GRMC governing board held meeting 022521

: Category: Front Page News Front Page News; Published: 03 March 2021 03 March 2021

By Mary Alice Murphy

As has become customary in the governing board meetings lately, Chair Alicia Edwards opens the meeting for introductions and announcements and then the members, who are all Grant County Commissioners, Chris Ponce, Javier "Harvey" Salas, Billy Billings, Harry Browne and Edwards, go directly into executive session, for an unknown length of time, usually at least a couple of hours.

At the latest one on Thursday, Feb. 25, 2021, Edwards said the introduction would be done later. [Editor's Note: The introduction may have been made, but not specifically.] The chair announced that Donna Bevill was being recognized for serving 30 years in the mammography department and Desiree Bernier for 5 years in patient financial services.

They went into executive session.

After making no decisions in executive session, the members came out of the session and approved the consent agenda of minutes.

Interim Chief Executive Officer Scott Landrum presented his verbal report. He said the hospital has a considerable number of positions posted on the grmc.org website. "There are a lot of them. Those are perused daily by the HR department to make sure they are staying up to date on them. Our organizational chart is a fluid document. As the hospital grows and makes improvements and makes a lot of progress, you will see changes. We are recruiting a new facilities director, a new case management person and a person who manages the clinics. I can report that our new pharmacist we recruited is working out beautifully. He is very involved in the 340B program, which is good for the hospital, and while I'm not ready to announce today for personal reasons, we have settled on and made an offer to a new lab director that will be coming on in the next week or so. We were able to recruit somebody that we're very, very happy with. I think it came up in the last meeting that we're ready to move our Ob department. We're just waiting for the final approval from the fire marshal. We will move the OB and labor together into a larger space. The inspection contract has been signed and we're just waiting for the inspection and approval. One of the things that my CNO (chief nursing officer) and I are doing is that under COVID, we are not allowing visitors. We still have only two entrances open at the hospital, the emergency room entrance and the cancer center and surgery center entrance. As many folks are vaccinated, we are able to get out into the hospital. The CNO and I are getting our regular rounding. We are rounding in regards to housekeeping. We are pulling up carpeting and putting in flooring, which is what all hospitals are doing currently. That is ongoing. We're looking at the cleanliness, especially in high-traffic areas like the ER. I'm happy to tell you that our contract to provide service to the VA, which had some issues in the past, that our application is complete with UNM. We're waiting for the release to welcome those patients to our hospital. Finally, our cancer center contract is coming up and we are perusing our current provider and looking at the previous provider to determine which would be best for us. We are doing our due diligence and working with counsel."

CNO Kelly Rodriguez said she wanted to highlight a few things in her report. "We are working on our joint survey window that is coming up to start in April. We're getting our hospital into a nice working order and making the hospital look like it used to. We're also working on our residency education. Starting today our students have onboarded, after going through the application and interview. We're excited to have five new nurses join us. We have completed our patient handbook, which will be distributed to our patients who are admitted to the facility. This is a great resource for our patients. It has frequently asked questions and they can look through the handbook and delineate out where to go. Additionally, we are starting a process with our registration team and the patient portal. We've had a patient portal for years, but we discovered that it wasn't always known about or advertised. This is something we discovered during COVID, when patients needed their COVID results. They have been swabbed and they are quarantining at home, but they can't come to the hospital to get the employer form for their family medical leave, but they can look it up on the portal. So, we are facilitating the process where registration can help people with the HIM portal, so they can see their results from home. All our projects in nursing are related to quality and safety of patients and improving processes and efficiencies, so we have multiple people working on teams, whether it's pic line or new pumps or moving labor and delivery. For my recognition, I would love to talk a little about Amanda Mondello. She's a registered nurse and has been with us for about a year. She truly is the epitome of our ICARE (integrity, compassion, accountability, respect and excellence) values. She has a bright smile on her face and has joined a lot of our teams. Our Echo sonographer Beth Rouhani is an amazing echo tech and keeps the program running smoothly."

