N. after your name, you are expected to know from day one everything a 30-veteran nurse does. This training that we are investing in, in those who have the sparkle in their eyes and compassion, will prepare them. The passport nurses will carry the weight until our new nurses are trained. We need to stabilize this organization. This organization would be nowhere without nursing leadership."

Rodriguez said the nurses from Western were the first class of bachelor's degree nurses. "They came to the interviews so very well ,prepared and ready. We were really impressed with them."

Allen Townsend of the GRMC Foundation noted that the foundation gave scholarships to several of these newly hired nurses.

Rodriguez said the 10 from the Philippines would be in OR, med surg, a couple in lab and development, as well as ICU. "We hired them through a company. When we interviewed them by Skype, we were impressed at how prepared they were."

Wilmot asked if the search for an emergency department director was continuing.

"I'm enjoying covering the emergency room, but yes, the search is ongoing," Rodriguez said.

Trustee Dr. Tsering Sherpa asked if the nurses were coming straight from the Philippines or if some were already in the U.S. Rodriguez said: "Some of both."

Sherpa said she had seen nurses from the Philippines at other facilities, and they are very hard-working.

To a question about housing, Rodriguez said the company works to find housing for them. She said one of the hospital's employees is from the Philippines and she is planning to bring them into her church group.

Miller said she wanted to compliment White on her report, which is always thorough.

"She talks about Vital Core," Miller said. "They are the company who provides services to the Detention Center. What type of services do they provide?"

Rodriguez said the company has medical personnel at the jail and a medical director over the group. "At discharge of an inmate patient from the hospital, we provide a sealed envelope, which goes with the patient to the jail. Since Peggy and I are the interim emergency department director, we see that the envelope gets to the patient."

Stokes said the process with the Detention Center is the same as the one with the Border Patrol.

Miller asked if the nurses are paid during their internship training, and Rodriguez replied that they are.

Miller also asked about the cardio-pulmonary rehab.

"I am the champion of that program," Rodriguez said. "It is in its infancy, but I am working with those with COPD to address their needs. Dr. Stinar is the one who wants the program. This is Gila Regional's program."

Carroccio said: "We had the very fortunate ability for our quality director and regulatory director to go to the Institute for Healthcare Improvement safety forum in Florida. She went with nine from New Mexico. She identified that everyone is working on their 5-star quality program, so we have healthy competition. A lot of people are focusing on the standards. I'm a quality advisory board member to the New Mexico Hospital Association. It's really nice to share quality information with non-winners. The quality director at NMHA called me and said they had an idea to use a podcast mechanism to disseminate the information. They asked us to be the first ones, so Renny (Mariscal) and his team with Amanda are going to talk about the care transitions, because we did win that award."

She continued and said her department did a campaign for flu shots. "Last year we were at 60 percent of personnel having received a shot. This year we're going to be closer to 80 percent to 85 percent. That will reflect in quality."

Sherpa noted that Medicare requires 90 percent by 2020.

Carroccio said there is a lot of influenza-like disease coming in. "We run a flu test."

Sherpa said it's a swab test. "We send it to the lab and have the results within an hour."

Trustee Joel Schram said he is pleased they are making progress on the flu shots. "Are our doctors and administrators part of it?"

"I am," Arias said. Others said that they were, also.

Doug Oakes presented the marketing report. He showed samples of new advertising. "We are advertising through November on the outside board, with information starting in February."

Miller said she loved the Christmas ad. "How are we doing with respect to the budget?"

Oakes said it is fluid. "It changes on a daily basis, but we're still within the budget. We're spreading out our spending for brand changes. Our ads are service line based to an audience we want to reach." To answer a question about TV, he said it's OK on local television, but it's a waste to advertise to Albuquerque or Santa Fe. "Yes, we do have billboards on U.S. 180. "

Wilmot asked about using social networking.

"We are media neutral," Oakes said. "We just do local. For instance, I can track and measure our success on Grant County Beat. I do try to do social media. For instance, we got shares on our immigration health care consortium. Generally, I find this community supports social media."

