By Mary Alice Murphy
The Gila Regional Medical Center Governing Board at its meeting on Tuesday, June 29, 2021, began the meeting by recognizing several staff members for their years of service at the facility. Although none was present for the event, all will receive plaques for their continuing service at the hospital.
They included Becky Estrada for 30 years of service in the laundry; Christopher Draper for 20 years of service in imaging; Rexine Sierra for 20 years of service in cardiopulmonary; Maureen Gilpin for 20 years of service in the nursery; Johnny Little for 15 years, now house supervisor; Sarah Chavez, 25 years in health improvement management; Nicole Vlanecia, 15 years in imaging; Philip Clark, 10 years in the emergency department; Pamela Apodaca, 10 years in the recovery room; and Ashley Bobo, 5 years in nursing.
With no public input, the board members went into a two-plus hour executive session.
After stating they took no action in the executive session, the board came back to order in regular session and proceeded with the agenda.The first verbal report came from Interim Chief Executive Officer Scott Manis. He said one of the items on the agenda is a one-year amendment to renew the professional services agreement with the UNM (University of New Mexico) Cancer Center. "We have worked diligently on an agreement that works well for both parties. We are committed to this very important service line for the hospital and the patients we serve here."
He noted that the previous month, the governing board members had approved an agreement for a cardiology site at the HMS Clinic in Lordsburg. "It will launch every other Tuesday, starting July 6. Dr. (Norman) Ratliff will be practicing out of that location on every other Tuesday. He's super excited about it. We are working together with HMS on some joint marketing to announce the service down there. The next thing I would like to announce is that we have been working very diligently with the National Sinus Institute to provide ENT (ear, nose and throat) surgical procedures at GRMC. We've been in communication with their primary doctor, Dr. Ian Alexander, and it's primarily to help them grow their local presence with the clinics they have here and in Deming, and be able to serve their patients at GRMC with the surgical procedures they need. That could start as early as July. I want to thank the OR staff and (Chief Nursing Officer) Kelly (Rodriguez) and her staff for getting that going. We are also working with representatives of the Economic Development Administration and the Southwest New Mexico Council of Governments and Priscilla Lucero (SWNMCOG executive director) and others in setting up the platforms and parameters for administration of the EDA grant we were awarded. We're working to refresh the bids from vendors and make sure to meet state procurement law. The same with the grant we have for the enhancement and expansion of the women's services area."
Rodriguez wanted to highlight the work they are doing around quality, safety and compliance. "We are waiting for our Joint Commission survey any day now, so we continue to try to be ready with our patient care. We are ready and excited to move past this and continue to work on the quality and safety measures. We are happy to report that Darrel McPherson is moving back to the county, and we are excited to have him as our clinical educator. We have made an offer to a case management director, so we are awaiting word on his potential coming here. We are also excited that Melanie Vigil will be coming from Texas as our match supervisor under the inpatient services director. We are excited to have that addition to our nursing management team, which we are rounding out. One of our big initiatives coming up is the swing beds, so that we can actually admit patients into that status if they choose to remain with us for their skilled nursing post discharge as an inpatient. So, we're tentatively looking at admitting patients to that status sometime in August."
She said they continue to work on their labor and delivery merger into one physical location. "So, we are working toward that. We are also working toward using the capital outlay money toward securing equipment that we've needed for some time. As I do every month, I want to recognize one of our outstanding staff members. This one came from Dr. Kotch, our emergency director. He wanted to recognize this individual for his outstanding work, who is willing to help wherever he is needed. It is Jeremy Sanchez, one of our security members. He does an excellent job keeping the facility safe and intervening in those high-acuity situations. Last, but not least, I want to recognize the recipient of our good catch award, my fish award. It is for Carmen Molina, a med surg charge nurse. She does an amazing job advocating for our patients. She came across a situation where she jumped in and advocated for the patient, so she got her rainbow trout for the quarter. We like to implement these things, because we have a phenomenal amount of people doing outstanding work every day."
Chair Alicia Edwards asked Rodriguez to relay the board's thanks to all the staff for their great work.
