[Editor’s Note: This is likely to be a multi-part series of articles for the 3.5-hour meeting. This is part 2 and starts with the monthly GRMC update.]
By Mary Alice Murphy
Grant County commissioners at the combined work session and regular meeting on Sept. 9, 2021 heard presentations, approved proclamations, heard an update from Gila Regional Medical Center, heard public input, and listened to county reports and elected officials’ reports all before getting into the regular business of the meeting.
You can read about the two presentations and the two proclamations at https://www.grantcountybeat.com/news/news-articles/67491-grant-county-commission-holds-joint-work-session-and-regular-meeting-090921-part-1 .
Gila Regional Medical Center Interim Chief Executive Officer Scott Manis gave the hospital monthly update.
He, too, as had the commissioners and previous speakers, recognized Executive Assistant Taysha Walter for the hard work she has done during her time at the county, including for the hospital. “You will be missed, not only by the county, but also by the hospital.” [She and their children will move to Las Cruces to join her husband who has been working there for more than a month.]
Manis said he would start with the micro and move to the macro. “We are continuing to comply with the governor’s public health order, with the mandate of masking and for vaccinations. As of Tuesday, 87 percent of our staff is vaccinated, with another 25 or 26 employees having received the first dose. We will kick off our strategic plan initiative on October 4. It’s a week-long process soliciting information from the community, our staff and the governing board, to map out our long-term strategic plan. We’ve been working on operational improvements for the past about a year and a half, and now we want to look at our future direction and how to better serve the community.”
He noted the search for a permanent CEO is ongoing. “We have a candidate on site today and another one next week, and another one a few weeks out. We hope to have one in place within the next few weeks.”
Manis said the EMS tariff pre-application has been sent. “They asked us for additional documentation, so I trust it will move on.”
He said the kick-off of Breakfast with the CEO had taken place. “We plan to do them once a month, with one-twelfth of the employees invited each month so we get to all of them. We just want to have an open dialogue.”
GRMC had its first ENT (ear, nose and throat) surgery case in more than five years, Manis reported. “It was done on August 24. I had a meeting last night with the surgeons and with the ENT surgeon Dr. Ian Alexander. We will start tonsillectomy and sinus cases in the near future. We look forward to growth in that area.”
He noted the hospital is kicking off an employee engagement survey on Sept. 20, which will last for about three weeks.
“For another good thing that is happening,” Manis reported, “we are starting to do advanced EMT training in collaboration with Doña Ana Community College. Nine have already signed up and four of them are ours. It is being done at the EMS main station next to the hospital.”
He said he would move to the macro. “The ‘Road to Recovery’ has been about a year and a half process. We are happy to report it’s been a good ride.”
Manis provided national statistics for rural hospitals between 2010 and 2020. “During that time 136 rural hospital closed in the country. Overall, there are just shy of 6,000 hospitals in the U.S. About 2,000 are considered larger community hospitals and 4,000 are designated as rural. During the period of 2010-2020, 897 hospitals were at risk of closure. Gila Regional was one of them. We were at a dire point. Twenty-five percent of rural hospitals are still at risk of closure, according to Beekers. It shows how fragile rural hospitals and rural health care particularly are.”
He said that during the past eight years before the last fiscal year, Gila Regional had lost $47 million. “This is from auditor’s statements. The hospital during that time had only two profitable years, and the 2018 one should have been negative, because in 2019, Gila Regional booked a $5 million adjustment that should have been taken in 2018. We were on the wrong course. When HealthTechS3 first got here in about June of last year, we immediately identified $12 million in needed improvements.”
For “fast facts,” Manis said the hospital is a $70 million operation. “We’re at $68 million, but we think we will hit $70 million this year. I’m bullish based on the trends.”
Gila Regional Medical Center employs 350 full-time equivalent employees, which are comprised of 430 part-time or PRN (when needed) positions. “We are the largest or second largest employer in the area,” he said. “We have 100 nurses. We have a $32 million labor expense with salaries and benefits. The rest is for equipment maintenance, supplies and materials.”
District 2 Commissioner Javier “Harvey” Salas said: “Without the partnership with HealthTechS3, we would be in trouble. At least we have the opportunity to improve. Gila Regional is still a vital part of the community. Thank you, HealthTechS3 for helping us keep our hospital.”
District 5 Commissioner Harry Browne said: “87 percent vaccinated. Well done. But with the health order and all, why are we not closer to 100 percent?”
