[This is part 4 of a multi-series of articles on the Grant County Commission meetings of July 6 work session and July 8 regular meeting.]

By Mary Alice Murphy

At the regular meeting Gila Regional Medical Center Interim Chief Executive Officer Scott Manis led off the reports with the monthly update, from the May results.

"It was another really good month for the hospital," Manis said. "I will give the operational highlights. At the June 29, governing board meeting, the members approved an amendment/renewal to the agreement with the University of New Mexico Cancer Center to provide professional services in our Cancer Center. It is an agreement we have had for the past four years, and we have agreed to renew it for another year. In the negotiations, we realized savings with the reduction of our on-site availability of the on-site medical oncologist, Dr. Rabinowitz. He was the replacement for Dr. Fontolonga when he left a few months ago. That, along with some other savings in processes, is in excess of half a million dollars. The next thing I want to report on is the CEO search. I am not directly involved in the search, but as an employee of HealthTechS3, I am reporting on the search. They are continuing to screen some applicants, and they will be presented to the governing board in the near future for their consideration and to determine which candidates they want to interview by video or onsite. That process is moving along. The next is that about a month or so ago, we spoke about the arrangement we've made with Hidalgo Medical Services to hold a cardiology clinic at the HMS Lordsburg clinic. That launched on Tuesday, very successfully. We're underway there. It's great for that community and for us. We're ready to grow that program. We're starting slow on every other Tuesday at Lordsburg. The next is an announcement we talked about at the governing board meeting. It is a partnership with the National Sinus Institute. They have a clinic they established here in town a little over a year ago, with ear, nose and throat physicians and providers. I met with the Physican's Assistant Allison, whose last name I can't remember at the moment. They are holding clinic here three days a week and two days in Deming. The Deming clinic isn't catching on as fast as they would like, so they will switch and have four days a week in Silver City and one day in Deming. More importantly for us, Dr. Ian Alexander, the leader of the group, is going to start doing ENT surgeries here in town, hopefully this month if they have enough cases on the schedule to warrant his travel. If not, then certainly by August. We had actually set a date in a couple of weeks, so patients needing ENT surgery will no longer have to travel to Las Cruces to have simple procedures, such a sinus polyps, ear tubes, and then eventually, probably in the near future, doing tonsillectomies, adenoidectomies and such here. They are very eager to do it and so are we. This will provide services we haven't had for five or six years since Dr. (Twana) Sparks left the hospital.

"The last thing really I want to say is just thank you to Charlene Webb for her support of the hospital, particularly during my time here. She was invaluable when I joined the hospital a year ago, helping me understand the lay of the land in the community and relationships with this commission. Charlene, you will be missed by me personally and overall, by the hospital."

Interim Chief Financial Officer Greg Brickner gave a recap of the May financial report. "We're still crunching the numbers on June."

He noted that surgeries were down slightly mainly due to the holiday and physician vacations, as well as only 20 business days in the month. "Overall, our trends are starting to stabilize, which is a good thing. The main metric to focus on is the financial strength index. It's still negative 1.7 percent, but it's calculated over the past 12 months and it's up more than 500 percent improvement from the negative 8.87 percent it was a year ago, which is phenomenal. In EBIDA (earnings before interest, depreciation and amortization), in May we had $560,000, continuing the trend over the past couple of months. For the full fiscal year, EBIDA is $14.9 million better than it was a year ago. That's being driven by revenue up by $6.7 million, operating expenses down by $8.2 million."

"One thing I want to point out is now that we're a critical access hospital, the key element is that we're getting paid a percent of our overall costs when Medicare figures it out by formula," Brickner continued. "That has been critical to the turnaround of the hospital. In the past two years, 68 hospitals have closed. We were on the brink of closing many months ago. That is no longer in our picture because of this push to critical access. There is kind of a negative I want to address, as we are implementing the switch. It does cost our Medicare patients more to come to Gila Regional. There is a co-insurance that patients at critical access hospitals have to pay that they wouldn't have to pay at PPS (prospective payments) hospitals. The good side is critical access helped stabilize our hospital, but it does cost Medicare patients more. The community is starting to see those costs, so we wanted to be transparent about it. It's the factor that is driving our financial performance."

District 3 Commissioner Alicia Edwards asked what kind of percentage increase Brickner was talking about.

"It's a 20 percent co-insurance for outpatient visits, so for a typical outpatient procedure, it's substantial," Brickner replied.

Edwards asked how someone could mitigate that.

"Medicare recipients can purchase supplemental policies," Brickner said. "A good insurance advisor could work with the patients to determine their needs, knowing this is a critical access hospital."

Edwards said she thought there were two or three insurance companies locally that provide those supplements. "A person over 65 on Medicare will make the choice whether to go to critical access hospital Gila Regional and pay the 20 percent co-insurance or go to a regular PPS hospital in Las Cruces."

She also asked if any hospitals in Las Cruces were critical access, and Brickner replied that the critical access designation is available only to rural hospitals.

Brickner also explained that the co-pays are on top of the normal co-pays and deductibles.

Edwards said that because the local residents wouldn't likely have a large hotel bill and travel bill to get a procedure done in Las Cruces, they might potentially choose that option.

"Potentially," Brickner confirmed, "but I would argue that we have phenomenal health care here at Gila Regional."

"I'm not arguing that at all," Edwards agreed. "I would guess that we have a potentially large population of people over 65 who could not afford that 20 percent co-pay or the supplemental insurance. What would they do?"

Brickner replied that there are a couple of options. "We do have a charity assistance program that we have had for years that support all patients regardless of age, based on their income and their financial status. We also assist our patients with applying for Medicaid. Those Medicare patients who fit the formula can apply for Medicaid."

Edwards clarified that a Medicare patient who also qualified for Medicaid, if they had a procedure, the Medicaid would step in and pay the co-insurance.

"We have a substantial population of low-income people and seniors on fixed incomes," she continued."What are you doing as a hospital to address this?"

Brickner said when a patient schedules a procedure, "we have a financial counselor who, before the procedure, goes through it with the patient on their insurance. For many patients, there is a pre-authorization required. The counselor goes through the impact and gives them an estimate. And it's literally an estimate, based on the information from the physician and the insurance."

"Fundamentally, it's your or the CFO's responsibility to make sure the financial counselors are doing their job," Edwards said.

Brickner confirmed that, but said: "They have a big job because we don't always know what the procedure will entail."

Edwards asked if the patient could apply for the charity care after the fact if the estimate is not accurate.

"Absolutely," Brickner replied. "There are many patients who do, even coming through the emergency room, that do not know how much it will cost for an emergency. When the bill process goes through, we can help them." He thought the information for seeking help was on the bill but wasn't totally certain.

Edwards said: "Given that our patient services has been shaky at times, I would implore you to make sure we are addressing this as completely and thoroughly as we possibly can. The last thing I want to see is a low-income senior choose not to have health care at all, because they don't know what their options are to be able to pay for it."

District 1 Commissioner and Chair Chris Ponce said he knows some people have trouble getting pre-authorization and wondered if this issue would make it more difficult to get pre-authorization.

"In this case, no," Brickner said. "We know that our revenue cycle has opportunities for improvement and pre-authorization is another element of that process."

The next article will get into the review and actions of the regular meeting agenda.