[Editor's Note: This is part 3 of a multi-part series of articles on the Grant County Commission work session on Aug. 18, 2020, and the regular meeting on Aug. 20, 2020.]

By Mary Alice Murphy

At the beginning of the Grant County Commission regular meeting on Aug. 20, 2020, the commissioners heard an update from Gila Regional Medical Center Interim Chief Executive Officer Scott Landrum.

"We continue to make progress on issues put forth by Health Tech S3, which is now managing your hospital," Landrum said after thanking the commissioners for hearing his report. "At the hospital meeting next week [Aug 27 at 9 a.m.], we will be presenting the new format for our financials, which will be more detailed. We are just at the point to roll out our productivity system. Five days a week, we have a morning huddle at 8:30. It's a safety and operational huddle with the department heads. We limit the large meeting room to 20 and the rest call in. We recently replaced the fracture table, which we use a lot because we do a considerable amount of surgery. The huddle is important because everyone knows exactly what is going on and it trickles down to everyone."

He said it would take three payrolls, each of which occurs every two weeks, to get the productivity numbers right. "It gives us a very current idea of our volumes versus our numbers of people. As you know, we've been approved for critical access status. We're waiting for the billing number so we can get the billing going. We call every Monday, Wednesday and Friday. They are probably not happy to hear from our controller Jennifer (Klotz). As soon as we can get the number, we can start our swing beds. The Rural Health Clinic status is also pending, waiting for them to come in. That will include the family practice and pedes (Pediatrics). We are in the process of opening our observation unit. Gila Regional Medical Center is remarkable. We are a critical access hospital, which is an average of no more than 25 inpatient beds, an average 4-day stay, and 35 miles from another hospital. But we are a critical access hospital on steroids. That is very good. Four-fifths of our revenue come from outpatient services, That is exactly where we want to be. A patient, for instance coming from the emergency room, can be kept in the observation unit for up to 23 ½ hours before letting them go home or be admitted to the hospital."

He thanked the commissioners for connecting him with Priscilla Lucero (Southwest New Mexico Council of Governments executive director). "Priscilla is helping us secure funds to replace the roof, which will cost $1.5 million to $2 million. It will be a sealed seam roof, which is more durable. Priscilla is a delightful person and a remarkable asset to your community."

He said he will meet with Hidalgo Medical Services, the FQHC (federally qualified healthcare center) in Silver City. "I will go to (Chief Executive Officer) Dan Otero's office to talk to him on how we can work together for the benefit of the community. We are talking about lining up in lab and radiology. As part of the critical access there will be a Chargemaster review, which will look at what we charge for radiology, lab, etc. We are looking at how we can be in line with other folks, because we would very much like Grant County folks, even if they have a physician in Las Cruces, we would like to see them get their pre-op here, with X-rays and labs and such. We are also looking at our hospitalist and ER contracts. I think the hospitalist one comes up for review in November. We will decide whether to continue with two hospitalist organizations or just one. Both give us great service. Dr. (Tsering) Sherpa, head of the hospitalist program in the hospital, is another real asset to the community. We are also looking at our computer needs. We are running Meditech 6.1.5, which is its most current one. We are looking at taking it to the next step, actually looking at a service cheaper than the one we have and will get served faster, quicker and more efficiently. We are continuing our relationship with our current recruitment group. They are the ones who placed Dr. Gibson, our newest general surgeon here. He is another phenomenal asset to this community. We are looking at urology, ENT and a variety of other things. We are in the process of changing our GPO, our group processing, from HRG to Visiat. The hospital had been using group purchasing for a while, It lets us do group purchasing, where we think we can do some efficiencies. We are looking at the clinic building in Bayard. Our accounts payable is on a 30-days basis and that's exactly where you want to be. Finally, I had a meeting with the medical staff last night. I told them we have an adequate supply of Remdesivir to treat COVID-19. We have 30 doses. We have no COVID patients in the hospital currently."

District 3 Commissioner Alicia Edwards had a question on the Rural Health Clinic inspection. "We've been hearing for weeks that it is right around the corner. Any update?"

Landrum said he wished he could give an update. "We are ready. It's like the billing numbers for critical access. They are all pending. It's like everything else; they are being held up by COVID. A lot of the services ask if we are willing to host them. Yes, we are. We can socially distance and wear masks and all that. I will get you the information as soon as we have a concrete number."