Interim Chief Financial Officer Greg Brickner gave the June financial report, which reports on the final May numbers. At the last meeting, he had warned that May might not be as good as April because of fewer business days. However, he reported: "May turned out to be a pretty decent month. We are starting to stabilize on many of our service areas. Our surgeries are down, but that's due to vacations and only 20 business days for outpatient services. We are still behind last year in many cases but starting to come up to par with last year, but we were profitable for May, which is a continuation from April. For the full fiscal year, we are profitable by $370,000, which is $10.2 million better than last year. I'm expecting a loss for June, depreciation, a revenue adjustment as we continue to transition fully into critical access status. June has been slow, as well, with physician vacations at the beginning of the month. I'm forecasting that for the full fiscal year, we will be at a negative $450,000, which is sort of our starting point for the budget. For the full fiscal year, we are projecting a profit of about $174,000. There are a lot of moving pieces. It doesn't seem like much to go from a negative $450,000 to a profit of let's say $175,000, but it is significant."
Brickner used a waterfall chart as a graphic. "We lose the volume decreasing bonus of $1.8 million, so that's a kind of negative we have to start from. We make up for that with revenue improvements. We try to be conservative in the budget. Where we see strength, we budget that to continue. Where we see softness, we budget for that. Will we get back to 2019 or back to 2018? Net-net we see improvement. With an increase in volume, we have to take care of the patients, so we have additional labor costs budgeted, which takes away from the revenue. As well we will see additional supplies costs, and we are budgeting in some inflation."
Governing Board Member Harry Browne said the hospital will lose the decreasing volume bonus because the volume is no longer decreasing. "So that's kind of a good thing. That came from Medicare?"
Brickner clarified that it came from Medicaid. "Yes, it's a good thing. In my raw quantitative analysis, it's a loss of revenue, but yes, overall it is a good thing."
"We know we are getting the $2.5 million from the EDA grant, so that's additional income," Brickner said. "And other things are in the bucket, so it gets back to the $175,000 profit."
Manis presented the Chief of Staff report for Chief of Staff Dr. Brian Robinson. "The medical staff is holding its quarterly general staff meeting this evening, so we'll be meeting with them. That's usually well attended. The next item is the credentialing report, which you received in executive session and will be taking action on in a few minutes. Finally, the continuing medical education committee is planning to do an event, probably sometime in August. They have identified a topic and invited a speaker. Not much else on the report."
Mike Lieb, HealthTechS3 interim services vice president, gave the HealthTechS3 report. "I would like to acknowledge that lots of very good work has been done here over the past month and the past year—the cancer center, the budget process, financial turnaround, quality support, clinical work, and survey preparation, as you know is coming up soon. The focus for the first year was standing this institution on its feet. As you've seen, we've gotten there. We know Gila Regional is here and will remain so for the long run. Now, comes the fun part. That's strategic planning, focusing on the future. How do we grow? What services do we do? That's all coming up in the fall. This shifts out of the realm of the emergency room and into rehab and growth for the future. Along that road, the CEO search is still going. We hope to bring you a handful of well-qualified candidates to you in July. We have also added a number of new resources to HealthTech. You may have heard that Jeff Hollingsworth is executive director. He is our material management guru. He was our Vizient rep for many, many years. He kind of fell into our laps this past year, and we snatched him up. He's been working with Michelle (Carrillo, GRMC materials management) at the hospital. We'll bring him out at some point fairly soon to look at compliance, procurement policies, just to make sure everything is running smoothly. We've also added back Sherry Benander. She was with us for a number of years and is back. She is our quality guru. She trained with the FBI out of Quantico in compliance. She does board compliance education. We have her as a resource for Denice (Baird, chief compliance officer) and Kelly and her staff. She will rejoin us in July. Lastly, I'd like to remind you of our trustee leadership conference in September in Santa Fe. I hope as many of you can make it as possible."
Edwards said she believes all five of the board members are planning to attend.
In old business, members were presented the confidentiality agreement, which is a refresh from last year's and needed to be signed by every governing board member. Also needing to be signed by the governing board members before they left at the end of the meeting was the acceptance of service to be given to Executive Assistant JoAnn Holguin.
Under new business, the first item addressed the medical staff credentialing reports, which the members had discussed at the executive session. They were approved.
Next was the election of governing board officers. Browne nominated Edwards as chair. Members approved the election. Browne asked Member Billy Billings if he would agree to continue as vice chair. Billings confirmed his interest and was elected. Browne was approved to continue as secretary/treasurer.
Members approved the renewal of insurance policies, as discussed in executive session, for professional services, general liability, cyber security and workman's comp.
Also approved was the second piece of the three-party annual auditor contract with DZA LLC to extend the contract for a sixth year. The contract is also with the state. Last month, Brickner said the hospital was allowed to keep the same auditor for up to eight years, and he thought it was prudent to retain the same group for at least another year.
