By Mary Alice Murphy

The Gila Regional Medical Center Governing Board which is made up of the five county commissioners, District 1 Commissioner Chris Ponce, District 2 Commissioner Javier "Harvey" Salas, District 3 Commissioner Alicia Edwards, District 4 Commissioner Billy Billings and District 5 Commissioner Harry Browne met in regular session on Dec. 17, 2020 in the afternoon.

Edwards chairs the board. She introduced Wayne Smith, the new interim revenue cycle director.

"We are looking at everything that takes place within the revenue process so we can get good solid processes going in the hospital," Smith said.

"And we are so happy," Edwards said. Browne echoed the sentiment and said: "We hope you'll be with us for a while."

With no announcements and no public input, the members went into an executive session.

When they came out of executive session, Edwards gave the routine statement that only agenda items were addressed, and no action was taken pursuant to New Mexico statute.

Next was the consent agenda, which existed of minutes from the November meetings. Board members approved them.

Interim Chief Executive Officer Scott Landrum presented his report. "I would like to reiterate some of the comments I made this morning at the Grant County Commission meeting."

[Editor's Note: Those comments can be read at https://www.grantcountybeat.com/news/news-articles/61997-grant-county-commission-hears-monthly-update-from-grmc-at-december-regular-meeting-121720 .]

"The vaccination program has started," Landrum said. "We are officially a pod that receives vaccinations from the hub at Memorial in Las Cruces. Today we are in our third day of vaccination and we are following protocols. We are vaccinating all those who are front line and may be exposed to COVID. As of yesterday, we had vaccinated 70 people. That is continuing as we speak. We have a Tier 1A and 1B that are part of the plan developed by our Chief Medical Officer Dr. Ron Dalton and Infectious Disease Specialist William Hemmer, in consultation with our Chief Nursing Officer Kelly Rodriguez. A question came up this morning [in the commission meeting] about when one can expect to receive a vaccine. I haven't had one yet, but when it's offered I will take it. Questions were also asked about the difference between the Pfizer, Moderna, AstraZeneca and Johnson and Johnson vaccines. The recommendation I have been given is you take the first one offered to you. The Moderna first will likely go to the nursing home residents. It doesn't require the super-cold freezer, which we have ordered and should be here within the next 20 days. We have communicated with all the providers in the county that they are welcome to use the freezer. It's come up many times about how many COVID patients we have at the hospital. It changes throughout the day. Yes, we do have some patients, but we have to protect their privacy. We are continuing with procedures at the hospital, with our Chief of Staff Dr. Brian Robinson and Dr. Dalton determining what is essential. Basically, it's if the person has to wait will there be damage to that person's health. That is what they are using to determine which procedures are necessary. We are still a busy hospital. We are doing outpatient work, and yes, we have COVID patients, but we are doing a good job taking care of them, and at the same time taking care of our other patients. Gila Regional continues to be a very safe place to come to get your work done. We ask patients to work with their physician if they are needing a procedure.

"One of the things we are doing is improving our revenue cycle," Landrum continued. "Our new revenue cycle director will be dealing with registration, coding, and billing. Gila Regional has been doing a very fine job at providing quality care to its patients for many years. However, we've not done a very good job of getting people registered and getting paid for what we do. That is what we're in the process of improving. Recently, our chief nursing officer, our chief quality officer and our chief financial officer presented to Prospectors requesting some new equipment as well as funding to move the labor and delivery area to a larger part of the hospital to better accommodate our mothers and babies."

He said it would come up later in the meeting, but they would be discussing the new contract for a group of radiologists to replace the ones that are retiring. "We've done a great deal of due diligence on this, and our own Rob Holguin is in the audience to discuss this when it comes up to answer questions. We're in the process of making some changes in our labs. Our lab director is in the process of retiring and we are replacing her—she's done a very fine job—with an interim that may become permanent. We have signed a contract with a group called Coker, in partnership with HMS, to bring in consultants. Because of HMS's problems with staffing their behavior health positions, we are joining with them to do an assessment of the community's behavior health needs. Finally, we are putting out a weekly newsletter that is going to all our employees on Fridays, keeping everybody up on what is going on. Tomorrow's will continue with a COVID update. Every morning we have what we call a huddle, much of which is virtual, with all our directors to determine what we need to do. That is followed by an update, which we call a COVID call to discuss everything about COVID, including PPE and the like. Last week, I had a virtual townhall with all our employees. They were asked to submit questions ahead of time. Their questions literally took up all the time we had, and we will continue to have them to provide a communication link with all our employees during this pandemic."