Edwards noted the Joint Commission did their survey virtually.

"I am told it will be done at least partially virtually," Landrum said.

"The longer it takes, the farther we are away from getting that additional reimbursement, correct?" Edwards asked. "We can't do the Chargemaster changes ahead of time."

Landrum confirmed it was correct. "We are ready on our end both on the critical access and the rural health clinic. When all the paperwork is done, we're ready to flip the switch."

District 5 Commissioner Harry Browne said he had heard a lot of good news and a positive outlook. "The negative was that we had to right-size the hospital. Have we completed all the layoffs?"

Landrum said the hospital still had a "few adjustments to make in our physician clinics. I made one yesterday. We are looking at relocating at least one physician into another hospital facility. It will be individual changes now. The reduction in force is pretty much over. We did end a contract with a physician yesterday. But I think the RIF is mostly over We may be top heavy when the productivity numbers come out. It compares the inpatient and outpatient volume with the numbers. I think for the most part, it is over."

District 4 Commissioner Billy Billings said he had heard "a lot of good news. I share Commissioner Browne's concern about the RIF. It hit close to home for a lot of people. People will have to uproot and will have to move out of the community. I hope with Health Tech here, we can avoid such things in the future. There were mistakes made in the past and even in the fairly recent past that led to the situation we're in now. I'm still not done asking if we can hold some things accountable. A former CEO walked out of here with $932,000 and now we're laying people off. And nearly $5 million in unpaid bills, so I'm glad to hear you're on a 30-day accounts payable. How did you accomplish that?"

Landrum said that Cardinal, which runs the pharmacy and has a contractual relationship with the hospital, "We have a cash call with them every week. Right now, there are a lot of funds coming in for various and sundry things related to COVID. A lot of the funds can be used for lost revenue due to no surgeries and few inpatients or outpatients. This hospital accessed the PPP funds, which is what you should have done, to pay payroll. I think several things were done, maybe even some reserves tapped. Cash is king. I can tell you that our July op (surgery) schedule was way back up, and we're just billing for that now. I know that paying your bills on time and getting caught up is like a jigsaw puzzle. There may be some contractual bills that we are catching up on, but for general bills, we are paying them on a 30-day schedule."

Billings commended Landrum for working with HMS, "instead of waging war on them. I think there can be a good partnership. I think they can refer patients to you."

Landrum said he thought the choice of words as a partnership was "spot on."

District 2 Commissioner Javier "Harvey" Salas asked if there were any news on the Cancer Center contract.

"We had a discussion with Ms. Lucero on that topic," Landrum said. "I think HMS has been interested in doing some things with the Cancer Center and behavioral health, too. We are looking at staffing. I misspoke. I think the issue I talked to Ms. Lucero was about behavioral health. We are looking at the Cancer Center and making some changes. We had some people there involved in the RIF. It is not off our radar."

Salas asked about the management contract.

Landrum said they were looking at an alternative. "I'll have to get back to you on where that is."

District 1 Commissioner and Chairman Chris Ponce said he is still hearing concerns over billing from the public. "I know what our priorities are with the hospital and I think things are looking good. We need to be reaching out more to the public about our hospital. I'm assuming we have someone in the PR and marketing department. I would really like to see us do something. We need to gain confidence for the public to use our hospital."

Landrum said Autumn Stinar, a physician's daughter, is doing the marketing. "One of the things we are looking at is social media, the hospital's Facebook, for one. We want to support events, such sponsoring school events and rodeos and fairs and all that sort of thing. A lot of that has come to a halt. There is some question about the value of billboards when you are the only show in town. We are looking at newspapers. Not everyone is on Facebook. At my previous assignment, we would post on Facebook and we would send it to the newspaper. Some things they will run without charge and other things they will charge for. I don't stay on Facebook. I know you have to have other ways to reach people. Autumn is pretty sharp. A lot of things had come to a halt when the hospital realized its finances were in jeopardy. As we climb out, we will start to add back some of those things."

Ponce said he gets lots of compliments on the nursing staff.

With no other questions and no public input, the next item on the agenda was elected officials' reports, which will be covered in a future article.

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