Browne asked if any part of the JACO survey would be in person.

Rodriguez said she didn't believe the "we've been told, so, we don't know yet."

Edwards said she thought Amanda Mondello could be a DAISY Award nominee and Rodriguez agreed.

Interim Chief Financial Officer Greg Brickner presented his report. "Overall, the volume in the hospital is kind of soft to slightly declining, which we're been seeing this year, mostly related to COVID impacts. Year-to-date our outpatient visits are down 10 percent, discharges are down 21 percent and emergency department growth is down 5 percent. We have a 2.9-day length of stay, which is very good for us as a critical access hospital. We have 54 days of cash on hand and a 1.32 case mix index, which is pretty good for a small hospital. Financially for the month of January, we ended up with a net operating loss of $2.5 million behind budget. There are some timing issues. Last month, we had a really good month, so, on a year-to-date basis against budget, the operating loss is only $375,000 behind budget."

Landrum presented Chief of Staff Dr. Brian Robinson's report. There were no new reports from the Medical Executive Committee. The credentials report and red flag report were made available in executive session. Peer Review Committee had no new reports, nor from the Bylaws Committee. The Continuing Medical Education Committee has not met and there have been no CMEs due to COVID-19 precautions. No new reports were from the Medical-Perinatal Committee, nor from Surgery departments either. "I don't want you to think the medical staff is not meeting. They are meeting constantly it would seem, early morning, afternoon and at night and many of these are done virtually, so there is still all of the work being done."

Mike Lieb, HealthTechS3 vice president of interim services, presented the HealthTechS3 report. "Last month, you asked me to do a state of union. We've been here 8 months. During that time, a great deal of work has been done, but much of it hasn't been seen by the public. So, I wanted to highlight some of the things going on. We've got plenty of work still to do, but plenty is happening. We've kicked back off the CEO search. We're hoping to bring candidates to you as quickly as we can. We want to make sure the slate makes everyone comfortable, and we want to do it as soon as feasibly possible without any hiccups. A couple of things I want to talk about is some of the clinical work that has gone on. Kelly alluded to some, but one of the things I want to highlight is that you do really good clinical work at this hospital. They recently received the Trauma Level 4 designation. It's an indicator of the skill set and education of the physicians and the providers there, but there are a set of regulations, so when an accident or trauma victim is coming to the hospital the ambulance crew alerts the hospital. There are notification protocols, so the tools, the staffing team are right there and ready when the patients roll in the door. It is an impressive thing for a small hospital. Also, you are rated a four-star quality hospital. That's not broadcast often enough. You have telepsychiatry services in place; they're working on a baby-friendly designation, for the maternity and nursery area. I won't go through the full list, but I do want to talk about the COVID vaccination process. My data is now three weeks old, but as of that time, we had administered more than 835 doses first and some second doses to healthcare workers both within GRMC and outside here in the community. All the healthcare workers at Gila Regional were offered the vaccine, 68 percent of them have accepted it. We have actually moved the vaccination clinic to the Family Clinic across the street and they are working in conjunction with other entities in town. William Hemmer, infectious disease specialist and his team have done a phenomenal job along with all the resources here. It's been a pretty impressive thing. The observation unit is complete. At the moment our census doesn't warrant opening it fully. We do have observation patients, but we have not put them designated to a specific spot. We have bed capacity, which offers some flexibility on our critical access number of beds. Swing beds, we want to get up and rolling, as we address staffing issues particularly in-house PT and case management, we'll get it kicked off. One, we'll get back those folks who have to go Las Cruces or somewhere else for a significant procedure, but they can rehab here close to home and family. We have contracted with Radiology Professionals of Las Cruces to take over the professional reads for our patients. Our long-standing radiology group is retiring the end of March. They opted not to renew, but we thank them for their many years of service to the hospital. We do expect this to be seamless for the patients. Surgical volumes had been pretty steady up until up through October, when we saw the COVID spike after Thanksgiving and through the winter months, so we have backed down on elective surgeries and procedures, based on reduced demand and the governor's restrictions. We do have a backlog of elective cases ready to go as soon as the restrictions are lifted. Our financial performance has tracked along with that. The trend is pointing in the right direction. Our operating expenses are down, basically due to everybody in the hospital. We started last July. We were at $7 million a month. Now we're down to about a million and a half dollars of expenses a month on an ongoing basis. People are managing and working well. It's a house-wide effort.
"As you know, we were approved for critical access payments in December, back to July. The technical conversion of all our billing systems was completed as of January 14. All the numbers are now tied together. As of today, we are billing all of our claims out at 100 percent under our critical access designation numbers. We are going to go back through July and rebill all the PPS claims. We're seeing the payments flow the right way they're supposed to. And we're working on addendums to the Medicare, Medicaid and managed care plans because they are tied to Medicare rates. Most of the external payers are in that process. Presbyterian has signed and claims were released to them for the old things on January 20. I believe United Health care has said they would sign as of April 1. Everything is grinding through the process and we're being very careful to test where we release large batches.

