Members hear good financial news

By Mary Alice Murphy

The Gila Regional Medical Center Governing Board held its monthly meeting on Sept. 28, 2021. Four of the five members, who are also Grant County Commissioners took part in the meeting. Chair Alicia Edwards, Members Harry Browne and Chris Ponce attended in person. Javier "Harvey" Salas attended by telephone and Vice Chair Billy Billings was unable to attend.

Members recognized Robert Scott for 10 years of service at GRMC in nursing.

With no public input, they went into executive session.

Following executive session, when they came back into regular session, they approved the consent agenda of minutes from the Aug. 26, 2021, board meeting.

Under reports/updates, the first to speak was Interim Chief Executive Officer Scott Manis. He noted the hospital continues to adhere to the governor's public health order on masks and vaccinations. "We are in the 87 percent range for employees being vaccinated. Those who are not vaccinated have to provide a medical or a religious exemption as well as submit to weekly testing."

In the mammography department, "we have been reaccredited by the American Cancer Registry for two additional years, with no findings. I would like to thank the staff in that area. At their recommendation, they have opened up for walk-ins. They prefer scheduling, but often there are openings, and they can squeeze in walk-ins, no pun intended [to laughter from the audience and members], although they may have to wait a bit for scheduled ones to be completed. We have already had 17 walk-ins in September."

Manis said the hospital has reached a 39 percent participation in the continuing employee survey. "We are trying for at least 50 percent, which is best practice, but would love to be above that."

He noted the hospital continues on its conversion of the Pyxis equipment. "It is on track for full implementation by the end of December. It is new medication dispensing and charge capture equipment in the hospital."

"Things are moving very well throughout the hospital," he concluded.

The members did not hear a Chief Nursing Officer report, because CNO Kelly Rodriguez was in training out of town.

Greg Brickner, Interim Chief Financial Officer, presented the August financial report. "We're pretty stable, and we have had a tick up in ED (Emergency Department) visits."

He put up the slide on August 2021 key metrics, where he pointed out the financial strength index at +1.96 compared to last year's -9.41. Volume trends are also looking good, he said, coming in close to plan, "consistent with what we've seen at the hospital over the past couple of months."

Brickner reported a $356,000 profit for August driven by higher revenue and lower expenses than planned. Year-to-date the profit is $590,000 compared to last year's loss of $867,000. "We will see the profit numbers drop in coming months, because of the raises we gave to staff, but that was planned and anticipated and we can afford it."

Manis gave the chief of staff report in place of Dr. Brian Robinson. "The first item is that Dr. [name unintelligible], better known as Dr. Sam, emergency department physician, was recently appointed emergency department medical director by our ED group Innova. He is replacing Dr. Kotch on an interim basis. As a result, Dr. Sam is part of the peer review committee and an interim member of the medical executive committee."

The next item addressed the Bylaws Committee. "Dr. (Colicia) Meyerowitz has been on the committee for a while. We've had some turnover, so she has agreed to be interim chair. We will discuss some new bylaws committee members in a bit, but she has agreed to be chair while the others get up to speed."

The Surgery Department at its recent meeting approved new quality indicators and new delineation of privileges forms, which any physician applying for privileges would use to indicate what types of privileges he or she was requesting in the surgery department to help with tracking quality and competency in the department. "It's been a long-term project on Briana's (Romo) behalf, so she's excited to get that done."

Manis said the general staff meeting would take place that evening. "It is open to any member of the medical staff."

Health TechS3 Vice-president of Interim Services Mike Lieb thanked those governing board members who were able to attend the recent leadership conference in Santa Fe. "This was another good financial month for the hospital. We have a lot of activity at the hospital right now and in the coming weeks. Julie Haynes from Health TechS3 is beginning work on strategic planning. Carolyn St. Charles will be here in early November doing a mock survey. Two names [unintelligible] are here as we speak doing work on the revenue stream. We also have Paula Digby doing the long-awaited coding training starting today. We will kick off the HR (human resources) assessment in October. Our third CEO candidate will be here in two weeks. We have CFO candidates being screened now and we hope to bring them forward in the future."

