[Editor's Note: This article combines bits of a couple of meetings, one a special meeting of the GRMC Governing Board on Aug. 1, 2022, and another of the Grant County Commission on Aug. 11, 2022. Other items of interest in both meetings will be covered in subsequent articles.]

By Mary Alice Murphy

During the Gila Regional Medical Center Governing Board special meeting on Aug. 1, 2022, an item addressed the fifth amendment to the contract with the University of New Mexico Cancer Center to provide cancer services to the GRMC Cancer Center.

Last year, UNM gave notice to the board that they were unable to continue to provide services to GRMC cancer center because of the difficulty in getting oncologists to Silver City. Because UNM and GRMC feel strongly about continuing these cancer services to area residents, UNM has continued providing these services, but this amendment, which ends on Aug. 31, 2022, is the final amendment.

GRMC attorney Scott Shanker gave an update on the cancer center at the governing board meeting. "At a high level of background, several months ago, we entered into a letter of intent with New Mexico Oncology and Hematology Consultants (NMOHC) to go into negotiations of a contract with them to provide cancer services to GRMC. It was all contingent on the parties adhering to all health care statutes, specifically to the federal Stark Law and the federal anti-kickback statute. All arrangements between hospitals and physicians must be consistent with fair market value that are reasonable in relation to payments. That language was specifically included in the letter of intent and the hospital engaged a third party to determine fair market value and compensation for services that were proposed to be performed by the group. After multiple meetings, phone calls, email exchanges, unfortunately the parties were too far apart on the compensation the group was willing to perform the services for and what the hospital was permitted to pay based on compliance with the two main federal laws. At this time, the hospital has terminated the letter of intent with NMOHC. The group was calculating its compensation requests on business opportunity and lost opportunity costs, and the hospital was looking at it from fair market costs, and unfortunately, the divide was just too wide to bridge. It is not a knock on the group; we understand why they were approaching it from that perspective. It makes good business sense for them. It's just that these federal laws require fair market value compensation for services to be performed, and that doesn't necessarily comport with the group's lost opportunity costs.
We're considering other opportunities to move forward. The group was professional, with very good, cordial conversations and discussions. This just fell apart due to requirements of federal law."

Edwards thanked Shanker for his concise and easy-to-understand explanation of what happened.

The amendment was approved to extend UNM services through Aug. 31, 2022, including radiologic oncology and medical oncology.

"We will have a call with UNM on Aug. 8," Edwards said.

[Editor's Note: additional background includes that Dr. McAneny founded the GRMC Cancer Center and developed it. But a prior GRMC Board of Trustees replaced her group, thinking UNM could do a better job. A fairly large uprising in the community against that decision did not deter the trustees, and they made the ill-fated decision in 2017, I think was the year of chaos. Because of that disjointed transfer of services, the Governing Board has been adamant not to disrupt services for patients.]

During board comments, Edwards read prepared comments. She thanked Dr. Barbara McAneny, CEO of NMOHC, for being willing to start the conversation with GRMC about cancer services.

At the County Commissioner meeting on Aug. 11, 2022, District 3 Commissioner Alicia Edwards, who also serves as the chair of the GRMC governing board, made up of the five commissioners, read in her comments some of the same things she had said at the Aug. 1 special meeting along with additions.

"I want to read these today, because the County Commission meeting has a wider audience than the governing board meetings," Edward said.

"In early 2021, knowing that UNM did not want to renew their contract with GRMC, we published a request for proposals and did not get a single response," she read. "Thankfully, UNM was willing to extend for a year while we figured out what we were going to do."

That was when they approached Dr. McAneny and NMOHC directly and began the conservation that led to the letter of intent being signed in early 2022. "It speaks to Dr. McAneny's desire to provide excellent cancer care to rural residents as well as her interest in serving Grant County specifically that she was willing to come to the table at all. I will always be grateful to her for that," Edwards continued.

"Unfortunately, the regulatory environment made a public/private partnership with GRMC and NMOHC impossible and we ended negotiations last week, so we could direct our full attention to ensuring there would be no interruption in cancer care. I want to make it clear that it isn't that UNM doesn't want to be in Grant County, but that it's extremely difficult for them to find oncologists who want to be in Grant County."

Edwards said it was astonishing how many person-hours went into the efforts to bring NMOHC back to Grant County. "The GRMC legal team did everything they could think of to overcome the regulatory barriers, and our incredible hospital staff went above and beyond under very challenging circumstances, as well as Dr. McAneny and her staff."

She noted: "We wouldn't even have been at the table for the conversation if it weren't for the financial turnaround we've experienced with HealthTechS3. I also want to thank my colleagues, Commissioners Billy Billings, Harry Browne, Chris Ponce and Javier Salas. Our mutual respect and deep commitment to our community has carried us through some very challenging conversations and incredibly difficult decisions on behalf of the hospital."

"Every single conversation about healthcare starts and ends with money," Edward said. "Equitable access to high-quality healthcare simply does not exist in this country. Even a high-quality teaching institution like UNM faces monumental challenges competing with not only the private sector, but with other public institutions that have huge endowments and way more state and federal funding.

"In that context, federal regulations that determine GRMC hiring a locum tenens oncologist is comparable to hiring the expertise, experience and resources of an organization like NMOHC and you have some idea of what we're up against. It's not that we can't afford to be in the competitive marketplace, it's that we aren't allowed to be. Not just GRMC, not just UNM, but every public entity in the state striving to meet the needs of New Mexicans faces similar barriers.

"So, once again, applying a one-size-fits-all model to the challenges facing rural America means we don't actually fix anything at all," Edwards concluded the comments at the Aug. 1 meeting.

She especially thanked Commissioner Billings for his direct contact to McAneny. Billings said: "No, thank you for what you've done." Salas and Browne also thanked her.

Browne said: "I'm extremely disappointed we couldn't make it work. Commissioner Billings worked with Advanced Air to match their schedules to fit in with the requirements of UNM. Thank you both for that."

At the County Commission meeting on Aug. 11, she talked about the results of the Aug. 8 meeting with UNM Cancer Center.

Edwards reiterated the UNM extension of services through Aug. 31, 2022. "We appreciate their support and help over the past months. UNM is working with us to ensure that none of our existing patients miss needed treatments and assessments."

"We are very fortunate to have Karen DeGenevieve, NP (nurse practitioner) rejoining the GRMC staff to help us bring the best care to our patients going forward," Edwards reported. "In addition, we are planning on bringing back Mike Torres to help manage the center. Our goal is to bring the entire cancer program back in-house as fast as possible, and to that end, we are working on bringing onboard two medical oncologists, potentially as soon as mid-September. Unfortunately, that means that new patient referrals, for that short duration between the end of August and the arrival of the oncologists , will need to be referred to UNM, or another cancer center of their choice, to be seen and begin treatments."

She said UNM is working "with us to 'fast track' GRMC patients and get them in quickly to their center in Albuquerque. All Radiation Oncology patients currently receiving care here at GRMC will be able to finish their planned course of treatment by the end of August. New Radiation Oncology patients will need to be referred out for therapy planning and treatment while we solidify the radiation program (targeted for October 1, 2022). We hope to have radiation oncologists, physicists and dosimetrists signed and onboard very quickly."

Edwards also announced that GRMC will make arrangements with patients that have to go outside Grant County for treatment to pay their travel expenses.

"I am confident that GRMC staff is doing everything they possibly can to ensure our cancer patients have access to the treatment they need," Edwards concluded.

[Editor's Note: Following articles will catch up to this point, with meetings and events from July 28, July 30, Aug. 1, Aug. 9, Aug. 10 and Aug. 11. Thank you for your patience!]