By Mary Alice Murphy

At the Gila Regional Medical Center Board of Trustees meeting on Sept. 27, 2019, preliminary business included introducing Dr. Colicia Meyerowitz, vice chief of staff, serving at the meeting in place of the absent Chief of Staff Dr. Brian Robinson.

As is customary, a safety moment, launched the meeting. Chief Nursing Officer Rose Lopez said an enhancement in the nursing program is important from a safety point of view. "We are enhancing coding to make sure the patient is getting the correct medication. We scan the patient and we scan the medication before it is administered."

It was noted that following recognitions and board input, the board members would go into executive session to hear the auditor's report to accommodate his needing to catch a flight.

grmcimg 0727Roberta "Bertie" Berry receives recognition for her 15 years of service. From left, are trustees James Marshall, Cynthia Moreno, Chairman Tony Trujillo, Berry, partially hidden trustees Jeannie Miller and Joel Schram, CEO Taffy Arias and trustee Dr. Victor Nwachuku.First to be recognized was Roberta "Bertie" Berry, who has served 15 years in the emergency room.

"It has been my honor to serve the community for the past 15 years," Berry said. "I'll be here a lot longer."

grmcimg 0728Rachel Benavidez receives recognition for her 10 years of service in the Cancer Center. From left are trustees Marshall, Moreno, Trujillo, Benavidez, trustees Miller and partially obscured Schram, CEO Arias and trustee Nwachuku.Second to receive recognition was Rachel Benavidez for her 10 years of service in the Cancer Center. "I love my job," Benavidez said.

Arias then presented another recognition. "Today is (Marketing Director) Doug Oakes' last day. He came to us in a turbulent time, and he captured in advertising the richness of our community."

Oakes said: "It was my greatest pleasure and an honor to serve Gila Regional. I'm grateful for the administration. I wanted to tell the story of this hospital and this community."

No one signed up for public input.

Trustee Dr. Victor Nwachuku started off the board input. "I wanted to recognize the physicians in the Medical Executive Committee. They include Dr. Robinson, Dr. Meyerowitz and Dr. Norman Ratliff. I thank them for the work they do."

Chairman Tony Trujillo said he attended the most recent meeting of the MEC. "I was impressed by what I saw and heard."

Trustee Jeannie Miller said she was impressed with the amount of work the hospital will do at the Mimbres Valley Harvest Festival. [Editor's Note: It would take place the next day.]

"Gila Regional, we need to think of Gila Regional not just as place for emergencies; we need to do more and get down into the community," Miller said.

Trustee Joel Schram said he was honored to attend the recent 50th anniversary awards banquet of the Gila Regional Auxiliary and the recent MEC meeting. "In both places, I felt very welcomed. The auxilians are neat people who wear our pink and blue jackets."

Trustee Ed Wilmot said as he gets to know more about the hospital and staff, "the more I'm impressed. Every Plant and Facility meeting continues to amaze me. It was impressive at the MEC meeting, too."

Marshall thanked the staff for the orientation he received as a newly appointed trustee. "It has given me a different view as I go through the packet. I noticed that in the minutes it doesn't give all the discussion. I think the record should show the history, so we can go back and find out what happened. I would like to be able to go back. I do that."

Trujillo agreed. "We're a group that wants to be transparent."

Moreno said she, too, agreed on the minutes, because sometimes, "I have to go back to work. I feel support because my questions get answered."

Before reports and updates, the trustees went into the first executive session to hear the auditor's report.

After about an hour of session, the trustees returned and said that no action had been taken in executive session.

Frances Day presented the Auxiliary report, as President Marilyn McCracken was attending the New Mexico Hospital Association conference. "We thank Joel for attending our auxiliary awards banquet. We will hold our big 50th anniversary event on Monday, Oct. 28, from 2-4 p.m. in the courtyard. We will have a brief history presentation. At the awards luncheon, Silver City Mayor Ken Ladner gave us a proclamation." She read it to the trustees. In included that the Auxiliary raises funding to provide scholarships to staff members and to fund hospital equipment. The group was founded in 1969 in the month of October. "Our volunteers put in 4,000 hours in the past year. We will have a banner posted at places the auxilians work. On behalf of the Auxiliary, we want to thank the board for serving the hospital voluntarily. Thank you for all you do."

Trujillo encouraged board members to attend the event. He read from a letter from the NMHA congratulating the Gila Regional Auxiliary on its 50th anniversary. Although it is not the oldest in the state, it is the most active.

Chief Financial Officer Richard Stokes said he attended the NMHA. "I sat with a full table of ladies from San Juan and they were bragging about all they did. I told them: 'You need to come to Gila Regional to see what our auxilians do.'"

Vickie Schram presented the Foundation report on behalf of President Allen Townsend. "We approved $25,000 to the Billy Casper Wellness Center for replacing carpet. We will elect new officers next month."

In the Chief Executive Officer report, Arias said she would like to highlight two departments.