Trujillo said he hears good things about Gila Regional's local ads. "It's because we have a good story to tell."

Oakes agreed.

Chief of Staff Dr. Brian Robinson said the hospital needs to promote the four-hour stays for shoulder replacement. "I think you would get a huge impact for that on LinkedIn. I don't need to be in it, but we can do it. For things we can do, these are a chip shot."

"We have to promote all our service lines aggressively," Trustee Dr. Victor Nwachuku said.

Oakes said he had finally completed the service-line ads. "I will run them in flights throughout the year."

Trujillo said people's stories are always good. "The doc's right. Service lines are important."

Oakes said for the branding campaign, "I want them to choose us as a choice. I want to create brand preference."

Miller noted that Gila Regional is a community hospital. "It isn't like we are picking out some. I also like the press releases."

Stokes at the beginning of his report said he finds it refreshing to have physicians saying: "What a difference a year makes."

In December, the hospital had a loss of $160,387, a bit better than what was the expected budget for the month. "That brings us to a fiscal year-to-date loss of $279,047, compared to last year's $4.4 million loss. That's a $4.1 million swing. EBIDA (Earnings before interest, depreciation and amortization) is $80,565. That generally shows the cash spin off. Year-to-date EBIDA is at $1.1 million positive as compared to last year's $2.3 million loss."

"We've had a change in methodology," Stokes said. "The pharmacy charges are half what they were. But the lower charges have not cut reimbursements. We are getting the same dollars as before. Health care pricing has gotten to where the charges are so high for patients, there is little value for us to have high charges." He said the new pricing is on the website and will compare Gila Regional with Deming's Mimbres Memorial, and Las Cruces Mountainview and Memorial Medical Center, using the Medicare approved CPT (current procedural terminology) code. Stokes said how the bills go out may require separate bills.

Miller pointed out that people complain about pricing at the hospital when they can get the same test at a stand-alone lab at a cheaper price. "But we run 24/7 and the tests are available when they are needed."

Wilmot asked if things were starting to stabilize so that changes won't be as dramatic. "When will we be in a position to determine whether we should go critical access?"

"Maybe this summer," Stokes said. "We have made a lot of progress, but we still have a lot of changes to consider. We have an issue with Presbyterian, because of them having the wrong code. There are still a lot of known corrections to make, as well as a lot of unknowns."

Trujillo said the hospital will have to have money in the bank before it can go critical access.

Robinson gave the chief of staff report. "In the MEC (medical executive committee), we are working on better communication and documentation. We are going to focus to reduce redundancies in meetings to have fewer meetings and get more done with the time we have." He said Dr. Stinar was congratulated for passing his critical care boards and Dr. Lash is now the chief of surgery. Dr. Meyerowitz is taking over chairmanship of the Credentialing Committee. Dr. Stanley will replace Dr. Meyerowitz as chairman of the Ongoing Professional Practice Evaluation Committee."

Arias acknowledged the physicians for taking on these committee responsibilities. "They usually come before or after work for these meeting. I sit in on most of them. I really applaud the physician staff for taking on these positions."

Morones, during the Executive Committee report, asked for the trustees to sign their annual affidavit to serve, as well as the conflict of interest statement. "They need to be done today. We do them annually to re-verify, especially the conflict of interest statements. The Open Meetings Act statute requires us to acknowledge that we are following the act and making any changes that need to be made. We will continue holding our meetings on the last Friday of the month at noon, subject to change. We must put out a public notice at least 24 hours in advance of a special meeting, and we can call an emergency meeting if an issue is not anticipated."

He said written minutes will be kept, except for executive sessions.

Nwachuku said the board members have talked about providing as much information to the public as they can of things that are discussed in executive session.