Browne asked about the timing of the hiring of the CFO. "If you're screening them now, we haven't hired a CEO. Will the CEO end up having a voice?"

Lieb said: "Assuming we get the CEO set up shortly, they will be in the interview mix as well. The hope is to get both in by Christmas."

"The CFO would be a Health Tech employee as per the terms of the management agreement," Lieb said. "We want you to participate in the interviews. We have big shoes to fill."

He noted that the person would also be screened for the financial skills as well as the skills of being able to present the financial reports in a way for the public to understand, so they would also need a PR (public relations) skill.

Browne also asked who is receiving the coding training.

Manis replied that there are two aspects. "One is on the inpatient side doing the evaluation of some of our inpatient documentation. The training would be coordinated through our case managers and nursing leaders, and perhaps more importantly for the emergency department physicians and our hospitalists. I'm not criticizing anything, but how could they document better in the overall clinical documentation? We have two people working here on this. The second prong came out of a request from the clinics. We had a request for some updated training on clinical documentation. So, the providers in our surgical clinic, our family practice clinic, our cardiology clinic are doing some training on medical records. Probably over the next couple of days, we will go shoulder to shoulder with each provider saying this is how you do this or this. What providers could tell you across the country is that they likely undercode, because they've been scared by the government on overcoding and the repercussions and auditing. We want it to be appropriate coding and documentation for appropriate financial reimbursement."
With no old business, the governing board went to new business. The first item, which they had heard in executive session was the credentialing report. The governing board members approved the credentialing report.

The next item addressed the roof improvement. Manis said the long-awaited contract for the roof had been awarded to J3 out of Bosque Farms, as a CES (Cooperative Educational Services) contract approved by New Mexico. The cost is $1.2 million and will come out of an EDA (Economic Development Administration) award of $2.5 million with a 10 percent match from GRMC, using its ICIP (Infrastructure Capital Improvement Plan) funding from the state.

"The project should get started around Dec. 1," Manis said. "The contract has been reviewed by our legal counsel, by (Southwest New Mexico Council of Governments Executive Director) Priscilla Lucero, the EDA and J3 and all have approved it. It meets all requirements. The caveat is that J3 has informed us of a 6 percent increase in materials from the materials provider. We will cover it with our own funds if we need to. The estimated completion date is July 2022. Only 25 percent of the roof was replaced a couple of years ago. This will finish the rest of the building. We do recommend approval."

He went on to say that the remaining about $1.2 million will go toward the HVAC system improvements. "We don't want to spend more on the rood and have less for HVAC. We are talking to architectural/engineering firms to help us guide the project. We are not ready to recommend a firm for the HVAC."

Edwards said she assumed that the HVAC contract would not void any of the roof warranties.

"That's why we want to have a firm to walk us through the process," Manis said.

The roof contract was approved.

The next item was consideration of a local product sale agreement to purchase LINQ I/II cardiac monitors from Medtronic. Manis explained they were for remote monitoring of patients. "It is implanted under the skin of the patient. We currently have about 90 in service."

Browne asked why it is a local product sale, and Manis said it's because it is specific pricing for Gila Regional.

The governing board approved the agreement.

The next item was consideration of a second amendment with ESS Hospitalists LLC. "They provide good service to us," Manis said. "Dr. (Tsering) Sherpa is their medical director on site for us. With this agreement, they will provide case management software that helps us evaluate a patient in the emergency department and their appropriateness for admission in real time. That will benefit us for after hours when a case manager might not be available. The financial agreement has remained fixed over the past three years. We're recommending a 1.5 percent increase for the first year and then it will remain fixed at that. It will increase our monthly cost from $119,500 to $121,000 a month on a three-year agreement."

Browne asked why it was called a subsidy.

Manis said in the agreement, there is a scale so that if the average daily census is over a certain number of patients, then the subsidy is reduced. "But our daily census hasn't hit that number, so we are subsidizing up to that. If our annual census was 25 a day, that subsidy would be reduced. Basically, that is because we pay for 24/7 coverage on site. We are willing to pay the subsidy to provide a higher level of service to our patients."