Rennie Mariscal, as director of clinical services, gave an overview of the clinics. "We have spoken about our focus on customer service. We are scheduling a call center just to take calls from patients for appointments, new and old. It will bring a reduction in the volume of calls in the clinics so they can focus on care. We have started a patient satisfaction survey. We did a pilot in cardiology and got great feedback. We will roll it out to all the clinics. With the pilot, we had a good response at 57 percent. We give it to the patient when they come in. Most want to fill it out at the end of the appointment."

For management of staff, "we are working on how we want the clinics to take care of patients."

For the rest of 2019, the plan is to do marketing for the existing clinics. "We will participate at the Mimbres Valley Harvest Festival – at least four of us, including Dr. Butch Rosser, Dr. Andre Worrell, Diana Portillo and I will be going out there. We will focus our marketing on clinic service lines. We will have a rotation of specialists and diabetes educators in Deming. We want to build occupational therapy, including RVUs (relative value units). The value of the visit is established through the complexity of the visit. For example, a complex medical situation or a surgical situation."

Stokes explained the RVU value is what CMS (Centers for Medicare and Medicaid) give as the intensity of the work provided.

Wilmot asked if the clinics have targets.

"Since January, we have been gathering benchmark data," Mariscal said.

Miller asked if the clinics know the source of referrals, whether they are internal or external.

"We know the providers meet with the clinical providers," Mariscal said.

Miller asked if there were a maximum number of patients. "For example, for one cardiologist and one nurse practitioner,"

"We know we always have the opportunity to grow," Mariscal said. "We are looking for another nurse practitioner. If it's anything we can do here, we do it here, but sometimes we have to refer people to Albuquerque and Las Cruces."

Arias said the hospital monitors all its transfers. "When we look at interventional cardiology, for example, we are gathering data for a potential cath lab here."

Mariscal noted that the number of clinical patients jumped in July, because nurse practitioner Mike Harris came in and his patients followed him. "Gila 1 is podiatry with Dr. Iwaasa and another nurse practioner. Gila Surgery 2 is in the same complex as the pediatrician. They do share clinic managers."

Mariscal said he had an anecdote to report. "When the staff prepped for this meeting, we played the Jeannie Miller game. Everyone plays the Jeannie Miller game to get the most complex questions that we may need to answer." Chuckles went around the room, as Miller is known for her multitude of questions.

Arias noted that she also wanted to recognize a department that gets very little recognition—the Materials Department under Michelle Carrillo.

"We do all the purchasing, shipping and receiving for everything, except the drugs and the food," Carrillo reported. "Our other subsection is distribution. We process 450 to 470 purchase orders a month, and we have freight of 60 to 70 UPS and FedEx packages a day. We receive 12 to 15 pallets of freight a week. We are within compliance at 91.6 percent, which fluctuates. Part of those out of contract were the clinics. Upstairs, we have Pyxis units (automated vending machines for medications) in labor and delivery, nursing, ER and the ICU. The good thing about the machines is that there are in secure units. We want to standardize what is in them. We are starting to reduce inventory and trying to consolidate the units."

Arias said Carrillo is over the contracts with vendors. "She will haggle on prices. There was a situation where people were being loose on credit cards. Now Richard and I have to sign off on orders."

Carrillo said she signs off on the order and it goes to accounts payable. "Things when they come through are checked and matched to where they go. I don't trust vendors. I've been here 26 years. We are in the first-floor warehouse. Our being on site makes a huge difference. I want to brag that discrepancies on accounts have improved. We work from 8 a.m. to 4:30 p.m. During evening hours, security has access to additional materials that may be needed."

Wilmot asked if she oversees every contract.

"Our contracts go through corporate compliance," Carrillo said. "Any time we get a capital request, it goes through me."

Stokes said he did the negotiation with a particular vendor and "we issued the PO. We have another piece of equipment in discussion with Medtronic on equipment for the OR. Michelle will do the analyses on prices, freight and the term of the contract. It comes through me or Taffy to give permission. She handles all the routine purchases."

Lopez concurred that Carrillo negotiates for prices.

Arias noted that all the information was in the packet. "I want to highlight, with the departure of Doug, our recruiter Kathy-Lyn Pacheco will be the interim marketing director. We have someone coming for an interview."

She said the employee engagement survey had already reached 45 percent response, with two weeks to go. "The cardiology clinic was the first to get to 100 percent, so they got a pizza party. When I gave the report to the commissioners, I said we want to give increases to staff members. Last year, we did analyses for bedside nurses and environmental staff and gave raises. We are analyzing CNAs, materials management, registration, OR techs and respiratory techs."

Stokes said the administration gets questions about the helicopter flights going in and out of the hospital. "They are parked here, so they are not necessarily flying people out. They could be going somewhere else."

Lopez presented her CNO report. "We are excited about the Mimbres Health Fair. The Cancer Center will also be there, as well as Beginning Years and the Stop the Bleed program. We are providing and making appointments for the clinics and for mammograms. Eloy (Medina, EMS director) will be giving a presentation on the right time to call 911. In the ER, we are at about 127 minutes door to door. The new ER director, Dr. Kotch, wants a robust process for the ER. We used to use Swank for education. We have changed to Relias, because we can customize it."