Chief Nursing Officer Kelly Rodriguez presented her report. "I want to highlight that nursing continues to work on safety and quality projects throughout the month. Even though we have had a change in census, due to COVID and our increased surg plan, our nursing departments throughout the facility are doing a fabulous job taking care of COVID-positive patients and suspected patients. Of course, those who are taking care of regular patients are also doing a great job. A lot of our staff have stepped up to take care of these patients in spite of their fears and anxiety and have done a phenomenal job. I want to recognize our employee infection prevention nurse William Hemmer. He has been working closely with the Department of Health and with the implementation of our COVID vaccination program. He has worked with the hub, Memorial in Las Cruces, to get the vaccines here. William is probably going to need a vacation after this. As a hunter he gave up his hunt, so we owe him a hunt. Additionally to that, the labor and delivery move is still a go. We're working on the last pieces. We're hoping for some funding. We finished Phase 1 of the Baby Friendly survey. Mary Gruska and her team did a great job. We have Phase 2 of the survey coming up in early 2021. We did have our recruitment dinner for our Western New Mexico University graduating nurses. We are in the interview process with two right now. We hope to hire a good number of nurses. I also want to recognize Chantelle Sifuentes, one of our CNAs. She is an excellent tech in maternal and child, but also works throughout the facility to help patients in all areas."

Browne asked about the recruitment. "You mentioned two had applied, which sounded disappointing to me. Are we likely to get more?"

"I hope so," Rodriguez replied. "I truly feel that it was because we had the dinner pushed back and we held the dinner the day before the pinning ceremony, then they graduated and then the holidays came. We're ready and open for applications after the first of the year, because the residency program doesn't start until February anyway. So, there's time. It's the holidays. People are tired, they just finished a long tiring program."

Edwards said the governing board really appreciates the staff recognitions.

Interim Chief Financial Officer Richard "Dick" Alesch gave the financial report. "Our gross revenues matched the approximated budget but was 13 percent less than the prior four months average due to the stop of elective surgery procedures. Net patient revenue was slightly higher than the budget. Our operating expenses exceeded the budget but were less than the past four months average. Our EBIDA (earnings before interest, depreciation and amortization) was $476,000. Due to COVID preparations, our surgeries were down 35 percent in November, as well as ER and outpatient visits which were also lower. Regarding our EMS services, we recently applied for a grant with the New Mexico EMS Bureau for a new ambulance with a 25 percent match from Grant County Fire Tax Funds. We are expecting to receive a decision by mid-April. Just yesterday, we received an addition $510,000 from the third round of provider relief funding. So, we have received a total of $6.2 million from the Provider Relief Fund."

Edwards said: "$510,000. Good news!"

Browne had a question about a non-operating budget item that didn't materialize. Alesch said he would have to get back to him.

While they waited for Chief of Staff Dr. Brian Robinson to get on the phone, the governing board members heard from Michael Lieb of HealthTechS3. "I'm glad you got to meet Wayne. Gila Regional Medical Center's care of patients is terrific, but the hospital needs to get paid properly. That are a lot of broken processes, but the quality of care is excellent with your great staff of physicians and nurses. We just have to make sure everything is billed appropriately. Fresh bills are going out by Jan. 1 with higher reimbursements. Then we will address a chunk of bills going back to July 1, when the hospital received its critical access designation, that we will rebill. It's been a huge task by the financial team, but you will begin to see it manifest itself in the cash. The CEO search is moving along. As of last night, three will be invited here to onsite live interviews sometime in January. HealthTech will do a deep dive. All have said they are excited to be invited here. As we've focused a lot on revenue, we have also looked at the expense side of the finances. Yesterday we called a meeting of directors with the goals of 1) thanking them and 2) we wanted to walk them through the 13-month rolling process to show them what progress was being made. We wanted to show to the staff that the turn is happening, but there is still a long way to go. We also wanted to talk about the fragility, such as the November cancellation of elective surgeries. It's these sudden pieces like that, which are hard to plan for. Still, we're way ahead of where we were. We wanted to make sure they understand their efforts are paying off, but we still have a long way to go. We need their ideas on new revenue ideas and expense management. They are the ones what know what works and what doesn't. We want to refocus on operational improvements, such as materials management and nursing. We have a master list that we will start chipping away at. It's the everyday people who are able to make the differences."

Dr. Robinson gave his report: "The Medical Executive Committee reappointed me as the chief of staff; Dr. (Colicia) Meyerowitz will remain vice chief of staff and secretary will be Dr. (Norman) Ratliff. Our credentialing report you have already received. Our peer review committee reported that Dr. (Laura) Davenport-Reed has decided not to go again before the committee. We really appreciate her many years of service. The bylaws committee you have received, and I can answer any questions, although I believe most are self-explanatory. The Continuing Education Committee had no report as no sessions are being held during Covid. The chair of the peri-natal committee is Dr. (Michelle) Diaz, with the representative Dr. Virginia Hernandez. Dr. Ratliff is the chair of the medicine committee with Donna Kiehne as the representative. The surgery committee chair is Dr. Diaz and the representative is Aaron Rudd."