Miller gave the Quality Improvement Committee report. "We held it Jan. 21 after the consortium. The status of key performance indicators run on the calendar year. We will report on them for 2018. Patient indicators are moving up. The IT department is one of the departments that support our front-line departments. Quality helps us practice our mission. I find myself entirely energized at the QIC meeting by our Quality Department. There is a lot of cross communication between departments. They really do a lot."

She said she presumed that the consortium conversations would not be just on immigration. "The Border Patrol is dealing with three different sectors, and each sector has a different set of rules. Everyone at the consortium meeting was very supportive of the Border Patrol. It was fascinating to see how our team made everyone feel comfortable. We all shared and talked about how we could work together. I hope it will go forward. I think everyone appreciated it."

Miller said the QIC will recommend to the board to include the word safe in the mission statement to read "in a safe and healing environment."

Schram noted it was already part of the strategic plan.

Arias asked what had to be done to get the wording changed. Morones said he felt it would be most appropriately done at a strategic plan meeting.

Schram presented the Finance Committee report. "One of the major things we accomplished is moving to a more sophisticated management system. It resulted in 800 positive adjustments. We have asked for more robust clinical reporting to determine what is adding the most to our bottom line."

Wilmot asked how the Plant and Facility Committee could report items to the Finance Committee.

"You can make recommendations to Richard," Schram said.

Miller noted that Stokes has started attending the plant and facility meetings.

"That might fit into the strategic plan," Morones said. "We will discuss it in executive session."

Nwachuku asked for the approval of the contract extensions for 10 on-call specialty agreements and nine other agreements.

Arias explained that the extensions were to give physicians ample time to review the new contracts and that the extensions were extending prior extensions.

The on-call specialty agreement contract extensions were for 30 days through Feb. 28, for Dr. Robert Carreon for orthopedic surgery; Dr. Michelle Diaz for Ob/Gyn coverage; Dr. Gregory Koury for pediatrics; Dr. Amos Lash for urology; Dr. Victor Nwachuku for Ob/Gyn; Dr. Okay Odocha for general surgery; Aaron Rudd, CRNA, for anesthesia; Dr. Stinar for critical care/pulmonary; Dr. Frederick Wendler for general surgery; and Dan Zerger, CRNA, for anesthesia.

The agreements included for physician member of OPPE for Dr. John Stanley; for surgical services provider employment for Dr. James Rosser; for family medicine physician employment with non-operative obstetric services for Dr. Virginia Hernandez; collaborative care in telehealth for Las Palmas Del Sol Healthcare; Locums Tenens staffing with Comp Health; master lease extension for the surgical services clinic building to April 30, 2019; employed physician extension with Dr. Norman Ratliff; a three-month employed physician extension for Dr. John Stanley; and an employed nurse practitioner extension for Cynthia Moreno, NP.

Stokes noted that the hospital has multiple pieces of property, so "we want a master lease agreement so we can add and subtract pieces as needed."

He also said that they, in reviewing the contracts, had found different contracts with different physicians. "The only thing that should be different is the particulars for that provider. We are standardizing these contracts to reduce variability between agreements. They will come back next month for approval of the final contracts."

Miller gave the Plant and Facility Committee report. "The safety moment that Mrs. Arias brought up is the same as what we discussed on how the hospital will handle such threats going forward. We get reports from Safety, Environment, IT, Medical Equipment and others. All maintenance has been completed. IT reported that the scanning and archiving mechanism conversion move from Meditech 5 to 6 has moved to live. We are moving ahead with leasing contracts for new IT infrastructure, so that we will have more space to do things in, and it gives us the opportunity to streamline the operating system and give us a smaller footprint of hardware. We are also keeping an eye on the Bayard Clinic facility as we move forward on that."

Morones presented the Human Resource Committee report. "We will move our quarterly schedule to fit the hospital's quarters. It will allow the HR Director to report to us. We are reducing information to make sure that what we receive is more meaningful. Mr. Wilmot is trying to focus what information the director will give us. It will be the same information, just more focused."

The trustees took a break and then went into executive session.

Live from Silver City

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