[Editor's Note: This is the second of two articles from the GRMC Governing Board meeting on Jan. 26, 2023.]

By Mary Alice Murphy

After the new business items were approved by Gila Regional Medical Center Governing Board members, they heard reports from the leadership team members.

Chief Nursing Officer Melanie Vigil gave the first update. She noted that great things are going on in the community, and the Beginning Years program is one of them. She explained that the staff members serve family members pre-delivery of their unborn children, and they continue to teach and help the parents with their child up to age five years.

"Beginning Years has updated its website," Vigil said. "The free home visit program continues to provide services to the family."

She said the staff recently attended a conference in San Diego, CA, to help them help families deal with issues.

Vigil noted the program served 286 parents and children last month with Toys for Tots, which gave toys to all the children in the program. Beginning Years also provided 40 holiday baskets to families.

"Each of our department directors recognize outstanding work of the nurses who go above and beyond," Vigil said. "We recognize them with certificates, events and letters from directors letting the nurses know how much we appreciate them."

She said the department's goal is to improve patient experience. "We have identified specific needs through comments from our patients. We have committees set up for all three items we determined needed to be addressed. They include discharge planning, patient food and the patient environment. The organization is supporting the committees."

Chief Financial Officer Patrick Banks gave his report. "As usual, I am reporting one month back. December is a big month for us, as it is the end of the first half of the fiscal year."

Regarding trends, which cover the trailing 180 days, Banks said the discharges are stable, and thanks to the great job the surgeons do, the surgeries are trending upward, as are ER visits, which went to 1650 visits, the highest he could find in looking back at records. "Our outpatient visits were also high."

He explained that because of the early in December board meeting he hadn't reported on November because the report wasn't complete. "We turned a good EBIDA (earnings before interest, depreciation and amortization). We turned a surplus. As we moved into December, our EBIDA stayed strong and we had a negative $8000 surplus, which is almost break even. It's our goal to do better than break even, but sometimes we don't get paid for an increase in volume right away.

"We did get an interim rate level from Medicare that reduced our rate per patient, because we had been seeing more patients during the month," Banks said. "Medicare is a large part of our patient population. Medicare tends to reduce the rate if you are seeing more patients relative to other payers. That turns into complex math. We didn't take a major hit in December, because we had predicted it and reserved against it. We took a minor adjustment. I don't expect any big fluctuations. I'm going to talk here year-to-date of an EBIDA of $442,000 for six months ending in December. If you remember, July was a challenging month for the hospital, so to be able to report a positive EBIDA of $442,000 means we're doing what we need to do. A positive EBIDA means we're paying our staff with revenues from the patients we are seeing. It is a very good indicator. We're proud to deliver those results while delivering great patient care. We funded $630,000 of merit increases as of Jan. 1. We also pay a lot of money for benefits for staff. We believe we offer the best benefits around. We have a 403B plan that has an excellent vesting schedule. We offer other benefits as well, and the benefits are only as good as utilization. We had our benefits rep out and they have committed to being on site every month or two for the rest of the year. We will be driving education around our benefits and getting folks signed up for everything that we want to be doing for them. Our net surplus, which was negative in July, is now $4.5 million as a result of a one-time inflow of cash we are expecting from the federal government. We took advantage of a tax credit program that was part of the CARES Act. It is called the ERC or Employee Retention Credit., because the hospital kept its employees through the pandemic. We will also take advantage of a payroll tax credit that will be reviewed by the IRS, and we expect it later this year. Any time you deal with the IRS, there is a risk, so we have taken a hospital assurance policy that will guarantee the hospital receives at least $5.6 million, perhaps up to $6 million or more. It won't exist next year. We'll keep looking for opportunities to finance our hospital."

He said he looked over the past 24 months in six-month chunks. "We've had positive EBIDA and surpluses in each six-month period. That's an incredible accomplishment for the hospital, so we can focus on the things we want to accomplish."

Banks said the key measures of liquidity show an uptick in days of cash on hand. "That is a result of careful management. We also have strong accounts receivable days, and we are continuing to pay vendors on time. It's, however, not just rosy, although we are tracking toward ending the year where we want to be."

Governing Board Chair Alicia Edwards said: "You mentioned your team a couple of times."

Banks said he inherited a registration team in June 2021that had something like six employees. "We started hiring immediately and got the function rebuilt. I had the opportunity to work with the rest of the revenue cycle team. On my first day, I realized that my business office manager had had 16 bosses in six or seven years. I hope Yvette got a new boss, me, that will stick around for a while and not exceed 16 bosses. I inherited an exceptional team of accountants, Kathy Madrid and Betty Roscoe that are real professionals. I also had to hire an accounting manager who has had to take on a difficult job of going through historical records that we didn't have the resources to tackle. This isn't indicative of issues with the books, but when you have sparkling books, it allows the Gregs of the world go in and seek out amazing insights. I am really lucky to work with a great team. I look forward to continuing to work with them for a long time."