Manis said the hospital is allowing for medical or religious exemptions. “Those employees are tested weekly and must have a negative test to continue to work at the hospital. To provide the testing, we do it three times a week for the convenience of the staff members. To manage the week-in-week-out testing has added a chunk of burden to us. They can also get tested at other places, such as the Department of Health or Hidalgo Medical Services.”
Interim Chief Financial Officer Greg Brickner continued the report with the financial recap on fiscal year 2021, which ended June 30, 2021. “In our preliminary report, we still have four outstanding transactions. But our EBIDA (earnings before interest, depreciation and amortization) improved by $18.7 million, which was a net 24.7 million improvement over last year. Yes, we’re in the black, with $5.6 million net profit. That means for every dollar we took in we have 8 cents left over. The previous year, for every dollar brought in, the hospital spent $1.32. Going to critical access was great for us. For those on Medicare, they will have a higher co-pay. That is not specific to us. Nationally anyone on Medicare who walks into a critical access hospital has a higher co-pay. The Office of the Inspector General has requested Congress to change that. Some patients have begun to get new bills. A large batch is going out [went out] on Sept. 15. Patients can mitigate the increased co-pay with a supplemental plan. Or the hospital has payment plans and charity plans. Patients pay no interest on payment plans. We have a charity program, and we can aid with Medicaid applications if the patient qualifies. The hospital will help whomever it can, including every member of the community.”
Brickner also made a point that the financial viability of the hospital also had an impact on the Grant County bond rating, as the hospital is owned by the county.
He said he pulled up Moody’s and in fiscal year 2019, which ended on June 30, 2019, the hospital had 25 days of cash. In March 2020, Gila Regional had 10 days of cash. “And they weren’t paying their bills.”
Today we have $12.2 million in the bank, which is about 72 days of cash and our accounts payable is at 1.3 days. “That means we are paying our bills on time. That should definitely help the county bond rating. We had a profit in July. We have had five months of profitability, and it is budgeted that we may have a small loss. But our EBIDA is $584,000 to the positive with a net $240,000. We will have money to continue to improve and use the profitability to benefit the hospital and the patients.”
District 3 Commissioner Alicia Edwards, who also serves as the GRMC Governing Board chairman said: “Thanks for the great news and the hard work.”
District 4 Commissioner Billy Billings said he remembered last year when a hospital vendor called him from Texas and said the hospital was going to go bankrupt. “He told me he only let the hospital get him $85,000 in arrears when he terminated the contract. Bringing someone on to bring us back to profitability was an action we had to take. I think HealthTechS3 was a good choice. Thank you, Greg, Scott and HealthTechS3 for all you’ve done for our hospital.”
Manis said: “On behalf of HealthTech, thank you for your recognition of our work.”
He continued his report by talking about the GRMC Workforce Initiative. “It has been weighing on my mind, but we are beginning to get it right in supporting our workforce. If not for our workforce, we would not have 24/7/365 service. I have celebrated with them in recognition of their hard work.”
Manis said the program had four focuses: retention, recruitment, a changing dialogue around viability and looking forward to engagement and sustainability.”
He talked about the national nurse shortage and showed a graph of the nursing open positions across the country and the number of travelers, who are nurses that go from place to place for weeks at a time. “Nursing has a lot of burnout, especially after the past year and more and many are stepping out of nursing. It’s not only nursing. It is also occurring in places like the lab, in imaging, in most departments. Contracting companies for traveling nurses are demanding $125-$135 an hour [which includes the companies’ compensation]. That’s why we want to support our staff and keep them here. We have lost a few to traveling opportunities. In our hospital, 71 percent of the nurses are our own; 12 percent are travelers; and 17 percent of the positions are vacant. That closely aligns to the national statistics, which show 19 percent open nursing positions. For our hourly wages, we weren’t competitive. We have started to bring the rates up. We are happy to report that we have raised them, so that they are starting at $30 an hour overall that equals about $39.50 an hour with benefits. Our range is right in the middle of what Philadelphia or Washington D.C. is offering. The objective is to continue to invest in our own people. We have some cash, so we can do some things. It helps that we have lowered overall monthly expenses from about $600,000 to about $300,000.”
District 1 Commissioner and Chairman Chris Ponce said: “We appreciate everything you’ve done. I just wish we could get 100 percent support from the community for our hospital. We truly believe GRMC is key to our community.”
The next article will begin with public input and go into county reports.