[Editor’s Note: This is part two of a two-part series of articles.]
By Mary Alice Murphy
The Gila Regional Medical Center governing board met Oct. 29, 2020 in its regular monthly meeting. Members of the governing board include the five Grant County commissioners. Chair of the GRMC governing board is District 3 Commissioner Alicia Edwards, vice chair is District 4 Commissioner Billy Billings, and the three other members are District 1 Commissioner Chris Ponce, District 5 Commissioner Harry Browne, and District 2 Commissioner Javier “Harvey” Salas, who was not in attendance at this meeting.
After the Interim Chief Executive Officer Scott Landrum’s and Chief Nursing Officer Kelly Rodriguez’s reports, which can be read at https://www.grantcountybeat.com/news/news-articles/60958-grmc-governing-board-met-in-monthly-session-102920 , Interim Chief Financial Officer Richard Alesch presented his report. “Our gross revenue, as well as our net revenue, was higher than July and August due to the 5 percent rate increase effective in early August, as well as continued growth in our outpatient services. Salaries, benefits and wages have decreased since July, which when annualized amount to about $4.5 million. Our contract labor is down from previous periods. However, due to staffing shortages in nursing, lab, and radiology, we are going to have to fill some of these vacant positions with travelers to take care of our patients. Total operating expenses of $5.7 million in September have trended down by $2.3 million from June’s expenses of $8 million. Our loss in September from operations was $487,000, and is a reduction of $1.5 million from July’s loss of $2 million. Outpatient visits continue to grow with an average of 195 visits a day during the week and 54 patients a day on weekends. Emergency room visits for the month of 1,086, average 37 visits per day, and we’ve been seeing that tick up to about 50 a day in the past couple of weeks. Surgeries totaling 268 averages about 12 per day with outpatient surgeries representing 89 percent of the totals. Our total client visits for September were slightly down from the previous month. That concludes my report.”
Edwards said she didn’t really have a question, but thought it was worth noting that salaries and benefits are down, but “we have some labor shortages. I think it is worth clarifying that the shortages are not in departments that had reductions in force. And perhaps some of the nursing shortages are going to be addressed by hiring LPNs, which we were not doing before. And then Kelly is going to have such an amazing recruitment dinner that we will snag all those graduating nurses from Western, right?” To which Rodriguez said, “yes, absolutely,” to smiles from the members.
Browne said the report shows that clinical revenue is up. “Can we get a breakdown by clinic? It’s helpful to see. It doesn’t have to be monthly.”
Alesch said: “We can do that.”
Landrum presented the chief of staff report from Dr. Brian Robinson in his absence. “The Medical Executive Committee has appointed a nominating committee for the chief of staff, vice chief of staff and secretary positions. Members of the nominating committee are Dr. Norman Ratliff, Virginia Hernandez, and Dr. Steven Kotch. Elections will be held at December’s General Staff meeting. The credentialing committee and red flag committee were discussed in the executive session. No new reports from the peer review committee. The bylaws committee has proposed changes to the rules and regulations to be in compliance with Level 4 Trauma designation standards and to reflect other GRMC practices. The CME (continuing medical education) committee has not met due to Covid-19 precautions. Under the heading medicine, perinatal and surgery departments, medicine is working to streamline the radiology registration process. Perinatal is working on communication and collaboration. And the surgery department has prepared an off-hours emergency surgery scheduling process.”
The HealthTechS3 report was given by Michael Lieb, vice president of interim services. “I do want to thank Kelly and all of her team for all their hard work, especially during this crazy pandemic time. You see from all the surge plans and the efforts and the financial turns, it’s an amazingly strong team at Gila (Regional Medical Center), and we’re proud of the progress we’ve made during this tense time. I want to make sure you know how thrilled we are to be working with the people here at the institution. We are progressing with the search for a permanent CEO and CFO, as well. We have started the screening process and there was a great deal of interest in Gila Regional and the opportunity that Silver City presents. A large number of candidates expressed interest, so we are weeding them down and we will work very closely with your search committee on the selection process and hope to roll that forward here and bring you choices within a very short order to evaluate. This was alluded to by Scott, the critical access transition is underway. Now that we have our PTAN number means we are about ready to kick off the billing. We are waiting on the interim rates to actually know what we can bill for, but Dick (Alesch), and Jennifer (Klotz) and Nicholas (Hallas) and the team are all set and standing by, so the minute we get that rate letter, we can move forward and make that conversion. We are proceeding with Vizient, on the GPO (group purchasing organization) conversion. Our target date is Nov. 1. The materials management team is working hard to get that rolling. We should start seeing benefits fairly quickly. This past week, we had Faith Jones and Heather Gilchrest here to meet with your clinical leaders on care coordination. This is a billable service from Medicare that you guys are already doing the work for, but now we have the ability to capture that, prove it and bill for it. It’s another new source of revenue for the care you are already providing to your patients. As always with the critical access conversion, we are managing cash closely. Dick and Jennifer are watching it on a daily basis, because it will be tight while we go through this swap over and conversion. Once we get on the other side, we expect great things, but the next couple of months we will be managing it very closely. Lastly, in reference to Covid, as you’ve met many of us from HealthTech coming in, we want to make sure we are protecting the environment as well. As the rapid testing becomes more available, we want to make sure that we don’t bring things into your institution or the community. We’ll pay for it, but we want to make sure you know we are holding up our end as well.”
Billings said: “We want again to thank you and HealthTech and Scott and Mike for the responsiveness you’ve shown to our concerns. We brought up the registration problem and it seems like it’s being tackled from several different angles now. In our search committee meeting, you mentioned this. I think it would benefit the public. I wonder if you could give us that curve illustration. I think the public wants to hear that we are turning this facility around financially.”
