[Editor's Note: This is part 2 of a more than 4-hour combination work session and regular meeting held Jan. 9, 2020. It covers the Gila Regional Medical Center monthly report in detail.]

By Mary Alice Murphy

The first presentation in the combined meeting of the Grant County Commission given by the Grant County Extension Service office can be read at https://www.grantcountybeat.com/news/news-articles/55343-grant-county-commission-holds-combined-work-and-regular-sessions-010920-part-1

The second presentation featured Gila Regional Medical Center Chief Executive Officer Taffy Arias and Chief Financial Officer Richard Stokes giving their monthly report.

"We are Gila Regional Medical Center are very excited about 2020," Arias said. "We were able to overcome many hurdles in 2019, and we're excited about polishing them now. We slipped from being a 4-Star CMS (Centers for Medicare and Medicaid) hospital, but I am eager to announce we have regained our 4-Star rating by CMS. I thank all of the staff, the clinics and everyone for their outreach programs. Gila Regional now has a full-time diabetes educator. We will reach out to the Extension Office to offer our services. We had our first-born of the year, and I want to thank the Auxiliary and the Foundation for providing baskets of items to the family. Earlier this week, we had an active shooter drill at Silver High School, which involved a lot of entities, including law enforcement and the hospital. We learned about triage on scene and the importance of communication when they are arriving at the emergency department, so they know exactly what to do to deal with the volume. We concentrated a lot on scene on how to manage the flow and on emergency medical services We are very concerned about the caregivers and the effects on them. We have organizations prepared to work with these people the day after and ongoing when they are involved in really traumatic situations. We are concerned about the patients, but also as much for the caregivers.

"We are very involved with the Western New Mexico University Nursing program," Arias continued. "And our providers are reaching out to other organizations in the community. Dr. (James "Butch) Rosser (general surgeon) is working with the university on a new technician program, and our Chief Nursing Officer Rose Lopez is working actively with the Nursing department to increase the capacity for nursing students and on jobs when they graduate. I know you were concerned about the Deming Clinic. Our administration met with town officials, and they told us: 'We want you here. We want you to succeed, and we will help you.' We are pursuing all venues to bring Gila Regional services.

"As we go through the financial crises, it gets worse with volume decreasing during the holidays," she said. "We are going on a hiring freeze. We will not be expanding programs, and we are not freezing hiring in areas where we need staff. I wanted to talk about Beginning Years (which began as First Born). What they developed years ago, the university is also engaged in a program to develop and increase the capacity of the program. People on staff go into homes with a newborn to help the stressors of having a new child in the home. These women give an extraordinary amount of information to the families. I am amazed at the commitment these women have for the families and their tremendous impact on families' lives. We mentioned in our last report the program we are working on with HMS (Hidalgo Medical Services) on the resident physicians that are coming through their program. We had a general staff meeting, including with Dr. Darrick Nelson, who is the residency director. He is excited to be part of working with Gila Regional focusing on how these groups must work together and how to integrate the providers into the hospital."

District 2 Commissioner Javier Salas asked about the volumes at the Deming Clinic.

"There are not as many as we want," Arias said. "We have an issue with marketing. People don't know we are there. All of our clinics are costing us money. It takes a good year to establish volumes. We want clinics to break even or make some money. We look for referrals from them for testing on the main campus."

Salas said he saw a clinic as feasible in Deming, but "why not one in the Mining District?"

Arias said so much has been established in the Mining District with Dr. James Skee's Silver Health Care facility and with HMS having a clinic there. "It was not clear to us that we should spend the money on renovations to a building and the costs to establish the clinic. The project was put on hold by the Board of Trustees."

"Why spend in Luna County and not in Grant County?" Salas asked.

Arias said the hospital had already committed to Deming before it was hit with a the $5 million reduction in reimbursement last year. "It was going to cost us about $300,000 just for the clinic facility in Bayard. The Deming Clinic was already started."

Salas noted that HMS was putting in a mobile unit, which was less expensive.

"Do we want to be in competition with other entities?" Arias asked. "The reason we headed to Bayard was we have developed a program working with the mines. They wanted to be with us. However, the corporate board chose to go with another company to provide services at all their sites. We are working with that company to bring all employee testing into our hospital."

"So, you're going to cede everything to HMS?" Salas said.

Arias said that was not what she was saying. "HMS is going after one block of people and we are going after a different block. Gila Regional has services that HMS doesn't, and HMS has resources we don't. We are seeing referrals from HMS coming to Gila Regional."

Salas continued his questioning. "What is the cost of the Deming Clinic over what you're receiving?"

"I can't give you the numbers right now," Arias said. "We have to have time to establish it. We are getting more referrals from it."

District 1 Commissioner and Chairman Chris Ponce said he had a conversation with a PERA (Public Employees Retirement Association) retiree, who told him Gila Regional was not taking his insurance. "We have a lot of retired members here. I'm not sure what insurance it is. It is costing people out-of-pocket if Gila Regional is not accepting the insurance. Can you look into it?"

"Absolutely we will look at the issue," Arias said. "Sometimes, we don't hear these things. We want to dive in and figure out what to do to fix it."

Stokes asked Ponce to give the information to County Manager Charlene Webb, "and we'll go into it. We got a call from a person who said the hospital didn't take his insurance. We looked into it and, although it was limited coverage, we do have a contract with that provider. Often, we find the insurance isn't telling the truth, especially with Medicare and Medicaid. Especially Medicare is ratcheting down its reimbursements. Some insurance companies direct people to go to Las Cruces. It's frustrating. If an insurance company doesn't get a 20 percent profit, they change the rules. We often treat people and have a negative profit."

