By Mary Alice Murphy

The meeting of the members of the Gila Regional Medical Center Governing Board, which consists of the five Grant County Commissioners, Chris Ponce, Javier "Harvey" Salas, Chair Alicia Edwards, Billy Billings and Harry Browne, began with introductions.

Edwards welcomed Human Resources Director Johanna Gramer to the meeting. The chair then announced that Jesse Doubrava, now in the Family Practice Clinic, has served Gila Regional for 35 years. She said she is always pleasantly amazed at how long some people have worked at the hospital.

Ponce said when he served in law enforcement that Doubrava was with the ambulance services at the time, and that "he was always professional and attentive. When I see him now, he's a great person, and I just want to acknowledge his service."

The members then went into a more than two-hour long executive session to hear reports, of which a few were repeated in the open session.

Scott Landrum, interim chief executive officer, presented the first report. "We are in the process of getting our VA certification. We had a veteran that we needed to take care of, and we were able to process the veteran out of network. We expect to receive our in-network approval any day. We're in the process of looking at a new contract for the Cancer Center. We're looking at several alternatives there. We've been told we have on the governor's desk what we presented at Prospectors for as much as $250,000 for equipment and as much as $200,000 for the move of our OB unit, as soon as we have the approval of the fire marshal. We have discussed in the past about questions from the public about the helicopter. The helicopter is based at Gila Regional and often it leaves empty to go somewhere else. We are taking care of most of our patients in house. Today, we have several surgeries going on as we speak. We have general surgery and orthopedic surgery. For cardiac patients, after we have stabilized them, we may send them out for further care. We are a level 4 trauma center, and I know we take care of many, many patients in our hospital. One day this week we had 29 patients and a full ICU (intensive care unit). For critical access, we must have an average of 25 and we try to keep it at that. But we are a very busy critical access hospital, with 80 percent outpatient, which is what you would want to see. We are reorganizing some of the leadership in the hospital. I know our CFO (chief financial officer) is reorganizing the way we do IT (internet technology). The Chief Nursing Officer is taking over case management, and I am taking over all the physician practices. We are recruiting a new radiology director. We are replacing our case manager and our clinic manager, who is moving to another state. And we do have a new lab person, who is a native of Grant County, and we are very happy to have her. We are in the process of replacing and recruiting a general surgeon, an ENT (ear, nose and throat) and a urologist. We have negotiations going on with an ENT, who might be able to come in from off site to provide services, I believe from Albuquerque. And I'm in conversations with a urologist, who would fly to Grant County Airport from El Paso one day a week. We have just finished a review of a mock survey for the Joint Commission. In addition, HealthTechS3 (the firm managing the hospital) is helping us with a survey to dovetail nicely with the change we're doing with IT. We expect that outcome within the next month."

No board member had questions.

Greg Brickner, interim CFO, presented the financial report on February results.

"In key trends, discharges in February were 69 less than last February, which brings us to 329 less than the prior year-to-date," Brickner reported. "Outpatient visits were down 560 than the prior year, while total surgeries were up by 30 over last year, bringing us to 89 more in the fiscal year-to-date. In the emergency department, we had 287 less than the prior year and 2,133 less than the prior year-to-date." He noted it is similar to trends across the country and a lot of it is COVID-related.

 

"For key metrics, our outpatient visits are 5 percent down; our discharge rate 7 percent down, ED growth 9 percent down, but our average length of stay is 2.8 days, direct cash on hand is 43 days, and the case mix index is 1.52."

He said he would switch out the days cash on hand for something more meaningful. "I'd like to talk about our financial strength index. It still uses the input of the days of cash on hand, but it also takes into account profitability, debt management, as well as the age of the physical plant, the hospital. Profitability is the largest input, so it is weighted. It uses a 13-month average. For February 2021, it is a negative 6.22, largely because of the lack of profitability, but it's still a 14 percent improvement over last year's negative 7.21. We're making progress. It should be more meaningful than days cash on hand, which is constantly fluctuating."

Edwards said cash on hand is simply money in the bank, "right?"

"Money in the bank and how fast we're spending it, yes," Brickner replied.

The February 2021 financial summary shows patient revenue down $544,000, but EBIDA (earnings before interest, depreciation and amortization) is $419,000 better and total net is $760,000 better than last year, he reported. "For the fiscal year, EBIDA is $1.1 million better and total net is $3.4 million better than last year."

With again no questions, the Chief Nursing Officer Kelly Rodriguez presented her report. She echoed what Landrum had said that she will be taking over the case management department, along with her inpatient supervisor Holly Glick to assist. "Another change is our ER director Payton O'Hare will be taking over the security department and managing them as well. We are entering the Joint Commission window, so we are always trying to be prepared in patient care, and, of course, looking at our process improvements within the nursing department. We are also looking at the plant and facility pieces, so we're doing a cleanup of waiting rooms, in anticipation of visitation, when people can come back into the facility. We are working on a large project of replacing carpet with laminate flooring in the medical surgical unit. It's looking very nice and will help with infection prevention. Additionally, we are upgrading epidural and IV pumps, things that are required for patient care. A large project we are working on is the changeover for our EKG program for our cardio-pulmonary area, bringing that to a new platform, which will help patient care and the viewing of documents for providers."

