Governing Board members heard several items of good news and about some promotions and hirings. 

[Editor's Note: Portions of this meeting were covered in a previous article, which you may read at: https://www.grantcountybeat.com/news/news-articles/73535-update-on-status-of-grmc-cancer-center . This article completes the meeting.]

By Mary Alice Murphy

At the Gila Regional Medical Center Governing Board meeting on July 28, 2022, Chair Alicia Edwards introduced Interim Chief Nursing Officer Melanie Vigil and Interim Human Resources Director Beverly Bush.

Interim Chief Financial Officer Paul Rogers introduced Finance Director Patrick Banks as the new permanent CFO as of August 1.

Edwards also announced those who received recognitions. Evangeline Lopez has served GRMC for 10 years in the laundry; Stephen Edwards has completed 10 years of service in security; Martha Placencio has served five years in the cancer center; and Miriam Duarte was recognized for her five years of service with EMS (Emergency Medical Services).

"Every time I talk about these recognitions, I always want to express how much we appreciate all of their work at Gila Regional," Edwards said.

With no public input, the board members went into executive session. Just before they left for the closed session, Edwards explained that one of the board members, Billy Billings, was out of state on personal business, and another member, Chris Ponce, was representing Grant County at Bear Canyon, where Gov. Michelle Lujan Grisham and Lt. Gov. Howie Morales would announce the plans to upgrade Bear Canyon Dam. With Edwards and Members Harry Browne and Javier "Harvey" Salas, the board had a quorum.

Following the closed session, Edwards noted that no action was taken, but covered only discussion on agenda items.

With no old business, the board members addressed new business action items.

The first addressed credentialing, which the board had discussed in closed session and approved in the open meeting.

The second item ratified, after the fact, the fourth amendment to extend professional services with the University of New Mexico Medical Group Cancer Center to the end of July. Browne said he would like to see the compensation amounts in these contracts. HealthTechS3 Regional Vice President Michael Lieb said some of the vendors consider their prices proprietary.

Lieb explained the following item, which address the renewal of a telemedicine agreement for equipment and services with El Paso Healthcare System, DBA Las Palmas Del Sol Healthcare. He said it combines two agreements into one. "We use them for emergency medicine consultation, for both emergent and non-emergent behavioral health and neurological issues. This averages about $14,150 a month. This is a four-year renewal through August 2026."

Members approved the maintenance agreement renewal with Functional Cardiac Analysis software and hardware with Vitrea Imaging Solutions/Canon Informatics, Inc. Lieb said the agreement renews the images and brings a software update to enhance the program.

The following item addressed a statement of work for purchased services for an employee survey and provider engagement survey with inclusion of culture of safety with Press Ganey Associates Inc. Lieb explained the worked including two employee engagement surveys, one of which would happen soon, and the first provider engagement survey would take place in September or October. He noted there would be two each over the next three years.

Bush said they would be looking at doing the surveys annually.

Browne asked about the costs. Bush said the hospital had paid for one but had not yet done the survey. Edwards explained that the hospital would get a credit for the one paid for.

Browne questioned the costs being close for one survey and for the remaining two surveys.

Edwards asked if it should be tabled and if it would cause a problem.

Browne said he hoped the hospital would not be paying for something that had not been conducted.

Bush said perhaps the hospital had not yet paid for it, but she would have to review it.

The board members tabled the item until the next board meeting. [Editor's Note: A future article will address the issue again.]

The members approved the capital purchase agreement for a Sterra 100NX (sterile processing unit via USDA funds) from Advanced Sterilization Products (ASP), a Vizient GPO (group purchasing organization) vendor. Lieb said it is an all-in-one system for sterilizing items in the operating room. It is USDA grant funded.

The following item also received approval by board members for a capital purchase agreement for surgical lights and surgical tables for the operating rooms, through Skytron, a Vizient GPO vendor. It, too, was paid for through USDA funding.

Lieb said the next two capital purchase agreements go together for 12 micro-computers for workstations on wheels (WoWs) for use in clinical areas from Dell Corporation, through NASPO ValuePoint Purchasing Cooperative and for 12 wheeled carts for use in clinical areas from Connections, a Vizient GPO vendor. These will be paid for with USDA funding.

Also taking advantage of USDA funding will be the capital purchase of two Osage ambulances for emergency patient response and transport through JK Ambulance Sales/Emergency Services Supply, a BuyBoard Purchasing Cooperative. An additional capital purchase agreement of patient treatment equipment for use in the two ambulances through Stryker Medical, a Vizient GPO vendor, will be funded by the USDA.