Manis said the hospital has faced some challenges in general surgery, because of health issues with one of the surgeons. "This is a recommendation for general surgery call service that is potentially and hopefully short-term to raise the call pay for general surgery after the 10th call in a month from $500 to $1000 per day." Governing Board members approved four first amendments to professional services agreements for on-call specialty services. The four were for Dr. Lawrence Gibson, Dr. Okay Odocha, Dr. James C. Rosser, Jr., and Dr. Frederick Wendler.
Next to be approved was a second amendment to extend the professional services agreement for cancer services at Gila Regional to be performed by the UNM Cancer Center. Manis explained it was a one-year extension to the original agreement, which would expire after four years on July 19. "We made minor modifications to the agreement. The biggest change is to do services with telemedicine by the medical oncologist. It has worked well during Covid, so we will continue the service. We chose to take some cost reductions. The overall cost itself is $1.081 million for the year, with about a $580,000 reduction. The main cost reduction is less hours with the medical oncologist on site here. We've already been doing that for the past few months with the departure of Dr. Ontolonga (spelling?), and the service has been well-received by our patients."
Edwards asked if Dr. Rabinowitz would continue to come in person about once a month.
Manis confirmed it would be about that often, but he would continue to be available through telemedicine.
Browne asked if because of issues before UNM Cancer Center was chosen, and this being a one-year extension, "will you be looking at other providers?"
Manis said with this agreement in place, the hospital would take a hard look at a broad range of providers, "evaluate our overall service needs, look at how we can grow our services overall, and that might be to explore other service providers, and we might continue with UNM."
Browne said he was happy there would be exploration of other providers. Edwards said she, too, was happy with the exploration, but "I'm also interested in getting our cancer services back to where they were."
Manis agreed. "We have never had a question or issue with the quality of service we provide, but over the past few years, the number of patients we have treated has decreased, and we earnestly want to grow that number back."
The contract extension was approved.
The following item considered a first amendment to a service agreement with Fujifilm for scopes in the operating room. Brickner said it is for maintenance and service support. "This one is maintenance and support for all our scopes, and we'll have another agreement later this year."
Next was consideration of a professional services agreement with the Southwest New Mexico Council of Governments for grant administration for the EDA $2.5 million grant for roof replacement and HVAC, as well as the $250,000 in capital outlay from the state. Manis said the SWNM COG team would make sure the hospital is doing timely submissions of paperwork for a total cost of just a little over $87,000.
The governing board members approved the agreement.
The following item addressed the contingency search agreement with HealthTechS3. Manis explained that the hospital is asking for help with recruitment of physical therapists. "We already have agreements with three other outfits, but physical therapists are very hard to recruit. The more bait we have in the water, the better chance we have of filling the positions. We have two open slots right now. The agreement is for 15 percent of the first-year salary for positions filled. It's lower cost than the other agreements we have, so it's a very fair agreement. Because it is with the same company as your management, I just wanted to shine some sunshine on it."
Lieb said it is HealthTechS3 policy whenever any agreements such as this are done, "we want to always make sure it is known, so that it doesn't slide under the radar."
Edwards asked how long the positions has been open, and Manis replied: "Lots of months."
The contingency search agreement was approved.
Next was a statement of work by the Tegria Services Group (dba Navin Haffty). Brickner said the company provides consulting services in IT and technical support. "It's a continuation of a master agreement we already have. This is for an additional work order."
Manis said he saw some puzzled looks. "This particular skill set is for an interface writer between pieces of our software. There is a skill set in our profession called HL7, health level 7, which is a special language and protocols that help our medical records talk to our radiology, for instance, our radiology system to talk to our lab system and such. Because they may be disparate systems or on the same platform. Those I just mentioned are on Meditech, but we have a number of other systems that may not be on the same platforms. They all use HL7 to talk among themselves, and this is particularly a person whose life is writing these types of interfaces."
The item was approved.
Next was consideration of a memorandum of understanding for collaborative efforts between the hospital and HMS. There has been an agreement before, but it had lapsed. It also comes with a recommendation from HMS. There is zero cost, "we just want to continue to support them."
Edwards said that the governing board had been asking for collaborations, so "thank you for doing this MOU."
The MOU was approved.
The last item was a resolution for the operating and capital budget adoption, for fiscal year 07/01/2021-06/30/2022.
Members approved it without discussion.
The meeting ended with adjournment.