"We know that access to the hospital and its services are very important to your people. Scheduling in the past has frankly been a mess, so, it's been a huge focus, particularly to getting radiology studies. For the last 12 weeks, we have seen our scheduling systems go up and our scheduling slots at about 45 a week with 100-125 slots available. We're starting to fill those slots we have. We do have capacity. Wayne and his teams have worked hard at the scheduling, so as of this point all current orders are scheduled across all the modalities. One thing that has become clear is that we've gotten all those backlog orders in. The only delays now are at patient request. We have capacity to grow and will push out to providers and ask them to give us another try. We've got these things cleaned up. Supply chain from the Vizient standpoint, the conversion is going fairly well. We have not moved our drug purchasing from Cardinal yet, but we're in process. Food pricing will move to Vizient with Morrison still in place. So, you see savings in aggregate. Some of you have asked about some things costing more. That is true in any conversion in any catalog with thousands of items, you will see some single items cost more, no matter who you go with, but in aggregate, we're expecting between 4 and 5 percent savings to Gila Regional over the course of a year. We won't restrict a physician or provider if they have a particular specific item that isn't necessarily on the GPO catalog, fine, go get it. We want to make sure we get the right stuff for the right use. The Pharmacy project is completed and occupied. The Board of Pharmacy has approved that one. Almost done with the Ob and labor. The section of roof G has been completed. We're waiting on funding applications to finish the rest of the roof. Under the rural health clinics, our pediatric clinic is relocated to the Family Medicine clinic under the rural health clinic designation. The foot clinic and podiatry will move to the previous pediatric clinic. We're moving some of these around to make better use of space and better patient flow. They will be completed mid-March. We have been fully recognized as a rural health clinic, which will change some of the billing gains. We're waiting for the welcome letter from Novitas, our third-party Medicare intermediary, then we can start billing under the new rules. What I really want to highlight as well, you've heard some of the reports from the folks and staff across the whole spectrum. The work that is really being done is by the folks at the hospital. We've given them some tools, but they're doing the work and you should be proud of them."

Browne said he reported that 68 percent of the staff has been vaccinated for the first shot. "Do you have any effort to convince the other 30 percent?"

Rodriguez said it is up to the staff member to accept the vaccination or not. "Some of them have comorbidities that they fear getting a vaccine that has not been tested for that, so they have refrained from getting it. Some have elected just not to take the vaccination."

Lieb said across the board in most hospitals that the 65-70 percent range is about the uptake rate. "It's been offered to everybody. It may be a delay and watch 'what happens to make sure nobody keels over from it before I get it.'"

Browne said he understands all that. "I was asking if you had a specific effort. It appears you don't. It might be a question for Mr. Hemmer. My preference would be to start working on a strategy and not to let it go."

Rodriguez asked: "You're looking for a strategy to capture the other 30 percent?"

Browne confirmed that. "I think it may be a strategy of continued education, maybe addressing specific issue with comorbidities. I feel this hospital needs to be a leader in this are more than anything else. I would like to see that figure get above 90 percent."