"We have a substantial commitment financially, already paid for to fulfill the USDA grant," Lieb said. "Our piece of these is $275,000 hospital working capital."

Edwards noted it was great for the hospital to have the option to spend this funding on needed items.

Members approved the items purchased with USDA funding.

The following item addressed a letter of lease agreement with Beginning Years Program for the Ridge Loop property. Lieb said the lease is reimbursed by the Early Childhood Department. It is a four-year renewal.

Resolution 2022-12 addressed the fiscal year 2022 budget update. Rogers said it is a regulatory requirement to report the year-to-date revenue to the state. "This is the final update for FY22."

Resolution 2022-13 approved signatory banking authority, specifically recognizing Banks as the new CFO. "Given the lack of a permanent CEO (chief executive officer), as I have been the consistent person serving the hospital, I ask that you add me back until we have a permanent CEO," Lieb requested. "I believe the limit is $50,000 for the CEO and $25,000 for the CFO. We added Harry (Browne) as a board member to the signatory authority some months ago."

The final Resolution 2022-14 addressed signatory authority for contracts and documents. Lieb again asked that he be added as the regional vice president of HealthTechS3 for $50,000 or less. Members approved the addition.

In reports, Lieb, giving the CEO report, said he had good news that was just released yesterday by CMS (Centers for Medicare and Medicaid). "We maintained our 4-Star rating. There are a couple of 5-Star hospitals in Tucson, but none in New Mexico. There are no other 4-star facilities within 100 miles of Gila Regional. Congratulations to the team. There are a whole bunch of factors that go into the rating. We have room to grow, but it is a recognition of the quality of what everyone in the hospital provides. As we work on patient satisfaction and employee engagement those numbers will continue to climb. Good stuff."

The second good news, he said is that the Imaging Department hasm coming in August, a heart-flow analysis diagnostic tool that uses CT angiography studies that are done on the machine. "Per Dr. Ratliff, about 20 percent of our patients shipped out for cardiac services are negative. Now with this tool we can detect that 20 percent before we ship them out for a big bill from Las Cruces or Albuquerque. The other 80 percent probably do need a cath or a stent, so they will be sent out. This is the only one of its type in southern New Mexico. We're starting marketing right away. This will be a pretty cool thing for us to have."

Vigil explained that it was basically a digital cardiac cath, so the doctor can see on the computer the flow through the heart to determine whether the patient will need a cardiac cath. "It's high level machine with views of blockages and such, and it is almost equal to the service of a cardiac cath. So, this is a huge opportunity for us here."

Edwards said she talked to Dr. Ratliff the afternoon before, and "he is super excited about this. It is a technology that, according to him, has only been available at academic teaching centers. We are the first in the state to have the technology, so he's really excited."

Browne noted that it would have saved him $80,000 for a helicopter ride and several days two years ago.

"Melanie, who has been promoted from acting CNO to interim CNO, has jumped right in," Lieb said. "She's also managing to keep the MATCH program going along. Paul introduced Patrick a bit ago, but Paul has also graciously agreed to stay on for about a month to make a smooth transition. As we are wont to do, we dropped him in the stew, but he's done a wonderful job. Tony (Marion A. Thompson, interim CEO) has been conducting townhall meetings across all shifts and departments and at all of our sites and is working on completing some financial projects we have going. The theme for all of these is respect. The behavioral standards committee had nominees from all across the house, and I believe it's seven members have been chosen to begin working on the engagement principles. There is a lot more to come for Team GRMC. More teams are working on the surveys. These are teams really working on the ICARE values (integrity, compassion, accountability, respect and excellence) of the hospital. Next up is rewards and recognitions. Many of these are being headed up by our employee engagement specialist, Julissa Alaniz. She joins us from Western New Mexico University. A really large focus on the people. We've been focusing on the money, and there's still a lot to do. We are engaging Jeanne Gustafson as the care manager to help us for a short time to work on the swing bed program. She should be here by mid-August for about 90 days to get the program off and rolling. We have plenty of care management needs, but we want to get this program stood up and rolling. We're not where we wanted to be, but we can do it now. Holly Glick has been set up as the care manager."

Vigil noted that Glick has been with the hospital for about 15 years.