Ponce said that the people he has talked to say that they are being told by hospital employees that the hospital doesn't take the insurance.

"That's another issue, and I will definitely look at that," Stokes said.

"What about if a person goes to Las Cruces to save $600?" Salas asked. "A lot of people are going to a place in Las Cruces because the co-pay is one-quarter of what yours is."

Stokes replied: "If I ran an 8-5 operation, I could cut some prices. We charge less than both hospitals in Las Cruces. We are a 24/7 operation. I explained to a fellow what we charge and why. What would you do to make sure we still have an ER here next year? Nationally hospitals are in a quandary on how to meet charge expectations and continue our services. We will go to a cash-only program in the second quarter of this year."

Salas said: "A person goes to Las Cruces and you're making zero, versus your making a little bit to be competitive. I see lots of Grant County people in Las Cruces."

Stokes agreed: "Yes, you will see lots of Grant County folks there, but the facilities are charging less than Medicare rates and are not reporting them. We are reimbursed at the rates Medicare dictates."

He began his report. "As Miss Taffy said, we had decreased volumes in November and December. The first two weeks of both months were strong and then they dropped with the holidays. We did not have a board meeting in December, so it gave us an opportunity to sit back. Six months to a year ago, when I sat and looked at data, I could easily spot a problem. That is no longer the issue. Now, when we look at data nothing immediately comes to the forefront of our minds."

"When we looked at finances, we started digging and doing daily charge reconciliations," Stokes continued. "It identifies charges at the patient level and how the information flows. It has given us opportunities for improvement. We corrected all the issues identified in radiology. We are working on the pharmacy, then extending to the Cancer Center and then we will move into labs next. Every department has to check that the modules are working correctly, and we spot check. It's a win for the hospital, and it's a lot of fun doing that kind of work. You have to like to do that kind of work, because it's tedious."

He continued by saying: "As we pondered over the past year, we projected 2019 to be a really good year. But that was until the foundation changed and we lost the anticipated $5 million in safety net care pool funding. We want to recommend to the board to bring in a national company to do a performance improvement study on us. We are looking forward to their validating what we've done and finding new things that we haven't seen because we can't see the forest, because we're concentrating on the trees. We are looking forward to having a fresh set of eyes looking at all the changes we've made over the past two years and figuring out future opportunities."

They are looking at two companies, both with some rural hospital experience, "because as you know, rural hospitals have difference issues from urban ones."

Stokes said the Family Practice clinic would soon be converting to the designation as a rural health clinic. After this one is completed, they will move to designate the Deming clinic as RHC.

"We received notice that the application has been approved and it was forwarded to the state and federal agencies involved," Stokes said.

District 3 Commissioner Alicia Edwards asked: "Is it policy to send out statements without details of the costs?"

"I'm not sure I know the answer to that," Stokes said. "We send summary statements."

"The statement says the co-pay is $75 and that's it," Edwards said.

Stokes said he will look into it. "One community I was at, people said they wanted details, so we sent out statements with details and the other side of the community said it was too much information."

Arias said the hospital has services that it has to subsidize. They include behavioral health at a loss of about $1.5 million, EMS also at a loss of about $1.5 million, and the ER also loses money. "If we were a big company, we would say, don't do them. But we have to provide the services to the residents. EMS belongs to the county, but I don't think the county wants to subsidize it. We lost a psychiatrist to HMS and Tu Casa. It is a big expense to recruit, train and then lose them. We are a hospital trying to find every penny. All our financial woes are tied to volumes and volumes to revenue. We have more than 600 people working at Gila Regional. It takes a lot of soul searching on what to do to improve finances. We give you a little snapshot. Your constituents give you a snapshot. Please come to Richard; come talk to me. I will put you in touch with any department that can answer your questions. I want you to understand that not one of us in administration, not I, not Richard, is not constantly engaged in process improvement to improve the bottom line so that we can continue great service to the people in the community."

Salas still pushed a question. "What astounds me is why you won't reduce prices on some of the services," Salas said.

"I urge you to speak to Richard," Arias said. "Say you have a product that costs you $100 to produce. You can sell 1,000 of them at 50 percent of the cost of production, but what will that bring to your bottom line? That's why Richard is trying to work at programs that will be better for the payer, for the customer. We will bring down your cost to closer to our costs to help you. But we can't go below our costs, because our insurance will not reimburse us anything. We can't give services for free."

Salas thanked her for explaining it, but "I can't understand why getting something is not better than getting nothing."

District 5 Commissioner Harry Browne said it struck him as a disconnect. "I am acknowledging that this is not the right forum for such a discussion. Most of the cost of that procedure is capital allocation, not marginal costs. In that case, if most of the cost is capital, then Javier can be right, so you could lower the price. If, on the other hand, most of the cost is labor and each procedure has that additional cost, then you're right and the more you do it the more you could lose money. If it's a cost allocation issue, I don't know how we are going to figure that out here."

Arias said: "It can't be figured out here. Please come see Richard and see it in black and white. That will give you a venue to ask the questions to follow through the process. I will tell you that every health care organization is struggling because of labor costs. But having people is the only way to take care of people. I'm extending this invitation to all of you again. These questions will continue to come to the forefront. Unless you give us the opportunity in a different venue to really show the detail, then it will always be a question."

The next article will get into county reports and the agenda.