[Editor's Note: This is part 1 of a two-part series of articles on the GRMC Board of Trustees meeting on July 27, 2023.]

By Mary Alice Murphy

The Gila Regional Medical Center Board of Trustees, appointed by the Grant County Commission, which had served as the GRMC Governing Board up to July 1, 2023, held their first meeting in the Board Room at the hospital on July 27, 2023.

Their first order of business elected their new officers. Dr. Fred Fox will serve as board chair, Betty Vega as vice chair, and Pat McIntire as secretary-treasurer. Other members include Mike Smith, Seth Traeger, Will Hawkins and Javier "Harvey" Salas.

Fox led off the meeting by reading a prepared statement: "This is the first meeting of the new GRMC Board of Trustees comprised of community members appointed by the Grant County Board of Commissioners. Our role is not to manage, but rather to draw on our collective experiences, knowledge and relationships to the people and constituents of Grant County to provide governance to the hospital."

He continued: "Our role is to provide oversight, insight and foresight toward the well-being of the hospital in concert with the established mission and vision."

Fox then read them. Mission: Providing exceptional quality, patient-centered care in healing environments. Vision: To be the best place to receive care, work and practice medicine. Values (ICARE) integrity, compassion, accountability, respect ,and excellence.

He said the board supports these goals and looks inward to help the hospital assure long-term quality of care, stability and resiliency in a changing health care world. "We also look outward to the people we serve and collaborate with others to meet the health care needs of the community."

Fox noted that unlike many hospitals, Grant County owns the hospital, authorized under the New Mexico Hospital Funding Act.

"Health care delivery is facing complex challenges and will continue to do to at the national and state levels, as well as locally," he continued. "The COVID pandemic stressed the system even more. GRMC has managed to weather this storm because of the concerted efforts of providers, the County Commission, hospital leadership and especially the entire hospital staff. This board sincerely thanks the entire hospital staff and expresses our appreciation for the dedicated care your provided and the resilience you showed during this difficult period."

He concluded by saying the board looks forward to working diligently to build on a new period of stability.

To recognize staff members for their years of service Fox said: "We are pleased to recognize today these individuals of the GRMC staff for their years of dedicated service." They included Kristin Montoya for 5 years of service in Quality; Ronita Rodgers for 5 years of service in Maternal Child; Cruz Ruelaz for 5 years of service in rehab services; Roberta Leigh Smith for 5 years of service in rehab services; and Lazaro Dominguez for 15 years of service in dietary.

Interim Chief Executive Officer Margie Molitor said now that the meetings were taking place at the hospital, she would try to get those receiving recognition to attend the board meetings.

After no public input and approval of the consent agenda of minutes, the first report came from Cynthia Lewis, interim chief nursing officer. She said she is always excited to "speak about what we do best, which is care for people. We are focusing on a culture of safety and a just culture. It was a focus of our LDI (?) in June. We learned that people think we need to do a better job in communication. Since Margie has been on board, we've done a much better job of layering, and from that, our patient engagement surveys have shown us that we are doing a way better job in meeting their needs. At the beginning of the year, the patient engagement stood at 13 percent. At the end of the fiscal year in June, we stood at the 55th percentile. This shows we are doing a better job in communication and in being able to communicate with our families and patients. The last part is making sure our nurses and caregivers are doing a better job communicating with our families, because that's our business. One of the things we do to recognize that is the Daisy Award. This is the third year of the Daisy Award in this facility. In the first year of the award, we got three nominees. Last year, we got 15 nominees. This year we have 45 nominees of 32 different nurses. The nominations come from patients or from family members. That's just closing the loop on our relationships with one another and reflecting our mission and values. It comes from help from the board and reflects our successes."