She also, as she does each month, recognized "one of our extraordinary providers, Ann Pavlokovich, who works in surgical services department, specifically in pre-op, but can also float where we need her. She never hesitates to jump to help in any of several levels of care."

Again, there were no questions.

Landrum presented the Chief of Staff report in Dr. Brian Robinson's absence. The Medical Executive Committee sent its condolences to the family of GRMC emeritus member Don Rudd. "He was much beloved."

The credentials and red flag report were discussed in executive session. There was no report from the continuing medical education committee, "which we expect to change soon, as we are beginning to open up." No new reports from the peer review or bylaws committees, and nothing from the medicine, perinatal and surgery committees.

The final report, the management report came from Neil Todhunter, HealthTechS3 president. "Greg mentioned about volume trends. We are seeing an increase in activity, particularly in the rural hospitals we manage. We expect to really see that change over the next month. We are starting to see things get back to normal. I heard today that Grant County is at 52 percent vaccination, which I think is pretty good. Hopefully, we will see volumes grow. A number of patients have had to put off things that they need to get done. Our critical access billing transition is still going on. Greg and his team are coming out the other side of that. We did get some good news. We got the interim cost report, and if that is accepted, it should add additional reimbursement to the hospital, so we're looking forward to that as well. We are working on old accounts receivable to get the cleaned up as well. In the American Recovery Act funding, about $85 billion is for hospitals. We are looking to our accountants to get some direction to see if there are opportunities to get some funding for our hospital. A couple of operational items, I want to mention—the scheduling of the patient fiscal services area is being consolidated and moved and seems to be working well. Later today, we will be working on credentialing of the new radiology group, which we think will be positive. The go-live date is the end of March, so hopefully that will come together quickly. I wanted to give some kudos to Greg, who is working with the local department managers on the budget, working from the bottom up to get their support and buy-in. The rural health clinic transition can begin, and that will bring enhanced reimbursement. Greg is also working with local employers to review and approve insurance billing arrangements. We are doing some rebilling for items that came in a little too early. We have done a charge definition, they also call it description, master, which looks at all of our charges to our patients to make sure we are within ranges of acceptability. There are about 10,000 different charges that we are making sure they are in the correct ranges of charges. Vizient, the group purchasing organization that we provide is in transition as well. Yes, some items will be more expensive, but in aggregate we expect to see savings of about $150,000. Then, there was some savings in food service that came through Vizient and that was about $25,000. We're still in the process of getting the 340B pharmacy process up and running. We will do that through the hospital, and we will work with local pharmacies. It means we will work to provide pharmaceuticals to certain payer classes and that will save them money. That should be a positive for the patients. We will work with the team on the cancer and cardiology transition we talked about. Carolyn St. Charles (regional chief clinical officer) will be coming in to look at things for the Joint Commission, but also to work with Kelly on the swing beds. We want to get them up and running. There are a lot of advantages—the patient gets to stay in the community and the family doesn't have to travel. John Freeman, our CFO, will be working with Greg as well. On physician recruitment, we continue to source candidates. We have a couple we plan to bring in within the next couple of weeks, through the board and the community and the leadership. We're planning to meet with medical staff on April 27 to give a sort of state of the union. And then the next day, we hope to have at least two sessions with staff."

No questions were posed.

The item of old business needed to be tabled to the April meeting. After some discussion, it was determined that the item of board appointment and acceptance to serve needed to be taken by the County Commission, not the governing board, so it was removed from the agenda.

Under new business, governing board members approved the hardware upgrade, software installation and maintenance agreement for the EKG PAC system with Infinitt North America, Datamed LLC, PC Connections for $112,705 for the first year and $100,000 for the following years.

Members also approved lab equipment placement upgrade and service agreement with product purchase agreement with Ortho and Cardinal for a Vitros 7600. Landrum explained that it was a large analyzer that labs use. "It's time to upgrade. They place the analyzer, and we buy the reagents. We will save about $124,860 over the lifetime of the agreements. We will bring them in and run them simultaneously with our present analyzers for 30 days to certify them, and then the company will remove the old analyzers. It is for a period of 72 months and will hopefully be in April that we have the new ones."

Also, under consideration was the O.R. Stryker Neptune bio-waste management system equipment placement agreement with product purchase and service agreement. Landrum explained the equipment scavenges OR waste. "Once again they provide the equipment, which replaces obsolete equipment, and we provide the disposables." It was approved.

A resolution addressed an ambulance purchase. Landrum said: "we're in the midst of getting a new ambulance for about $148,500 and we're waiting on some grant funds." Brickner explained that the purchase would be made only if the hospital receives the grant funds from the state. "You will be agreeing that the hospital cost will be capped at $23,000."

Edwards noted that the match is about $60,000 total, because 25 percent is matched by the county from county fire funds and $23,000 is the hospital cap.

The resolution was approved.

The final item was the consideration of medical staff credentialing reports that were presented in executive session. They were approved.

The members agreed to adjourn.

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