By Mary Alice Murphy
At the beginning of the regular monthly meeting of the Gila Regional Medical Center Governing Board on Jan. 28, 2021, Chair Alicia Edwards introduced the new Interim Chief Financial Officer Greg Brickner and then recognized several GRMC employees for their service.
Eloy Medina, Emergency Medical Services director, was recognized for his 30 years of service in the department.
Shelly Burrola has served 30 years in the Emergency Department
William Hemmer, whom Edwards described as a very busy person right now as he serves as the hospital's infectious diseases specialist, has worked at Gila Regional for 15 years.
Elia Maez and Jarita Diaz have each served for 15 years in the Emergency Department.
The board then went into executive session for more than two hours.
Not having taken any action during the executive session, the members, who are also county commissioners, District 1 Commissioner Chris Ponce, District 2 Commissioner Javier "Harvey" Salas, District 3 Commissioner Edwards, District 4 Commissioner Billy Billings and District 5 Commissioner Harry Browne began the rest of the open meeting action agenda.
The first item was approval of the consent agenda consisting of board meeting minutes from Dec. 15 and 17, 2020, with the addition of a new legal notice: PURSUANT TO NMSA 1978, SECTIONS 10-15-1 (G) (9) AND 4-48B-3(H), THE MINUTES OF THE PRESENT OPEN MEETING WILL REFLECT THAT FOR THE FOLLOWING MEETINGS, THE MATTERS DISCUSSED WERE LIMITED ONLY TO THOSE SPECIFIED IN THE NOTICE OF THAT CLOSED MEETING.
The board members approved the consent agenda.
The updates and reports began with the Chief Executive report given by Interim CEO Scott Landrum.
He said he had several points to make. "The vaccination program at Gila Regional has gone very well. We receive the Pfizer vaccine from Las Cruces delivered to us by the National Guard. Hidalgo Medical Services and the state Health Department have also received the Moderna vaccine."
Edwards interrupted to say she had heard last night that Silver Health Care had received some yesterday [Wednesday, Jan. 27].
Landrum said he had heard that, too, and continued his report, saying that progress on the revenue cycle is moving forward. "One of the issues was registering people for procedures, especially in radiology. We have moved five individuals to our office on the hill. We moved the computers and desks, and we are ready. We will be working through our backlog."
"A couple of weeks ago, the new pharmacist, Dana Hessel said the department needed to address issues with the 340B program. It was called a replacement program. We are all electronic, with the cancer center, infusion therapies and cancer center drugs. It is monies that we can get back. We got it all straightened up under critical access and the correct numbers. Our new pharmacist is very astute. This will include the retail side. I understand all pharmacies in town do participate in this program. It is very typical in critical access hospitals and it will include all the retail pharmacies. It's a good thing for the patients and it's a good thing for the hospital. It's a program that we need to extend."
HealthTechS3 Vice President of Interim Services Michael Lieb said it has been a godsend for critical access hospitals throughout the country. "Not only does it bring reduced prices to the consumer, it's also beneficial to the other pharmacies. They, in effect, order their drugs through the hospital for the outpatient meds. Our most conservative guess is that's it's worth about half a million dollars to the hospital."
Browne asked if there were a concern that Congress might cut off the program.
"We don't think so," Lieb said. "It may not be as robust as in the past, but I don't think it's going anywhere. We hope."
Landrum said they are looking at the Cancer Center contract. "I've been in touch with both the previous provider and the current provider. We will be requesting an RFI (a request for information) from the previous provider with Dr. Barbara McAneny and we're also in contact with our current provider and looking at ways, if we do stay with them, we can enhance our current delivery system and satisfaction of our patients. I want our new interim CFO to be very successful, so I have accepted two of his responsibilities, housekeeping and EMS. I have had EMS before and because our CFO has been working with Charlene (Webb, county manager) on getting ambulance funds, I will be working with Charlene on that. Our dietary is being handed off to our facilities director and we will be looking at our Morrison's contract to see if we want to continue. So, we have a new organizational chart. I thought it right to take over some of the CFO responsibilities, because he has his hands full."
"Coker update," he continued. "We had a conference call last week. We engaged with HMS on this effort to bring back behavioral health services to the community. We closed our inpatient behavioral health unit because we were losing about $2 million dollar a year. We're looking at ways to provide the services. HMS closed its outpatient areas, too, due to a loss of funds. We've been working with Ms. (Priscilla) Lucero (Southwest New Mexico Council of Governments executive director), our wonderful local person, looking at grant funding. Our conclusion is to have a slightly different target. We have looked at what it would cost to reopen our behavioral health unit and for HMS to reopen its services. We have a hold on the money. Those numbers are big. We know behavioral health loses money, but we think it is a service we need to offer to the community. When we conclude the study, we will give the information to Ms. Lucero, with the metrics she will need and the kind of money we will need for her to solicit grant funding."
