[Editor's Note: This is part 3 in a multi-part series on the work and regular sessions held Dec. 10 and 12, 2019.]

By Mary Alice Murphy

At the beginning of the Grant County Commission regular meeting on Thursday, Dec. 12, 2019, District 1 Commissioner and Chairman Chris Ponce announced that County Manager Charlene Webb had received an award at a recent Freeport-McMoRan grant awards ceremony on Dec. 4.

Ponce:
She received an award for all her good work. Our county manager has a tough job. It's great she got this award. She has five different commissioners going in five different directions. You do a good job and we appreciate that.

[The next agenda item was presenations.]

Gila Regional Medical Center Chief Executive Officer Taffy Arias:
I would like to introduce Emergency Medical Services Director Eloy Medina to tell you about a new program we've started.

Medina:
It's a Community Paramedicine Program. We signed a contract with Blue Cross Blue Shield and Centennial Care. We will start in January. Blue Cross Blue Shield has identified a number of people calling 911 multiple times. They are considered high risk, and some have mental health issues. Up to about 300 in the county qualify for in-home care. We will evaluate them. They don't realize the resources that are available. We will do home safety assessments to make sure they have running water and food. We will get them to resources before they come to the ER with complaints. It is holding steady at about 250 people who may qualify. We will be reimbursed $136 per visit. It's the way EMS is going across the country. The person has to be a client of Blue Cross Blue Shield, but Western Skies and others are jumping in, too. Albuquerque now has a full department of 16 people from 8 a.m. to 5 p.m. It's not a revenue generating effort. It does save hospital costs in the ER.

District 2 Commissioner Javier Salas:
Do you have enough resources?

Medina:
I'm going to pilot it myself, and we may have to add people. We want to know the impact. Yes, people should call 911 in an emergency.

District 3 Commissioner Alicia Edwards:
How many times can they get this a month?

Medina:
If the first time, we find they need more help, we will assess it. There is a Blue Cross Blue Shield representative here, so we can get help immediately. It's for persons in the area. Becky Rydeski is the resource manager with Blue Cross Blue Shield locally. But that's not the person I'm talking about. I forget her name.

Edwards:
Are insurance companies beefing up their personnel in Albuquerque?

Medina:
Yes, Albuquerque is handling its case load very well. Southern New Mexico is just getting up to speed.

Arias:
We've been involved with community activities. We held an event, Light Up a Life, on Dec. 4, an annual event. Residents are invited to submit photos of their deceased family members or friends. The photos are laminated and put on a lighted lattice wall. This year our speaker was Dr. Donald Stinar, who read a lovely poem about life and death. He brought a sense of emotion and what a physician goes through with facing death of his patients. We also took part in the family party for the Beginning Years program. We held a community medical education talk with Dr. Butch Rosser, who gave a presentation on GERD and heartburn. We are looking at a relationship with Mayo Clinic. Dr. Ratliff found out Mayo has an e-consulting program only for rural hospitals to bring specialized services to the smaller hospitals to prevent patients having to leave the facility. That's another service we can bring to the community.

For another program, I had a brief meeting with Charlie Alfero on expanding the residency program at Hidalgo Medical Services. The hospital is not interested in having its own residency program, but we have committed to supporting the HMS residency program for those who want to work in rural health care. We had a meeting with HMS CEO Dan Otero, Alfero and Dr. Virginia Hernandez. We all have tasks, and we will continue to support the program. We had a visit from a man who used to be on the Foundation. He asked if we want all the Billy Casper paraphernalia. If the county wants any of it, we would love to share it.