He said he knows there is a lot of apprehension in the community on the COVID surge. "I want to assure all of you that the members of the staff and the MEC are working very hard to be responsive to the needs of our patients. Our goal is and always has been to take excellent care of our patients."

There was no old business. The next item was new business, with several action items.

The first was the professional services agreement with Radiology Partners, dba Imaging Associates of New Mexico—radiology interpretation and interventional radiology.

Rob Holguin said: "We have done quite a search to find the best group to meet the needs of our patients and to keep those patients here in town. We didn't want just a telemedicine group, but we wanted onsite service, too. This group will do three days a week service onsite. This is a reduction in our former services, but it was difficult to find a group, because of our location. We are not near an Interstate highway or a major airport. This group also provides services in Las Cruces and it will easier for them to come up. Our decision was who would be able to be here and serve our community. This group floated to the top. We are working with their IT group and they are well versed and prepared to take over this type of contract. As one of the largest in in the country, this group will help us maintain our reports through our very good IT department."

Governing Board members approved the professional services agreement.

The next agreement was the credentialing agreement with Radiology Partners dba Imaging Associates of New Mexico.

Holguin explained that this agreement allows the physicians to practice at Gila Regional. Lieb said the agreement is to make sure they are doing their peer review. "Our credentialing committee reviews their credentialing."

It was also approved.

Next was an equipment lease with Baxter for Sigma Spectrum VI (6) Pumps. Landrum said he would explain the contract. "This is basically Kelly's contract, but she had to run to another appointment. This contract replaces the existing pumps at $5,500 a month with Baxter. We are getting 125 pumps, which are a newer iteration of the pumps we already have. These are all remanufactured pumps that Baxter certifies and we're only getting 125 of them. We've had more, but nursing re-evaluated how many we would need and came up with 125, while saving $40 per pump. It is a yearly cost of $396,000. This is very typical of hospitals to lease these pumps."

Browne clarified that it is for six years, 72 months, not an annual cost.

Edwards said she understood this contract replaced the contract signed on Jan. 7, 2020, that was never implemented. Landrum said that was his understanding. Members approved the contract.

The next item was the professional services agreement for the chief of staff. Landrum said the next four were agreements. The contract for chief of staff was a maximum of $122 an hour, but Dr. Robinson has not taken any money for the past year. "Others have also not taken reimbursement, because they say they know the hospital is in a difficult financial position. For the chief of staff, the vice chief of staff, the peer review person and the bylaws member, it is important to have an agreement in place."

All agreements were approved.

The next item was approval of the medical staff services credentialing reports, as had been presented to the governing board members by the vice chief of staff during the executive session. Landrum said: "These reports are recommended by the Credentialing Committee."

The governing board members approved them.

Landrum presented the bylaws rules and regulations revisions as recommended by the Bylaws Committee, as Meyerowitz had presented to them in executive session. Landrum said they have to do with board certification, disaster privileges, as well as certification review. "These have been thoroughly reviewed by the medical staff and have put them forward to you for approval." Members approved them.

Browne asked about the response time for the emergency department. Landrum said he thought it was just clarifying the telephone and physical response time.

Edwards asked about the ED (emergency department) non-board certified or non-board eligible requirement to have PALS training. "Who would an ED practitioner be who was not board certified?"

Lieb said: "You might have someone who has practiced for many years, but never sat for their boards and technically would no longer be board-eligible but who is well-qualified otherwise. It's not uncommon to have someone who is qualified and credentialed, but not board-certified or no longer board-eligible."

Landrum said that almost all the hospital physicians are board certified. "The reason you are seeing this is because it is a requirement of the Level 4 Trauma designation that the physicians be board-certified, and if not, to have PALS (pediatric advanced life support training)."

Members approved it.

The last item addressed the delineation of privileges for the medical physicist. Ladrum said because the hospital has a radiation oncology center, it is required to approve the delineation of privileges for a medical physicist.

"It covers diagnostic radiological physics, therapeutic radiological physics and medical nuclear physics," Landrum said. "It requires a lot of regulations and a lot of checks and a medical physicist comes in and does this. It is important to delineate that they have been granted these privileges."

"And who are we granting these privileges to?" Edwards asked. Landrum said he did not have the name.

Lieb explained that the board is not granting privileges to an individual. "You are approving the set of requirements. They have to certify the equipment, so they have to have significant qualifications."

Edwards asked: "If we approve this document, will you use this document to privilege someone to do this?"

Landrum said it was either with UNM or with the medical physicist they contract with.

Lieb said the closest comparison would be a job description. "These are typical doctoral or with post-doc education and they do this sort of work. It's typically a contract position. This position will cycle through the UNM contract."

Landrum said the contract with UNM is good through next July.

The meeting adjourned.