He concluded with saying the governor's orders lapse after the first of February on limiting surgeries. "Drs. Brian Robinson, our very fine chief of staff, and Michelle Diaz, our surgical medical director, have been working together at least twice a week to review procedures that come up and they determine which surgeries are essential to be performed. We are looking forward to the lifting of that requirement of essential surgeries only, because surgeries are backlogged. Our volumes are down as a result, because we are 80 percent outpatient work at Gila Regional, so it directly affects our viability."
Browne asked for an update on the percentage of staff being vaccinated. Landrum said he did not have the numbers yet. "We are still giving second doses. I suspect we are doing better than the 40 percent opting out."
To the question from Browne about if the governor's order about essential surgeries was related to the red-yellow-green system. Chief Nursing Officer Kelly Rodriguez replied that it is not.
Landrum also noted that the New Mexico Hospital Association is lobbying the state to let hospitals make those decisions. "We haven't been as affected by COVID as many other hospitals have. We've managed it very well. And yes, we would like to get back to work."
Edwards congratulated Rodriguez on becoming the new permanent CNO.
Rodriguez thanked her and said she was also excited to become part of the revenue cycle process. "I've been asking to be part of it and nursing has been pulled in. It's imperative for the hospital because nursing is where the charges are generated in multiple areas, whether it be surgical services, inpatient or in the emergency room, nursing is critical to the revenue cycle. To be part of solving some of the issues is important. We are working on our bedside procedures. We have finally received an updated list from CMS (Centers for Medicare and Medicaid Services), so we can update our clinical services, so we can capture that revenue for what we are doing for facility charges. Again, very important.
"We are implementing a couple of new pump items," she continued. "One is the new IV pump system, which we are upgrading from the older Baxter 2 system, and in addition to that we are adding some new epidural pumps in the maternal/child department. The old ones were end of life. We are working on re-establishing our pick line team, which is a team of nurses who place pick lines at the bedside. We did have a program a couple of years ago and we're bringing it back in. We did put the nursing peer review on hold for a short period of time. It was not a good time, because of the holidays and the influx of COVID. Staff didn't have a lot of time. Based on recommendations from our Cobre Valley materials manager visitation, we are working with Michelle Carrillo and Jeff Rushing on our materials inventory to bring it down to the levels we need. We continue to work on the labor and delivery renovation, which was slowed by the damper issue, so we are working on that. Back to Mr. Browne's question from last meeting, we did have seven Western New Mexico University nursing students apply. One has already passed her boards. We will make a formal offer to her through the residency program. We are just waiting on those additional six people."
She said she also wanted to recognize Pedro Corral, a surgical services nurse, who has been very helpful in reorganizing the inventory in surgical services, so that it's easier to count. "We're actually doing inventory today. His expertise in all the thousands of pieces of inventory is making me very happy to have him a part of that. I also want to recognize one of our PBX operators, Brianna Deldestino, who works in registration. We had a situation recently when a fellow called in who was suicidal. She stayed on the phone with him the entire time until the police and the ambulance got there. So, she deserves kudos for keeping a very calm, cool head and talking this patient through his crisis."
Rodriguez explained that usually those calls go to Dispatch, but sometimes people call the hospital directly.
New Interim CFO Greg Brickner presented the financial report for the month of December 2020.
The first highlight was net patient revenue for the month was $119,000 less than the budget, due to shifts in the payer mix. "Our revenue for the month included $3.6 million in special programs, with $1.9 million of that a volume decreasing adjustment, which was $1 million in November, and $1.7 million for the hospital access payment. The targeted access payment you may know as the Safety Net Care Pool. Operations for the month were $80,000 higher than budget. Discharges exceeded budget by seven, five of which were in OB (obstetrics). Total outpatient visits were 982 less than budget, As Scott mentioned elective surgeries continue to be evaluated on a case-by-case basis per the governor's order. There was $1.8 million in non-operating funding, which includes proceeds from the Cigarette Tax Bond, of $1 million and $500,000 for COVID stimulus. Net results from operations for the month were a net loss of $1.4 million. These results were due to the lack of volume due to COVID-19 restrictions. However, actual results are a net surplus of $3.7 million, created by $5.1 million for special programs and $1.5 million in non-operating."
He said his department has started on the 2022 budget. "We are trying to do a bottom-up budget by working with department heads and getting them involved in the process."
Browne said the non-operating revenue didn't square with what he thought the hospital might get when the payroll protection plan loan reverted to a grant.
"We did not receive PPP funds, because we have more than 300 employees," Brickner said. "But we did receive funds from Health and Human Services, so we were able to secure $500,000."
Browne said the Batch 1 of PPP had been carried on the books as a liability "until we got word that it was converted, but that hasn't happened yet? I assume it would be non-operating funds."
Brickner said he did not believe that it had yet been converted from loan to grant.
