By Mary Alice Murphy

After the reading of the Gila Regional Medical Center Mission, Vision and Values, the Board of Trustees heard Chairman Dr. Fred Fox give his comments.

"Yesterday [Sept. 26, 2024], I gave my first report to the Grant County Board of Commissioners," Fox said. "I will do the same every quarter."

He said he thought board training should continue with studying critical access hospital cost-based reimbursement. He talked about information on three different programs with various links in their summaries for exploring the issue. "If you like I will email you this information with their links."

Fox recognized two employees for their years of service to the hospital. They were Steven Navarro for 10 years of service in Cardiopulmonary respiratory therapy and Carolyn Torrez for 20 years of service in Labor and Delivery. Neither was present. Fox thanked them for their service.

With no public input, the board members approved the consent agenda of the board meeting minutes draft.

Board members also approved the A) Sleep Lab medical director agreement and B) the employed practitioner agreement in pediatrics with Dr. Herr. "I'm happy we've been able to get a pediatrician so rapidly."

Other agenda items approved by the board included:
C) the professional services agreement for pediatric on call coverage;
D) a hardware/software service agreement for infrastructure PCC-Cisco Smartnet for maintenance and technical support services for the hospital's network hardware;
E) a hardware/software service agreement for the rental and combination of all GRMC's Nutanix Nodes under one end date of 11/6/26 for virtual server environment maintenance with licensing and support - PCC- Nutanix Renewal;
F) a hardware/software service agreement for the main back-up system and disaster recovery for all server environments -PCC-Rubrik Data Management System;
G) a service agreement to renew security operations center/incident response plus its remote engineering- PCC- Security Operations Center;
H) a service agreement renewal- PCC- Security Operations Center;
I) the purchase of C Arm X-rays - two machines, one for general imaging and one for use in the O.R. (operating room) suite. It includes a 1-year full-system warranty from FujiFilm;
J) a service agreement for the CT scanner, a 4-year service agreement for the CT scanner, including preventive maintenance service, parts and repairs with Canon Medical Systems; and
K) a placement agreement for laboratory supplies for Antigen Reagents with Quidel Sofia.

The board had no old and no new business. The next agenda item went into reports and updates.

Interim CEO Margie Molitor gave a brief Chief Nursing Officer report for Interim CNO Cynthia Lewis, who had a family emergency.

"She is getting ready to onboard our new CNO Ron Green," Molitor said. "We do have a new HR (human resources) director, who is being trained by our current HR Director Jeff Rushing, who is leaving to be closer to family in the southeast. We have a new lab director starting Oct. 15. We have the Daisy Awards, which you are all invited to, on Oct. 12. We had 51 nominees for 36 different nurses. That speaks volumes to what our community thinks of our staff here. [Editor's Note: See
https://www.grantcountybeat.com/news/news-articles/80691-grmc-presents-2023-daisy-award].

Fox agreed and said the large number of nominations show that the nurses provided exemplary care in all areas. "I'm pleased to see Ron Green become Chief Nursing Officer."

Molitor said Green and Chief Quality Officer Ramona Wilson were at a New Mexico Hospital Association meeting. "Ron received an award for his efforts to help save our Cancer Center." She noted he and his family lived in Papua New Guinea for four years where he did clinical work and accounting.

Board Member Pat McIntyre, former nursing professor at Western New Mexico University, said: "And he's a graduate of Western."

Chief Financial Officer Patrick Banks reported his August report that "we are noticing a difference in volumes from the past couple of years, although the OR (operating room) volumes track well. In September you will see that dip quite a bit. Discharges were down. Outpatient visits is trending fairly consistently, and the curve has shifted up."

He noted that seeing the shifts in volumes year-over-year show the challenge that hospitals face. "We have more than enough people to justify a hospital and our services are needed for the foreseeable future, but not in every service line, with not enough to show the law of large numbers predictability. It puts the onus on us, the administrators and the directors and staff to execute every day, which is something I've talked about before."

Board Member Will Hawkins asked about the lower OR numbers in July. "Is that because people go on vacation?"

Banks replied: There are two things that can cause surgical services to drop. The No. 1 thing is the surgeon taking vacation. The other thing that compounds that, July, in particular, is the summer month when people are going out of town. For elective procedures, people tend to schedule them for other times of the year, because in summer, they like to be doing other things. If you look three years back it's the same. That's why we can predict it, and it's why we came in on budget this month."

Health Tech Regional Vice President Scott Manis said the seasonality is common in different health care services. "Surgeries are always down in the summer and OB (obstetrics) is always highest in September, which means January and February are cuddling months, right? Mondays are always the busiest in the ER (emergency room). It's just a fact in every hospital. Some of it is predictable, but it's different in a large hospital with a lot of surgeons, for example. With a small hospital with just a few surgeons, if one goes on vacation, you see that dip."

Fox said in the OR, it's common for there to be more surgeries at the end of the year, because people want to get them before their deductibles go up again in January.

Banks noted it's the same for annual procedures like colonoscopies or mammograms that people want to get before the deductible kicks up again.

Molitor said the September report will show a dip in OR volumes, "because we had people on vacation."

Hawkins asked if the rise in ER visits in August could be attributed to the re-emergence of Covid.

Banks said Covid in not driving volumes. "While we are seeing it in the community and everyone needs to be aware of it and get your booster shots, we are not seeing it driving hospital volumes. We'll keep an eye out as the respiratory illness season comes on, but it's still up in the air whether Covid will increase or just be a bogey that gets diagnosed once in a while."

"So in spite of the variability, we wound up with a net operating surplus of $50,000, which reflects another month of us working the volumes as they came through," Banks said. "What you see is our over-budget lines are fairly consistent. We're not blowing money out of the house on one line and making it up somewhere else. Our volumes were up and our expenses were up accordingly. When we look at the year-to-date, I can't help but compare it to the prior year. There's no business where comparing being up $1.6 million from the prior year is a bad thing. I wouldn't read this as the hospital will never post a loss again. It's going to happen. It could happen in September if volumes stay low. But let's stick to our plan, which includes $6 million in capital purchases this year. With a year-to-date revenue of $15 million that is a robust expected revenue."

Fox noted that the hospital can have a really busy month, but it is not being paid that month, because of delay in payments.

Banks said he presents revenue in an proportionate amount that is an estimate of what "we expect to collect. It is an estimate, but we're generally pretty correct.We write off what we don't expect to collect, and report what we expect to collect from usual services."

To a question about the prior year, Banks said: "We started out a tough year. We had a lot of contract labor that we didn't have control of, but now we have control of our labor."

"We have 41 days in AR (account receivable) as of August, so about a month and a half until the estimated revenue is actually realized," he said.

The next report will start with a report from the HR Director Dustin Knowles.