Edwards presented the Chief of Staff report for Dr. Gregory Koury. "We just approved the credentialing report. The MEC (medical executive committee) approved a new and improved EMTALA (Emergency Medical Treatment and Labor Act) policy as of Jan. 1, 2023.
She listed other policies that had been approved by the MEC, including the Medical and Advanced Practices Professional Staff vaccination requirements policy that was approved on Dec. 14, 2022.

Denice Baird presented the Quality Report, according to the agenda. "Actually. this is the Compliance and Risk report," she said. "We partner with an external vendor on our patient safety program to maintain a hotline, which allows staff to provide an anonymous report on concerns that may impact the integrity or trust of our facility as well as anything related to safety. Under this program, the company offered additional ways including a one-click to a portal where they can make their report or through an app on their phone. It allows them to report without having to talk to a live person, and it allows them to report without fear of retaliation. It was a nice win for us and did not cost the hospital more."

"We also have an event reporting system, also called an incident reporting system that reports an event with a patient or with someone they work with, any concerns, even an accident outside the facility," Baird continued. "This supports our patient safety. We had a bit more than 1200 reports during 2022. That sounds like a lot, but when you look at the number of visits, almost 52,000 over the last year that is 2.3 percent of the patient that visited resulted in a report. We pass them onto the performance committee which can look at reducing that number."

She reported 150 complaints in 2022, which is less than half a percent. "We will also pass them onto the performance committee. Every quarter we receive the star rating. I cannot report for two more days, but we have not changed. Kudos to our staff for providing excellent patient care."

Next was the CEO report from Interim Chief Executive Office Greg Brickner. He said that because half the fiscal year is gone, "to ensure we are on track, I've focused teams on finishing projects. Our No. 1 goal is excellent health care for Grant County residents. Yes, Gila Regional is facing some of the same challenges, but we've defended our service lines and expanded them. Our bone density tests are back. The swing bed program is in operation. Dr. Ratliff has his advanced non-invasive diagnostic test for cardiac problems. Everyone at GRMC is working hard. Every day we use our resources. We gave raises to our employees, physicians and nurses. We've had wins, such as reinstating our Cancer Center, recruiting two oncologists and a nurse practitioner for the center. We have recruited a new general surgeon and we have a new anesthesia machine. We updated the dictation system. The survey of providers shows we still have a lot of work to do."

He said the hospital turned on the new washing machine, and also implemented a new HR (human resources) department system. "The team rallied to figure it out. We continue to seek a way to expand communications, through Facebook, educational videos on our Facebook page, and we have relaunched our employee newsletter. We are holding employee townhalls and our clinical teams have improved collaboration. We did an employee survey, and our directors are working on improving things from the survey. We have restarted things that we had to close down during Covid. We held the Trunk or Treat and started again holding education classes for new mothers. On the upgrade of the EMR (electronic medical records), we shared demonstrations for the employees. The MATCH (maternal and child) renovations started last week. We have a new 3-D mammogram unit arriving in March. And, of course, we continue providing excellent care to our community. In December, as Patrick said, we had 258 surgeries. That is our general surgeons coming together to provide excellent care to our neighbors."

He said this month they are taking a different approach with educational videos. "We are going behind the scenes to show the support staff who help things on the front lines. We can highlight their amazing work. More than 38,000 times, patients have called on GRMC. This highlights how vital GRMC is to the community. Our team continues to be ready for the next 38,000 times the community calls on us. In my remaining weeks with you, I continue this bias toward action to continue the momentum of the first half of the fiscal year."

Scott Manis presented the HealthTech management report. "As Greg just mentioned, the health care system is challenged across the country, with volumes and financials being stressed. Fortunately, we haven't seen that as much here. It's remarkable to see the progress here. We are on the right track."

He noted that the candidate for CEO that had been identified withdrew.

"We have identified a very good interim CEO and arrangements are being finalized while we continue the search for a permanent CEO," Manis said.

Governing Board Member Chris Ponce said: "You mentioned another interim CEO. We are seeing positive strides, and every time we have a new person, we see different ideas. I hope the interim CEO can continue without changing course."

Manis said he appreciated the comment. "My heart and soul have been here. I've heard those same conversations with each incoming interim. This one will be well-versed to ensure a smooth handoff."

Under board comments, Members Billy Billings and Ponce had none. Browne said he appreciated the patience of the members to fit his scheduling as he had a dental appointment that afternoon.

Edwards said when she hears about the accomplishments of the past six months, "it's pretty amazing. Imagine what will happen in the future with stability."

She said she had a conversation with a person that had confidence "we will become a $100 million-dollar hospital."

The regular meeting was closed with an additional executive session at 2:30 p.m. "We do not plan any action after the session," Edwards said.

The meeting adjourned from the executive session.

To read the first portion of this meeting, please visit https://www.grantcountybeat.com/news/news-articles/76482-grmc-governing-board-holds-monthly-meeting-jan-26-2023-part-1