The Chief of Staff report was presented by Landrum on behalf of Dr. Brian Robinson. Under medical executive committee, the members recognized William Hemmer and Roberta "Bertie" Berry for their outstanding work with the COVID-19 vaccine distribution. The credentials report and the red flag report were made available to the board during the executive session. Under peer review, pediatrician Dr. Andre Worrell has been appointed as a member of the peer review committee. Under bylaws, there was no new report. Under CME, continuing medical education, there was no report and no CMEs have taken place due to COVID cautions. Under the medicine, perinatal and surgery departments, they are working on enhancing communication during COVID. They continue meeting virtually, with very good attendance.
Lieb gave the HTS3 monthly management report.
"I want to extend my appreciation to the five of you as board members, to JoAnn (Holguin, administrative assistant) and the entire community group for all your work on the CEO search," Lieb said. "It's been an enormous effort and has taken lots of extra time. We look forward to a successful resolution to that.
"A couple of things," he continued. "We are working hard at improving access to hospital services, with appreciation to our staff, nurses and physicians, we are trying to get those patients that are backlogged for an extended time to get them in quickly, get seen and get them back out to the doctors. It's been a huge focus, along with the revenue cycle, so we actually capture what we are doing, billing appropriately for it, and we got a nice notice from Novitas that we have about a million coming in, which I assume is future 2021 billing now. The gears are clicking now and we're starting to see it and you should see it relatively soon. We're looking at some other things. By virtue of your access now to Vizient, the GPO, we're starting to look at our pharmacy pricing. We're leaving Cardinal to manage it, but we are asking can we shift drug purchases to benefit us. We are analyzing that and will get back to you. And we're looking at the cafeteria and the food purchases to see if there is an opportunity to boost quality and improve pricing. Lots of work underground. Finally, Edwards asked me to come back next month to give a report on our SWOT analysis and where are we on our various projects that you have heard of over the months, such as physical moves, staffing, all those different things. It will be sort of state of the state address of the hospital to get you current."
With no new business, the board members went directly into new business, which consisted of 19 professional service agreements for various positions within Gila Regional,and amendments to agreements.
The professional agreements, all of which were approved by the governing board members, included naming Virginia Hernandez, MD, as chair and Gregory Iwaasa, DPM, to the Bylaws Committee; Gregory Koury, MD, as chair, Donna Kiehne, CNP, Nathan Williams, MD, and Ronald Dalton, MD to the Credentials Committee; John Stanley, MD, as chair, Michelle Diaz, MD, Frederick Wendler, MD, and André Worrell, MD to the Peer Review Committee; Tsering Sherpa, MD, as chair and Norman Ratliff, MD to the Pharmacy and Therapeutics Committee; Norman Ratliff, MD, as chair and Donna Kiehne, CNP to the Medicine Department; Michelle Diaz, MD, as chair, and Virginia Hernandez, MD to the Perinatal Department; Michelle Diaz, MD, as chair and Aaron Rudd, CRNA to the Surgery Department; and Norman Ratliff, MD, as Medical Staff Secretary/Treasurer.
An amendment to the physician employment agreement with Gregory Iwaasa, DPM, was made to correct his reimbursement. Landrum read the agreement, stating that GRMC would reimburse Iwaasa for medical licensure, dues and subscriptions up to $2,500 matching all other GRMC physician contracts. "Apparently it was simply left off of his former contract." It was approved.
The next item was a third amendment to the maintenance and support agreement for the API Healthcare Time Clock. Landrum explained it was because "we will be moving to another system that will be more efficient and cheaper, but we are in a position where we have to amend it for the third time to provide for the continuing use for one year at a cost of $103,570.31. We are not quite ready to move to the new system, but I think this will be the last amendment."
"So, by the first of next year or the end of this year, we will be approving the new system," Edwards clarified.
The amendment was approved.
The action items concluded with three annual requirements for the governing board with the Open Meetings Act, the Conflict of Interest Form and the Board Affidavit of Consent to serve.
The OMA stated that meetings would be held at 9 a.m. on the last Thursday of each month, with the possibility of special meetings and the requirement for written minutes.
Browne requested that the OMA change Board of Trustees to Governing Board throughout the document and that the word possible be struck from the requirement of notice of an emergency meeting 24 hours prior to the meeting. The OMA was approved with the amendments.
The governing board members approved signature authority for Landrum up to $50,000 and Brickner up to $25,000, with large contracts required to come before the board. The item would replace previous signature authorities.
The medical staff credentialing reports included a new applicant, whose name was not understandable, and the rest were reappointments. One exception was a doctor being given a leave of one month. No additional privileges, only one resignation, and no corrections to previous report. The members approved the credentialing report.
The renewal of the conflict of interest is an annual requirement, and the form was approved for signing by the members of the governing board.
The next annual requirement was the board affidavit of consent. Holguin said they need to be signed and witnessed by a notarizing body.
Browne said he felt the Grant County Commission "has fallen down on the job because the commission has not appointed us. I thought we were governing board members because we are commissioners, but the form says appointed by the commission. Because we are in strange territory here, maybe we should have legal counsel on this."
He moved to table the board affidavit of consent until "we have ironed out the issue of appointment."
The motion to table was approved.
The Governing Board adjourned.