Lieb said: “Sure. Although it’s not positive yet, but the reduction in loss over the past several months is good. In July, the hospital had a $2 million loss. It dropped in August and more in September to a $400,000 loss. So, the pieces we put or are putting in place, the critical access, the rural health clinic, the Level 4 Trauma and the productivity management, the staff management, all of those pieces are starting to have their effects. What you are seeing now is that slowing of the curve. As these pieces take hold, as the GPO pieces take hold, as the pharmacy and drug prices take hold, as all these bits and pieces take hold, you will start seeing that trend upward over the next couple of months. We are very excited to see that. It is our expectation here that given the population, the quality of care provided at GRMC, the community support, as evidenced by all of your time, the ability to improve access, get those patients into GRMC for imaging, for lab, for their procedures, all those efforts are going to turn everything upward. We have no reason to believe that this place won’t fly and will fly financially fairly quickly. It’s exciting to watch. The trends are all good.”
Edwards said she wanted to add: “I love it when you say this institution is on its way to flying well.”
Then she said she had been reminded that the governing board needed to discuss the scheduling of their meetings in November and December, as the November meeting would regularly fall on Thanksgiving and the December meeting on Christmas Eve. “I’m going to suggest that we have the commission regular meetings, which are scheduled on Nov. 19 and Dec. 17, in the morning and the governing board meetings in the afternoon.”
Ponce asked if that would be a problem for end of year business. County Manager Charlene Webb was in attendance and said that usually there is not that much business to take care of in November and December.
Edwards suggested 9 a.m. for the commission meetings and 1 p.m. for the governing board meetings. The members agreed.
Under action items, several came before the board.
The first was to approve or disapprove the Varian linear accelerator service agreement amendment 2 to extend the contract. Landrum said it’s for the cancer treatment area. “It’s always going to be expensive, but we’re bringing it to you now as an extension, because we were able to work it down to a lower number. Originally the number included some items that because we are already up and running and because we do regular maintenance, we do not need. The agreement is for $92,366, and everything has been through procurement compliance which includes compliance with the procurement code.” Governing Board members approved the item.
The next item was an amendment to the employment agreement with the new general surgeon Dr. Laurence Gibson, who had greater than expected re-location expenses by about $7,000 due to the pandemic. Landrum explained that HealthTech requires that any agreement concerning a physician must be approved by the board. The amendment was approved.
An extension of a service agreement with GE covers six separate pieces of imaging equipment, including glass tubing, on a consolidation plan for a total of $201,202. The agreement was approved.
A capital purchase of hyperconverged infrastructure (IT hardware/servers) replaces aged and failing IT hardware infrastructure. It includes an addendum to PC connection for Microsoft software licensure purchasing, a quote for capital purchase of IT hardware servers and related components and configuration service and a software and service agreement. Landrum explained that it is highly sophisticated equipment that takes the hospital to a higher level and is a purchase that has been pending for a while. He said it will cost $829,000, but the hospital has the money for it allocated to improve the Cancer Center’s operations and the electronic records system.
Browne moved to approve it and said that it was presented to the board in executive session by Ken Stone, the IT department director, who explained the purchase and that the money comes from cigarette tax receipts. “I just hope we’re not overly dependent on people continuing to smoke.”
Edwards said she wanted to make it clear that this item is replacing hardware and not the Meditech software system but is an upgrade of hardware needed to facilitate the use of the Meditech software.
The next item addressed a master re-key project by Overhead Door Co. of Albuquerque, who is a CES (Cooperative Educational Services, which serves schools, municipalities and non-profits throughout the state) partner. Landrum said they’ve been looking at the facility, including the roof, the HVAC system, etc., and “we’re looking at our master re-key project. This is something that is for life-safety code upgrade. It is expensive, but it is something we must do. It is to the tune of $130,000.”
Edwards clarified that when the hospital was looking into the other areas, they realized that there were some areas that people couldn’t get into because they were not master-keyed.
During discussion after a motion was made, Ponce thanked “you guys for finding that, because it was a safety violation. I appreciate you’re paying that much attention to certain things.” The motion was approved.
Item No. 6 approved adding Silvia Madrid to the list of nominees for the team to assist with the CEO search.
Next was consideration of a resolution, recognizing the importance of providing behavioral healthcare services for the residents of Grant county and the surrounding area.
Edwards said it was her resolution because of a lot of interest and concern in the community over behavioral health issues. “We are having significant conversations with HMS (Hidalgo Medical Services) to bring behavioral health services back to GRMC in some form. The idea behind the resolution is to give that idea some teeth. That we actually put on paper that we are serious about getting this done. The board at HMS has also reviewed this resolution and are in favor of us passing this and are very much in favor of moving forward with GRMC on this issue.”
Browne thanked Edwards for her hard work on the issue and recognizing the importance of the issue.
Ponce echoed the thanks for addressing the issue as it is very important for Grant County “during this time especially, and I’m hoping we can move forward.”
Billings thanked Edwards for the resolution and pointed out that what the hospital had in place wasn’t working. “I’m looking forward to keeping what was working and fixing what was broken. I’m looking forward to partnering with HMS where we can have a system that works better, not only compliance-wise, but also serves the patient needs better than we’ve ever had before.”
Edwards concurred that the members have had so much conversation about the importance of partnering with other providers in the community. “The first step in this partnership is that HMS and GRMC have agreed to split the costs of a community assessment on healthcare needs.”
The last action item was consideration of the medical staff credentialing report as presented to them in the executive session.
The meeting adjourned.