She noted that Gila Regional can take care of stroke patients. "We are 100 percent NIHS (National Institute of Health Sciences) certified for stroke care. We are also using the tele-neurology very successfully."

Marshall said he has brought patients into the hospital in the late evening. "If triage is busy, we are met with a closed door. I may bring in a patient with dementia. It would be nice to have a button to push rather than having someone have to get up to open the door."

Lopez said they are evaluating the ER waiting room. "We want to put in a doorbell. We recognize that it is a challenge. We are hoping to make it better."

On the issue of traveling nurses, she said three international nurses have arrived and are waiting on their social security cards.

Chief Quality Officer Tanya Carroccio said she wanted to highlight how incredibly important it is to be continually ready for an assessment survey. "In safety and quality, we always need to be accredited. M.D. Anderson recently lost its accreditation. Large or small, we have to follow the same standards. CMS looks at hospitals with a fine-toothed comb. We are always looking at our accreditation. It's a high priority and we look at it from a continued readiness perspective. We have consultants come into high risk areas to look at them with a new eye. We do mock surveys. We are training nurses to do them, so we know what regulators are looking for. The surveys are written as if for the Joint Commission. We work closely with communication. I would like to point out that I sat for a professional patient safety officer accreditation. I got a scholarship for the intense courses. I passed. I was surprised at the things I learned, and I will always continue to learn. The courses covered five domains: safety culture, leadership and safety, patients and safety, system thinking and design, and measuring and improving goals."

Miller noted that the multi-disciplinary approach always comes through. "I'm so glad to see you pull them together."

Arias said marketing will continue to highlight services and technology at the hospital. "We are doing campaigns to highlight individuals. The first was Rennie. Next will be the stroke support group, which started in August."

Stokes said his news on the finances wasn't great. "We spent more than we took in. The year-to-date loss is $279,900 compared to a $377,000 last year. Cash collection is down to 29 percent, but it's up in net revenue to 123 percent. In cash collection, we are taking contracted cash and collected cash and creating a percentage. We had a shift in the payer mix. I'm not to the point of concern. I don't like it, but we're continuing to manage net revenue. We're not resting."

He said he got the contract for a vendor for a zero balance account project. "We need some data from IT, and I need to review the contract, which I just received about an hour ago. Then Miss Taffy needs to look at it. My goal is to have it done by next Friday. The contractor usually takes about 60 days. They need access into our Meditech. The question we always run into is bandwidth in IT. Every month, we will make a submission to this company. Hopefully, we can identify issues before we send it to them. September is generally a slow month. We are projecting 161 admissions and maybe a few more in ER. Surgery may be low. Oncology ticks up, but gross revenue looks to be low. We continue to hold cash collections at about $4 million a month."

Marshall said he has lots of questions and wants to sit with Stokes. "I see 67 positions open."

"Taffy will be culling positions," Stokes said. "In our budget, we put in what we have and what will be coming."

For the chief of staff report, Meyerowitz said Dr. Robinson said he didn't have anything to report. "The MEC is a great group of physicians working on policies. In the OPPE (ongoing professional practice evaluation,) Dr. Stanley is trying to streamline the process, with Dr. Dalton looking at it, too. In bylaws, we are looking at the fair-hearing procedure."

Wilmot noted that there is in action item from the last meeting. Trujillo said last month the trustees approved the nurse practitioner privileges.

"I asked about the sign off sheets with electronic records," Wilmot said. "I was looking at whether everyone is doing what they are supposed to do in the approval process. We need evidence in the approval process. Do you think it's important enough to have evidence of completion of the process?"

Meyerowitz said maybe it would be beneficial to have signatures in one place to make sure the process is followed.

Stokes said at the end of each document is a notation: approved on this date.

Nwachuku asked how the privileging is done.

"When they come to privileging, they have to have a case log," Meyerowitz said. "For instance, for infusion or procedures, Dr. Stanley has been signing off on them."

In board committee reports, Trujillo said the Executive Committee reviewed and approved agendas.

Miller reported on the Quality Improvement Committee. "I want to call attention to the fact that trustees have access to our report. It is critical to know. If you have questions, forward them to me or Tanya. We will be looking at the risk management plan draft. Another thing—on the last page are all the plans and policies that the board has to sign off on."

Schram gave the Financial Committee report. "We discussed volume information, which contributes to less than satisfactory income."

When it came time to approve contracts, because terms couldn't be discussed in open session, trustees said they hadn't had time to look at them.

"It was short in time again," Wilmot said. "Can you get the information to us faster? We need more time to review them."

Marshall said: "I would vote yes all day, if it stays authorization by CEO."

Carroccio said: "As we revamp the compliance program, we will delve into these questions. I think we can make a lot of changes."

Marshall said he cannot defend approving a title.

It was decided to table it and discuss the terms in executive session and bring them back for approval as the first item in open session.

Plant and Facilities, Human Resources and the Bylaws committees didn't meet last month.

Trustees went into executive session after a 15-minute break.

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