Vigil then presented the CNO report and gave some of her background. "I've worked the most in the maternal and child department and served as supervisor. I'm very excited to be in this role. I was named as acting in June, and now I'm interim. I'm learning a lot and I see across the system that we're excited again about nursing and the different opportunities we see across GRMC to make things great."

She said she wanted to give credit to everyone in the departments who prepared so well for the Joint Survey.

"Right now, we are focusing on preventing falls, including education of patients," Vigil said. "We also continue to work on the protocols for sepsis and working on education as patients come into the hospital. We're spreading that around the departments. We're communicating to the departments about patients that are at sepsis risk and treating them accordingly. We're excited about the swing bed program and learning more to get it going. It will be a big service to our community."

Rogers presented the CFO report for June. "We are reporting a net surplus of $1.532 million, which includes two normalizers, a physical inventory adjustment of $492,000 and supplemental Covid funding of $1.351 million. The total net surplus excluding normalizers is
$673,000."

"The physical inventory adjustment is added expense we saw in June as a result of performing our annual inventory," Rogers said. "We found $492,000 of OR supplies, which were less than what was on our books. We researched to find out where it went. We found a functionality that is in our software that had been mistakenly turned off back in November or December. Supplies that are consumed are normally recorded as an expense and that didn't happen for six months. Because of that, we saw an adjustment that increased our expense in the month of June. What that means is that we underreported our expenses in the OR over this period of time. A physical inventory is where we discover things like this."

Browne asked if that meant the hospital wasn't charging insurance.

"No, no, it had nothing to do with charging and billing," Rogers said.

"So, we knew supplies had been used for billing purposes, but not on the accounting side," Browne confirmed, and Rogers affirmed that comment.

Edwards noted that the $492,000 was not on the cost report.

Rogers said: "It is reported on the cost report, which will be reimbursed by the cost report filing at a later date." He explained that it doesn't matter when it occurred, because it is on the cost report in the same year. "Adding that normalizer back in, brought us up to the $1.532 million. On the other hand, the $1.351 million is supplemental, and we earned those dollars. Excluding the normalizers, our surplus is $673,000. I thank the OR director for discovering the problem with the software."

Rogers said volumes showed a sizeable decrease from May, which is mildly concerning, "but we saw the same decrease last year, as well as in surgeries. The ER and the outpatient volumes saw moderate increases."

Lieb said: "We see such seasonality at most of our hospitals. They happen due to vacations in the summer and due to pneumonia, for example, and meeting deductibles in the winter."

Rogers then compared the month results of $1.532 million "which are incredibly better than budget," to the prior year. Last year, "we saw a $13.157 million surplus due to receipt of $6.3 million for PPP (payroll protection program) and $2.9 million in provider relief funds that were recognized as earnings in the period. Another normalizer last year was the receipt of $4.1 million in reductions in revenue, which brought the retroactive Medicaid rate settlement. We saw in this year total operating revenues ahead of budget and expenses of $7.2 million because of the inventory adjustment."

"We are finishing the year with a net surplus of $7.1 million on a budget of $1.72 million," Rogers said. "It's been a very good year for the hospital. I thank everyone for their hard work."

On the key measures of liquidity, "most of them are moving in the right direction, with one slight negative. The net AR (accounts receivable) saw a slight increase, but they are still under 30 days, which is a target benchmark."

Lieb said: "We've probably cut that metric to a third of the about 90 days we were at a couple of years ago. We've done a good job of cleaning up the billing, the old accounts payable. We do a weekly cash call, so we can see what it is."

Browne asked if the hospital has a goal.

Rogers said: "I think our goal is to pay our local providers as quickly as possible and to take advantage of our cash discount, and maybe extend the time, while not losing the cash discount."

Lieb said the hospital is under the HealthTechS3 target.

Rogers showed the capital expenditures for the year, with the hospital purchasing just under $2 million in hard assets.

Salas said he was really glad the hospital caught the $492,000 error because of checks and balances.

Edwards thanked Rogers for everything you've done in service of Gila Regional, "and for being willing to stay on to finish projects."
She then presented the Chief of Staff report on behalf of Dr. Brian Robinson. The first item is the credentialing, which was presented in closed session and approved in open session. She also read a list of items for information only. They included new policies that the Medical Executive Committee had approved.

The quality report came from Chief Quality Officer Denice Baird.

