By Mary Alice Murphy
This part 2 of the Gila Regional Governing Board meeting on July 29, 2021, begins with the Chief Nursing Officer report by CNO Kelly Rodriguez. The first part may be viewed at https://www.grantcountybeat.com/news/news-articles/66637-grmc-governing-board-holds-monthly-meeting-july-29-2021
She said the Nursing Department overall is taking a step back on project management in nursing itself. "We are going to start focusing more heavily on one organization project that directly affects quality, so we can start improving in those areas to get us up to the top 10 percent. Sometimes the projects will be overlapping with others, but we want to focus on those quality initiatives that need to happen to improve processes within the department. For a while so much was being thrown at us, we had to prioritize. We'll still do that, but with more focus on organizational quality to improve our patient satisfaction rates. We meet every month to review projects."
In reference to what Interim Chief Executive Officer Scott Manis had said about the swing bed program, Rodriguez said the program would start Aug. 2. "We have finished two of the three trainings to update our providers on how to integrate the swing beds into the medical-surgical unit. There are very minimal changes to how we will care for them, but we will have specific goals for them to achieve during their swing-bed time. So, we will be working on those processes as we get patients and tweaking them to get to an optimal swing-bed program. We will have our first two patients and then we will submit for our survey."
"We are waiting excitedly for our capital outlay money for labor and delivery renovations to be awarded to us," Rodriguez said. "We have done a lot of leg work on the labor and delivery area to prepare for what we need for a contractor, what sort of equipment we need and looking at the renovation. Once we have it, we can start running it. I wanted to let you know that Darrell McPherson, our clinical education director, has onboarded with us. He has hit the ground running. He's doing assessments and intervening in those areas that need an education initiative. We are also working on recruiting for a case management director. We've interviewed a couple of candidates, but we're still looking for that right person. For our Beginning Years program, we have surveyed our clients, and some want to go back to the in-person visitation, whether meeting at home or outside in a park or in the office. Those who wanted to remain in telehealth will remain in telehealth with the providers. We have extended the services to 5-year-olds. We have started looking at service contracts and adding quality and assessment committees to meet with our contractors to make sure we are meeting those quality metrics related to the contracts. We've set up about five committees, so we know we are in compliance with quality. Every year is the New Mexico Nursing Excellence Awards. Last year, we did our first in a long time, so now we are looking at who we will nominate this year. Our deadline is coming up and the award ceremony is set in October. We're excited to nominate someone again this year. Scott talked about the wonderful comments related to our nursing department. In addition, I want to talk about Destiny Gallegos, whom I am recognizing this month. Beyond the letter from the patient, she has received multiple compliments from our patients' surveys. She is a great addition to our pre-op and PACU (post-anesthesia care unit). She just graduated from Western in December, and she is one of our residents, doing a great job."
Last, "I just to talk about Covid, we want to make sure the public remains up to date with what is going on in our areas. We still have limited visitation, from 10 a.m.-noon and from 4-6 p.m. Everyone still comes through the Emergency Room entrance to be screened, except for cancer and surgical patients, who go through the cancer-surgery entrance to be screened. As we continue to see things in the news, the hospital has never been never out of the woods on wearing masks while at work. Staff is continually educated on that, and we continue wearing our masks. As for Covid and the Delta variant, the Department of Health does not submit back to us our Delta variant rates. Of course, samples from the hospital are sent to the Department of Health. What we're seeing in the state of New Mexico, they are saying at the state level that New Mexico has about a 10 percent Delta variant rate. You can go into county data on the DOH website. As of today [July 29], we have 11 cases, so a very low rate. The other thing I can say for us, we continue to diligently screen, and the Delta variant has not changed how we treat and care for our patients."
With no questions for Rodriguez, Interim Chief Financial Officer Greg Brickner said he had no June summary, because it was the end of the fiscal year, "and we're drilling into it. One of the things we're looking at is the Medicare cost report. In January, right after I came on, we did a six-month estimate on the Medicare cost report. There is a really big change from the pre-critical access or PPS (Prospective Payment System), which is what we were before. It's a new process for the hospital. We got the results in February. The way the formula works, it works against us in the successful last six months, so we are doing an 11-month estimated cost report and then we'll use that to book our financials. My goal is to get as close as possible with our final cost report, so when we have the full 12-month cost report that will go in the audit. It will be trued up, but I want to get as close as possible when we publish the June results. I'm taking a little extra time there. At the end of the fiscal year, we had really good news come through. The loan for PPP (Payment Protection Program) was forgiven. That will show a very positive result for the end of June, but we already spent the money, so it's not like we have a huge windfall of cash. Fiscal year 2022 is building on the success of last year and hardwiring some of the processes and improvements into normal operations, so we are solid and maintain that fiscal prudence discipline. The key challenge is paying back the accelerated Medicare payment we received. Last week, it was about $100,000 we paid back. It is a total of $6.8 million that we have to pay back. We started paying it back, I believe, in April. My financial forecast has $4.2 million that we are going to pay back over the next six months. That's a lot of cash that's going to go out the door and why we have to continue the discipline we instituted last year in our financial results."
