Photo and article by Mary Alice Murphy

GRMC Board Chair Dr. Fred Fox, at left and GRMC CEO Robert Whitaker, right, recognize Robert Candelaria for his 10 years of service in information systems.

The Gila Regional Medical Center Board of Trustees met for the monthly meeting on Nov. 15, 2023.

Board Chair Dr. Fred Fox presented some statistics to the board members comparing large hospitals with those in rural areas. He noted that nurse practitioners who serve rural communities have a greater satisfaction in their jobs. "Although rural hospitals have their needs, there are also benefits." He said that rural students are more likely to have a mentor and receive advice than those in urban settings. He said there are about 1300 critical access hospitals in rural areas along with about 900 rural hospitals without the designation. "Although rural hospitals have their needs, they also have capabilities and are wonderful places to live." The next day was Rural Health Day.

Under recognitions, the board members honored Robert Candelaria for 10 years of service in information systems; Jennifer Medran for 15 years in maternal child; and Valerie Sanchez for 15 years in quality.

Several items on the agenda were discussed in executive session and approved in regular open session. They included consideration of a pathology services agreement with Pathology Consultants of New Mexico; and two resolutions for signature authority to list CEO Robert Whitaker for banking and contracts.

With no public input, the board members heard reports and updates. The first came from Chief Nursing Officer Ron Green, who said he would continue with where he left off the previous month, with the three Rs, recruitment, retention and reduction of travelers. "I did some recruiting of Western New Mexico University's nursing students, several of whom are graduating in December. I talked about our nursing internship program, which is a six-month program that helps them transition between school and a career. I have also talked to students at several other schools. We have some verbal commitments, so we're working to finalize them to get some more on our team."

He said the department had done a major upgrade in its electronic medical records system as part of the Meditech Expanse. "We had a few hiccups, but they were resolved fairly quickly and the transition went well. Nurses are happy with the new product and say the flow is much better. We also implemented some software in our Maternal and Child department. It integrates with Meditech Expanse and will decrease documentation and double documentation, so nurses will spend more time at the bedside."

On the topic of retention, Green said: "We are working with our current nurses and cross-training them across departments. This will allow more depth for staffing and gives those nurses an opportunity to grow their experience and make them more well-rounded."

As for reduction of travelers, he said they have looked at schedules and are looking "to consolidate and maximize staffing
we have. We have a few contracts we are not going to renew and will look to reduce the number even more over the next several months."

Board Vice Chair Betty Vega asked: "In reducing the travelers, are you going to increase the permanent staff to cover the work they do or what are you going to do?"

Green said: "Part of that is looking at our current staff and making sure it's appropriate. The key is recruitment and retention and to grow our own nurses to fill the positions. We will still need a few travelers. We will make sure we are adequately staffed in order to provide quality care."

Board Secretary Pat McIntire asked how many graduates Green expected to hire.

He said he would want to made sure of acceptances before giving a number. "But we had a great deal of interest."

McIntire noted that WNMU graduates its bachelors of science in nursing in December, so this it the time of year to be recruiting and hiring.

Green said it was a smaller graduating class this year, with maybe 14 or 15, so it's a smaller pool of candidates to capture.

Fox said his experience with nurses graduating from Western "is that they are excellent and have provided excellent care."

Green said he always speaks highly of them.

Board Member Will Hawkins who was attending remotely asked via text what the optimum number Green was looking at to be adequately staffed.

Green said he was looking at about eight to enter the residency, and that includes not only nurses but positions in radiology and lab positions for travelers.

Chief Executive Officer Robert Whitaker said "We are looking to fine tune the number of providers, not only nurses, that we may need travelers for."

Interim Chief Financial Officer Leonard Brinkley said: "We will have better numbers for you this month than last month. Our volumes were up, which bring better numbers. Our discharges were down 17 from October. We had good outpatient volume at 5,447, good surgical volume at 258 about flat to last year, and we served 325 in the Cancer Center. Physical therapy was up 50 percent. We had 1400 ER visits at a rate of 45.2 a day. We budgeted 46 a day, so we were close. We had a surplus of $134,000 after budgeting for $7,000."

He said on total operating revenue, the hospital is up to $1.4 million over the prior year. "Our operating expenses are up $981,000 driven by travelers and cost of cancer medications, for which we will recoup a lot."

Vega asked how many physicians are doing surgeries at the hospital. Binkley said he would get the number to her.

Fox noted that collections on expenses lag from six weeks to two months, so these are revenues from expenses that took place about two months prior.

Whitaker said at the end of every month,"we gather all the charges and when we do the revenue budget, we look at historical data. We calculate and estimate what our revenues will be be. For instance, if we bill $29.9 million, we may charge $100 for a service but the insurance company may pay only $50."

Binkley said about 62.3 percent of the billed rate ends up as revenue deductions, which means the hospital has a 37.7 percent payment rate. That is based on a six-month run of fully adjudicated claims.