Putting political hats aside, I had a wonderful experience when I went to the Becker's conference, which presents technology information for the medical community. The conference had more than 1,000 attendees. I participated as a viewer. I had the totally accidental meeting with Rudy Guiliani. When I met him, I realized how much power he has. I overheard a conversation and was impressed with his sincerity on what he was talking about. I also had the pleasure to be selected for a small break out group with President G.W. Bush. The rest were CEOs and CFOs of huge health care systems that were revenue-generating in the billions of dollars. We all had the exact same issues I have—revenue, patients, reimbursement, lack of resources, lack of being able to expand, lack of reimbursement from the government, so I can tell you I did not envy any of them, because I realized that my problems are just as great as theirs, but I'm in a small community. I can tell you that every dollar they lose, I also lose and it has a greater impact on us. One thing that President Bush said that I want to share with you is also my philosophy. He said: 'I'm smart enough to know what I did not know, so I surrounded myself with experts in each of those categories and I trusted those people and we worked together for the common goal.' I think that is the key to all successful organizations. Decisions have to be made with the team, always thinking about the people you serve. I wanted to share because I thought, if he's doing it and I'm doing it, it's the right thing to do.

Edwards:
A note for you in your conversations with the Mayo Clinic. We have a significant number of people here who use United Healthcare and Mayo does not accept that insurance or Medicare.

Arias:
Thank you for sharing that.

GRMC Chief Financial Officer Richard Stokes:
Mayo actually just started accepting Medicare. And this is my report for October, the fourth month of our fiscal year. We made a $12,600 profit, bringing us to a year-to-date loss of $1.429 million. We collected 32 percent and we have 120 percent cash to net revenue.

I wanted to address what we are doing as it pertains to critical access. The board has had a huge discussion on the pros and cons. They want to know the pitfalls. The board has not yet made a decision. But in reality, we are already a critical access hospital. The designation would bring no change to services. We operate basically as a 25-bed hospital this year, last year and the year before. Doctors ask me why we are not like we were 10 years ago. One of the reasons is CMS (Centers for Medicare and Medicaid) changing to promoting less inpatient services and more outpatient. We are already 80 percent outpatient and 20 percent inpatient. Once the board makes a decision to go to critical access, it will increase reimbursement levels. It is basically a reimbursement program.

Arias:
We plan to go out and educate the community on what critical access is. We will start at the first of the year.

Stokes:
If we switch to critical access, we will be one of the larger hospitals, but there are also many that are larger than we are that are critical access. It's a different reimbursement methodology. Medicare is racheting down what meets EMS criteria. A lot of time people don't meet the criteria. We had an 80-year-old blind person with balance problems. Medicare turned down the payment, because they said the person could have come in a car. Medicare is ratcheting down payments for transportation. We want to pick you up, but it's getting hard to get reimbursed.

Edwards:
There are a significant number of 80-year-olds who do not have the option to come in a car. So, what is the option?

Stokes:
We will have to get more aggressive on charity cases. We have to bill patients over and over and then it's bad debt. If we proclaim them as charity cases, we get some reimbursement.

Edwards:
If it's Medicare is it bad debt or written off?

Stokes:
CMS requires that we treat Medicare patients the exact same way as we treat Blue Cross Blue Shield patients. We want to qualify people for charity care. We had another disabled person who couldn't pay but had been sending us $25 a month for years. I discovered it, talked to her, she applied for charity care and had the debt forgiven.

Edwards:
Many are living on Social Security, which averages about $700 a month. They are under stress from being dunned to pay. This is no reflection on the hospital.

Arias:
You and I talked, and I talked to risk management. Now we cannot do transportation out of the hospital. I agree that it is appalling. We just have to tick off things. It's dangerously close to rationing health care."

Edwards:
I think we're already there.

Browne:
It's already there. I also don't believe we can afford everything. It's possible Medicare has a point that it is not cost-effective to send an ambulance, when it might be cost-effective for the person to come another way. Now that we have a Lyft driver can you share the contact information and find out if the person is verified? We are spending a lot on healthcare.

[Editor's Note: We understand that the Lyft driver is no longer providing the service.]

Arias:
Hospitals are so regulated. EMS has to respond. If we send a Lyft driver, it puts us in a liability situation. We have to find a way to make it work.

Browne:
I would like to see the October report.

Stokes:
I was told it was sent to you.

Webb:
Our email address has changed from .com to .gov.

The next article will address the forest plan revision update from the Gila National Forest Supervisor Adam Mendonca (pronounced men-dohn-sa).