Browne said: "So they bill the patients, and if it's not enough, we pay them more, and when there are more patients, the subsidy will go down."

Lieb commented from the audience that it was the cleanest he had ever heard it described.

The agreement was approved.

The next two professional services agreements named Dr. James Rosser and Michael Harris, FNP-C (certified family nurse practitioner) to serve on the bylaws committee. The compensation is $110 per hour up to a maximum of $6,600 a year. Manis noted these are mid-term appointments Oct.1-Dec. 31, 2022, instead of the typical two-year agreement, but it is required due to turnover in the committee.

Governing board members approved the two agreements.

The next item under consideration addressed a memorandum of agreement with Grant County to allow the Grant County Sheriff's Department to co-locate some communications equipment to a radio repeater site that GRMC owns and maintains primarily for EMS communications. "We can pool off each other as they will be the same frequencies that we can share. Each will maintain its equipment, but we will share the utilities. There is no financial exchange."

Edwards said the county appreciates the hospital sharing its location. Members approved the MOA.

The following three items addressed consideration of the master terms and conditions to sales and services; the technical assistance, maintenance and support of network hardware, wireless access points and servers to Cisco Smart Net Total Care; and a renewal agreement for hardware and software, as well as support and service for GRMC's information system virtual environment with PC Connections.

Brickner explained that renewing the items early gets better pricing for the hospital.

The members approved the three agreements with PC Connections.

Next, Brickner addressed the amendment No. 6 to the Technology Services agreement on the 340B drug pricing program and split-billing software with Sentry Data Systems Inc. "Sentry will provide data exchange. We are working through the tech issues we're getting to bring the provider practices up to where they need to be." He said the hospital is fine. It's the provider practices having issues with the different platform from what the hospital uses.

Members approved the amendment to the agreement.

Brickner recommended the purchase of EPIC CVx cardiology ultrasound system from Philips Healthcare. "This is to replace one of our two Echo machines. We will fund it with cash."

Browne asked what the life of the equipment is.

Manis said generally 7-8 years. "One is past end of life and is giving us troubles."

Ponce noted the hospital has received capital outlay funding for equipment. "Have you updated your priorities?"

"This is in need of urgent replacement," Brickner said. "We have spoken with our directors and found out what their needs are. We just updated it last week."

Members approved the purchase.

Next came a consideration of the interlocal contract for cooperative purchasing through the Houston-Galveston Area Council to purchase an ambulance through contracts competitively solicited by another government agency while meeting New Mexico procurement code.

Brickner explained that getting into purchasing groups allows them to get competitive prices for needed equipment. He explained the next one is similar, just with a different group, the National Purchasing Cooperative, which will be used for purchasing a transport van.

Manis said each group, of which the hospital becomes a member facilitates the purchases of the ambulance and the transport van.

The two items were approved.

The next to last item considered a resolution to approve the appointment of a 403b tax-sheltered annuity plan advisor for the employees.

"Our advisor, Robert Rydeski, has resigned," Brickner said. "This resolution will appoint Kenneth Heiser as our advisor. He will be the advisor for the Brighthouse Financial Plan. Nothing changes for the 403b plan. It's only changing the person that people call with questions. Mr. Rydeski has agreed to do a warm handoff of the plan. If someone calls him because that's the number they have, he will give them the new information. This does not impact the investments, and loans would continue as they are now."

Edwards said the board is confident that issues will be taken care of by Brighthouse.

Brickner agreed and said the employee accounts are whole.

Members approved the resolution.

The final item was another resolution, this one for approval of a grant application for the American Rescue Plan Act funding.

"Last month you approved a grant application for up to $1 million for medical equipment," Manis said. "Upon the advice of Ms. Lucero and because of conversations she had with the state, she recommended we apply for another grant up to $1 million, with this one for EMS equipment for a couple of ambulances. The cost is more like half a million dollars, but we are coming to you with this resolution."

Members approved the resolution.

The governing board adjourned.