The next report came from Chief Financial Officer Patrick Banks. "It's a fun month, of course, completing all the end-of-year reports. At the beginning of this fiscal year last July, we started in a real hole. We took a million-dollar bath in July. We've stopped the bleeding, but we've been digging out of a $1.8 million of operating losses last July and August. We kept chipping away this month, and that's the basis for the expectation, which you saw in the budget for next year, to be at break-even at the end of this fiscal year 2024. I've been saying all year that volumes are startlingly consistent, and these slides show things we need to keep track of. The yellow lines are budget, actual lines that are blue. They bounce around a little bit. The reason for change in the budget traditionally in the second quarter of the year, we generally see lower volumes, because the weather is better and respiratory season is over, with maybe people taking better care of themselves in summer, Overall, in comparison, in June we didn't see a drop in discharges, and we saw a slight rise in operating room visits. The picture shows a fairly robust surplus of $200,000, which includes no adjustment in year-over-year comparison. With the rate increases last month, we haven't recorded any significant reserves nor any significant expectations in excess revenue on the settlement. The $200,000 surplus for the month puts us at an operating loss of $405,000 for the year. Realistically, the trajectory of the hospital is better than we thought we would get to this year when we were at last year. When you compare to last year, you need to realize that we lost our subsidy from the state, so this is us entirely standing on our own. We've budgeted break even for this year, and we need to hit that. We have $10 million in non-operating revenue. That's working with Health Tech and Priscilla Lucero (Southwest New Mexico Council of Governments executive director) to look for grant opportunities and every angle to pursue them aggressively. That reflects the hospital receipt of ERC Employee Retainment Credit, which is the last of the pandemic aid. So, $10 million of non-operating revenue is not something we're going to plan for. We think this is really the end of the Covid money. We've improved enough in our P and L (profit and loss) to stand on our own and any grant money we get will go to improving care, of both the plant and the ability to offer services to the community. Our days of cash on hand is 130 days, which is not great by hospital standards, but it's a far cry from a few years ago of 9 days of cash on hand. We're working on a budget that will allow for some capital purchases this year, and we're already starting to work on an MRI. We've started working with the state on funding telemetry improvements."

Trustee Smith said he gets a weekly report from NIH (National Institutes of Health) and it reported an increase in Covid in the northeastern states.

"That's why we stay ready and why we keep cash on hand," Banks said.

Chief of Staff Dr. Colicia Meyerowitz said Grant County is third in the state right now for Covid cases.

"I think we should anticipate at least by September or October an increase in patients again," Smith said.

Banks said: "I don't know if we call it Covid or respiratory season or what, but thanks."

Meyerowitz presented the chief of staff report. She introduced herself as chief of staff since April. "I work as a hospitalist as well as in outpatient. I am a provider. I'm chair of the credentialing, chair of the MEC (medical executive committee) and of bylaws and peer review. I have a wide breadth of experience in the hospital. For the rules and regulations and bylaws, we meet about four times a year and we continue to evaluate them for changes. For the bylaws there were just a few changes. Suzanne Sandoval works in the office, and she made a change to the definition of quorum, because we have trouble getting enough members to show up. So, quorum is the number of practitioners present at a meeting and that would include electronic votes as well. That was passed by the bylaws committee, then it goes to the MEC and on to the board. In the rules and regulations, we got rid of section 22, which delineated what each specialist had to have as qualifications. We decided it was better to move that over to the delineation of privileges for each specialty. Suzanne compressed the rules and regulations by moving a lot of the rules of the pharmacy out of rules and regulations because they are already regulated by policy. Any changes, such as formulary by the pharmacy will still be voted on by the MEC."

Fox said he had reviewed them, and he thought the changes made sense to update, and changes were the only issues that the board should address.

Meyerowitz said the next group of issues addresses the competency exams. "Basically, these were created years and years ago by Dr. Donald Stinar, and the anesthesiology department re-evaluated them and most recently Aaron Rudd. There were several questions that caused a lot of discussion. Different practitioners disagreed on it based on their board certification. Recently Aaron Rudd and Dr. Sam, the chair of our emergency department, re-evaluated them, and they adjusted the exams to be a lot more palatable according to current standards. They changed the passing grade from 85 percent to 80 percent, because there is still a lot of discussion. Anesthesiology is exempt because it's part of their certification. The last group of policies were in reference to peer review and practice evaluation. All practitioners are evaluated twice a year in case any issues of concern pop up. If a surgeon has been trained in a new surgical technique, they are evaluated. The policy was updated to address any concern that may come up. Peer review policies were reviewed and changes made. Anything that comes up needs to go through the MEC. Self-referrals were looked at in terms of physicians. That was taken to legal and there were no concerns. The issue of first assists in the OR has been removed because they are not practitioners. They are primarily nurses or medical students, and they are not certified. All of those have gone through credentials and the MEC."

Fox noted that any students who are first assists have generally come from teaching institutions and their credentials have come from the institutions and that they are up-to-date and covered by their institution's insurance.

The next article will begin with the interim CEO report and then the Health Tech report and addressing the new business agenda items.

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