Billings said: "he gets the education part, but twisting someone's arm to get a shot they don't want to get, couldn't that put us at risk?"

"My first preference is not to make vaccinations mandatory," Browne said. "But whether it puts us at risk, that's a question for a different place. I'm pushing from the education point of view." He said from two workshops that he has attended he sees little risk to the vaccine."

Denice Baird,ncompliance officer, said Hemmer has done a lot of education with staff who have declined the vaccine or state they have fears. "I will personally say I have severe allergies with anaphylactic reactions to some things. I was very hesitant to take it. He and the pharmacist have done a lot of education. They made me feel more comfortable, and I know they have done that with multiple staff members. I think it's as Mr. Lieb said it has come down to a lot of people saying they want to see what happens first. I have been asked by staff members what reaction side effects I had. I've explained my side effects and then said I will do it again. I will take it again despite the fever and body aches and everything else I experienced with it. Then there's that other population that don't want it, and we can't force it on them. William has spent extensive time educating and so has the pharmacist."

Ponce said he respects those who don't want to take the vaccine. "That's their choice. But because some people aren't vaccinated, we will have to stay on the course we are right now, with masks and such. We have to have respect those who want to take it or not take it. "

Lieb said he didn't believe "we will be without masks, hand washing and all that for many, many months, if at all in 2021."

"So, I'm really happy to hear that," Edwards said. "In the fall, we had some issues with mask wearing at the hospital. We have to set the example for the community, as Mr. Browne said."

She said she wanted to congratulate the hospital on the critical access. "It's great to hear that we are 100 percent billing critical access. Want to thank the effort of many to get to it."

Lieb said it's a team sport and dozens of people worked to get to this point.

Edward said Mr. Landrum forwarded to her with a letter from Rural Radiology that was so complimentary of the hospital, talked extensively about how much they enjoyed working there. "Just nothing but nice things to say about our hospital during their time here. I want to thank them for their long-time service at our hospital. The last thing I want to say, is you were talking about the rural health clinics. The rural health clinic increases our reimbursement rate but does not increase patient rates of care, right?"

Lieb said he believed that was correct. "We get reimbursed for a percentage of our expenses for overhead and everything else."

The old business was the Open Meetings resolution, "which we managed to mess up. We got rid of some required language. It's back in," Edwards said. The item was approved.

Browne wanted to know why "if possible" is required wording.

JoAnn Holguin, GRMC executive assistant, said sometimes, "it is not possible, for instance, a contract that's going to be expiring. We cannot always have 24-hour notice."

New business brought up several items.

The first was approval of a HealthTechS3 IT assessment services agreement.

The next item approved the second amendment to Practitioner Employment Agreement with Michael L. Harris, CNP.

The governing board also approved the clinical database replacing the IBM/Truven for collection/transmissin of CMS.

Also approved was PET Scan Coach Agreement with Alliance HealthCare, which extends the agreement to have a coach and technician at the hospital every other week.

The governing board members approved the medical staff credentialing report.

The last item was a resolution for provider relief funds audit recognition. Salas moved to accept it. Ponce seconded it for discussion.

Brickner said the hospital worked with the auditor and "what you will approve today is recognition of expenses in last year's audit. This is the final item to close out the audit. You're approving 75 percent of the expenses. What is left will be approved in this fiscal year."

Brickner said approving this audit will allow the county to move forward as well.

Edwards said one of the board's requests was to look at contracts more than $500,000. "It is my understanding that the state auditor transferred that audit responsibility to the hospital's audit company. Do you have an update on that?"

Brickner said he did not and would report back. Landrum said he also didn't have any further information.

Edwards said it's appropriate to explain because the board has spent a lot of time discussing it. "There was a large payout to a previous CEO, and we've had a lot of questions on that payout, so we wrote a letter to the state auditor requesting that every contract under that CEO be audited."

Brickner said he would get an update.

It was approved and the meeting adjourned.