He noted that the October monthly loss was $525,000, year-to-date, which is a great improvement over the prior year loss of $1.2 million at the same time.

Board Member Seth Traeger said he looked at the report, but because of the high cost of chemo drugs, for instance,
the loss is because of cash flow issues.

Binkley agreed: "We're paying now, but receiving the revenue later."

Vega asked why they were not able to project the cost of chemotherapy drugs.

"When we did the budget, we didn't know the Cancer Center was going to really take off," Binkley said. "Cancer treatments are very expensive."

He noted the key measures of liquidity show the net AR (accounts receivable) days better at 39. "The lower the number the better. We are trending in the right direction. We have 136 days of cash on hand, higher is better. We had a cash balance of almost $32 million. The current ratio of 4.4 is higher than last year at 3.7. The higher the ratio the more capable the hospital is at paying off its debt. We're at 43 days of accounts payable. That's the number of days it takes an organization to pay its obligations. We're better than we were last year at 55."

Fox noted the cancer center increase in volume. "In our community, we have an aging population and their needs for geriatric care includes cancer care. That tells me that we are doing a better job of providing that care to our residents."

Vega said the Cancer Center has been underrated, "because they are very good. And it's great for patients to be able to stay here for most treatments and not have to go out of town."

Chief of Staff Dr. Colicia Meyerowitz would give her report when she completed her full day of work that had already been scheduled before the day of the meeting changed.

Whitaker gave his CEO report. "I'm glad to be here. My first two weeks here have been a whirlwind. We had the Gila Regional Foundation board meeting today. They talked about the gala and that it went well. They also announced a concert on Feb. 17 at Light Hall at the university, that they are collaborating with Rotary on."

He gave updates on construction projects. He said the labor and delivery construction will begin in January, due to needed lead time on materials. It will be the same for the HVAC system in the operating room, again due to materials, according to the contractor, Trane. "It will be about a four-week project because it was scaled down because of costs. The hospital is waiting on permits for the orthopedic clinic. We are looking at making some minor changes to a couple of areas - the ER lobby and the outpatient waiting area, to make changes in line of sight and more space. We made a recent purchase for the orthopedic clinic, a shoulder positioning system, to make it easier for the physician to do shoulder scopes. It's on order."

Fox asked if the ortho area would be large enough for additional providers. Whitaker said it will have four exam rooms, which because they are former patient rooms are larger than most exam rooms, so there is a potential for additional providers.

"We have a lot happening here," Whitaker said. "It's a lot to learn in a short amount of time. I'm getting a lot of help from Ron and Leonard."

Scott Manis, HealthTech regional vice president, said HealthTech is happy to have Whitaker on board. "He jumped right in with both feet. He's also out meeting with the community. He will be the face of the hospital in the community. He's transitioning very well. He's a seasoned CEO, so he knows what questions to ask."

Manis said the promotion of Ron Green to CNO was a well deserved promotion. "I've gotten to know him since I first came here in 2020. He's doing a great job."

"For the CFO search, we've been screening candidates," Manis continued. "One is coming on Friday, one that Robert recommended. You don't hire the CFO, we do. And if the person is the right fit for the hospital and the community, we will hire that person. We also do the negotiating for financial terms. Carolyn St. Charles, our chief clinical officer, will be coming next month to spend time with Ron, Ramona (Wilson, chief quality officer), Denice (Baird, compliance officer) and Tanya (the new medical staff services officer) to make sure they have the resources they need. Faith Jones, also one of my colleagues, was here during this past month. Her focus is around what we call primary care management continuity. It's where Medicare pays us for encounters, but not necessarily physician encounters, in the clinics. It's a care management, care coordination program. The hospital gets paid for that. "

Green said Jones is very helpful to the clinics, which are growing.

Manis said HealthTech has a new budgeting tool, which it will be rolling out to help the hospitals they manage, with the budgeting process. It should make the process easier. And it will tie directly into the financial statements as well.

"As you know, Patrick (Banks) will continue to be very involved with financial functions at the hospital here," Manis said. "Lastly, we continue our webinar series. Today I hosted one with one of our other hospitals on their dramatic changes in their HR (human resources) process and the improvements that have come from that. It will be on our website for anyone to tap into, as an interactive interview. Our HealthTech Conference will be May 5-8, with information for booking your hotel rooms and such, has come out. You should receive that. It will be in Nashville, Tenn."

Fox said he participated in one on social determinants of health and feels that some should be educational for the board members. "Could you send us some that might be helpful to us?"

Manis said they are typically focused toward hospital operations.

Fox mentioned swing beds, and Meyerowitz who had just arrived, said she had the hospital's first swing bed patient. "There were some computer snafus, but the biggest thing is to watch for Medicare recommendations, because if they are not followed, they can ding you and you might not get paid. Generally, I think it went as smoothly as a new process can go."

The members went into executive session.