Baird said the hospital had been notified that the Joint Commission in-person one-year follow up survey would be done in July, but "we then were notified that it is no longer required by CMS (Centers for Medicare and Medicaid). It was canceled, so we will go back into our regular survey window sometime between January and mid-June 2023. We had our survey of the pathologist lab last Saturday. We do have the report. A lot of the improvements we saw skimming through it are in policy. We have an interim infection preventionist, who joined us early in July, by the name of Marlene Vickery. She comes to us with 37 years as a nurse and 17 years certified in infection control. She has hit the ground running, getting to know staff. We did offer the chief quality position and it was accepted by our now former inpatient services director. She was going to be here today, but she became ill. This will be my last quality report. She will be here next month. Melanie talked about the fall program they are working on, using signage and a Helping Hands program. Our new inpatient services director Amanda Mondello is very creative and has done some really nice flyers and presentation boards and signage for us. Our goal is to have no more than 3-5 falls per 1,000 patient days. This is a national benchmark. We are currently just above that at 6, which is common right now considering we're coming out of a pandemic, because of a lack of visitation. A lot of times families are important, encouraging patients to get some help or by helping them to the bathroom. The No. 1 cause of falls is a patient on the way to the bathroom."

She said they continue to work on reducing the days for trauma transfers. "Some of our challenges are transportation resources. Also, delays in initiating that transfer and also having some CT transfers that are longer than we hope for. We are working with our radiation provider to reduce those times. We are also working on a faster response to a trauma activation, through education. Our cardio-pulmonary group is working on a time frame from a blood gas result to a clinician to provide treatment. Our goal is three minutes to someone who can initiate treatment. Surgical services is working on an improvement as well to do a type of risk assessment to see if there is something they can do before it becomes a safety event. It is required by Joint Commission that the hospital assess high-risk items before they become an event. Anything that has a hinge has to be processed in the open position, so any bio-burden is removed and sterilized. They are looking for education opportunities, policy opportunities, anything that will improve the procedure. We had a baseline of 52 percent. We have a new person in that department, and that could be an issue. Our goal is to get to 100 percent, and just in a month, we have gotten to 96 percent and for July, most departments that have reported in are at 98 percent. Just the awareness has raised the level."

Browne thanked Baird for her reports. "We will miss you."

Lieb added that Ramona Wilson has been named Chief Quality Officer. "But there is no one in the institution who has done more heavy lifting than Denice. I'm glad she will continue with the risk and compliance issues, but I want to say thank you."

During board comments, Salas said it was wonderful to see financial improvement and the capital expenditures, but "also seeing the ability for the hospital to do the capital improvements. I would like the community to be informed of all the good things going on in our hospital. I thank everybody."

Browne had no comments.

Edwards said: "Thank you and congratulations to everyone at Gila Regional for the renewal of the 4-Star quality rating. We just have to be grateful for ourselves and each other for the progress we've made and for making the 4-Star rating possible. I also would like to thank Dr. Ratliff for making the digital heart-flow machine happen. Melanie is doing two jobs, as the MATCH director and now as interim CNO."

She noted that the financial complexity of a hospital is "mind-boggling, as a lay person. There are incredible layers. Prior to the last couple of years, the financial department was only skimming the top of what we needed to look at and what the challenges were and what solutions were needed. I thank Patrick Banks as financial director for peeling away all those layers in our revenue cycles. I think your promotion to CFO will be great for Gila Regional. I want to highlight the hiring of an employee engagement specialist. I have heard, and I fully believe that the hiring will be a game-changer for the hospital."

"I want to talk about swing beds," Edwards said. "The whole concept of swing beds, I'm guessing, is not well understood in the community. Literally, this is an opportunity, especially in our community where, for many people it's a hardship for families to visit when a family member is getting treatment and care in another community. This will allow us, when a person has to go to another community for care, they can come home that much faster and get their follow-up treatment and care right here at home. Thank you for all that.

"I said this a while ago, but I want to reiterate and acknowledge that we had the financial capacity this year to invest almost $2 million in capital for the hospital," she said. She noted she had been fortunate not to need much care at the hospital, but some months ago, she was there with a neighbor and "I noticed that the carts and computers looked rather ancient. I'm glad to see they are being replaced."

Edwards also noted that Denice Baird has been the go-to person for so many things. "I realized that Denice was doing the work of six people in her department. She kept a lot of other people going. She'll be going back to risk and compliance instead of all the other jobs. Thank you so much."

The meeting adjourned.