Governing Board Chair Alicia Edwards asked if the $4.2 million would pay it off.
"No, we will still have another $2 million to go," Brickner said. "That (the $4.2 million) is what I'm estimating in six months. I do a kind of six-month look forward on cash. I'm including that payment because Medicare is deducting that payment when they send their payments every week.
"It's 25 percent we have to pay back during the first year and then it goes to 50 percent in the second year," he said. "So really that's a negative cash flow. We spent it last year, but it was critical to keep the hospital going."
Governing Board Member Harry Browne asked if there was interest charged.
"Not this year," Brickner said, "but it will be charged after the first year." He said it thought it would be close to being paid off at the end of the first year and clarified that the interest would be charged only on the remaining amount of the loan.
"In your action items," he said "there are budget adjustments that true us up where we think we will end up in June. We are updating it based on what we know now."
Edwards commented that it keeps the hospital out of trouble on the audit.
Brickner noted another action item on the agenda is a resolution on the modification on health care benefits to employees. "Our goal is to keep the same benefits, but we're trying to figure out how to keep the cost lower. Likely we will have to change our broker of record. We want to lower the hospital cost without changing the benefits. If we make changes, we will bring them back to you."
On the dual status application to continue being a county-owned hospital, but also achieve non-profit status, he said the attorneys are looking into the situation, working on a draft application, and clarifying some of the nuances with the IRS, because there is not a box on the form that says governmental entity. "Step 1 is to get our 501(c)3 designation. Once we get that, we will ask for forgiveness and go with another firm to resolve the 403(b) [a retirement plan for certain 501(c)3 employees] adjustment."
Interim Chief Executive Officer Scott Manis presented the chief of staff report on behalf of Dr. Brian Robinson. "The credentialing report, which you will approve, you received the information in the executive session. The Bylaws Committee has two new members, Dr. James Rosser and Nurse Practitioner Mike Harris. They are reviewing the medical staff bylaws. The Medicine Committee canceled its meeting last month and for the Perinatal committee there are no significant actions. They welcomed a new departmental director, Melanie Vigil. The Surgery Committee has a meeting coming up in September.
"Reporting on behalf of Mike Lieb of HealthTechS3 this morning," Manis said, "there are two items. HealthTech has been working diligently on the CEO search and identifying candidates. There are a large handful going through the process, doing background checks and screening activities related to them. It is anticipated that the panel of applicants will be brought to the governing board at or before the next meeting in August. The second piece is that we have initiated steps on strategic planning for the hospital. We've done a lot of big action items over the past year—seeking the critical access status, becoming trauma designated and moving into the rural health clinic. Now it's time to really drill into looking at the long-term future of the organization now that the facility is stabilized. The first step will be some very specific steps and that will be facilitated by a lady by the name of Julie Haynes. She will be on site in October interviewing governing board members, hospital administration, medical staff and community members, some patients in soliciting feedback about the hospital about the direction the hospital should be going moving forward specifically for growth. All the information gathered will be aggregated and brought to the governing board and the community over the months following. The process will start in earnest in October for interviews."
No old business. In new business, the credentialing of medical staff report was approved.
The EMS tariff change application as prepared by staff was approved.
A change to the September meeting was approved to change it to Sept. 28 at 9 a.m., with the work session canceled. Edwards said it would be a combined meeting.
The next item was a resolution to mitigate the cost of health insurance benefits to hospital employees while not changing the benefits. The governing board members approved the resolution.
Brickner said the next item, an agreement with Cisco Services is an enterprise agreement for the Cisco Security Choice Suite, which provides the entire suite of networking applications in the hospital. "This contract renews that. It's a combination of some hardware, as well as the software that services that hardware."
Members approved it.
The next four items were considered in one motion and approved as first amendments to professional services agreements for on-call specialty service coverage for Dr. Roberto Carreon, Dr. Michelle Diaz, Dr. Victor Nwachuku, and Dr. Brian Robinson.
A resolution amending the approved and adopted budget for the fiscal year commencing July 1, 2020, and for transferring and appropriating funds thereof was moved and approved by governing board members. Brickner explained that some fees increased, but the change was made to comply with state classifications that are different "from ones we traditionally use. I know part of this was we had to flow the PPP and it comes in as a non-operating expense. It's different from the geography we use and the way things map through on the state report."
The last item was an agreement/resolution to renew the contract with the Southwest New Mexico Council of Governments. Manis said the hospital rejoined the group last year. "The fees are only $400 annually, but because it's a quasi-governmental relationship, they require a resolution." He said the fee is only a small part of the hospital's activities with the SWNMCOG Director Priscilla Lucero, and that it is critical to working with the community and participating with their expertise in grant programs.
Members approved the renewal.
They then adjourned the meeting.