New permanent CFO announced.
By Mary Alice Murphy
{Editor's Note: This is part 3 and the final of a series of articles on the Dec. 20, 2023 GRMC Board of Trustees meeting. It continues the updates and reports. And I made an error at the end of Part 2: The next report will come from Chief Nursing Officer Ron Green.]
Chief Nursing Officer Ron Green presented the next update at the Dec. 20, 2023, Gila Regional Medical Center Board of Trustees meeting.
Green noted that at the last meeting, he had reported that the hospital had a handful of Western New Mexico University graduating nurses that he hoped would join the hospital's nursing residency program. "I'm happy to say, we have signed six to begin the 4-6 month program on Jan. 4. It's mostly a process to bridge the school experience to traditional nursing. We have a couple of others due to family situations who we are hoping will join us in late spring or early summer. We are excited to have them."
In another piece of information he said that he knew a lot of the board members have seen the county's Covid cases increasing per New Mexico Department of Health, "which surveys our clinics and our emergency room to determine the percentage rate of active Covid cases. In October, we were at almost 2 percent and in November we went up to 5 percent, with the last week of November spiking up to 9 percent. To protect patients we implemented having our providers wearing masks again. When the number goes down we will remove the mask mandate."
Board Chair Dr. Fred Fox said the CDC (Center for Disease Control) had placed New Mexico in a very high category for respiratory diseases, "whether it was RSV, Covid or flu. The hospital rate is also going up for RSV in children and adults, especially those under the age of 5 or the elderly, especially in the unvaccinated population. I'm glad to see the hospital using the masks, which are protective for transmission of the infection."
Board Secretary Pat McIntire commended Green on the nursing residency program. "It not only helps the nurses get up to speed, but it also improves retention."
Board Vice Chair Betty Vega said her husband had had a procedure done at the hospital in October. "He had excellent care here. My question is: 'What percentage of those hospitalizations are those who do not have the required or recommended vaccinations? "
Green said he did not have those numbers because they are not being tracked.
Fox said: "Nationally, it shows a higher percentage of hospitalizations and deaths for those not vaccinated, especially in the elderly who have other comorbidities."
Green gave the clinic report. "I'm excited to report that Dr. Herr will join the Gila Family Health Clinic in February as a pediatrician. We also have Tiffany Maxey coming to join the Cardiology Clinic to help Dr. Ratliff and Erin Klinesmith. The Cardiology clinic has about a 2-month waiting list, so this will speed up the process of those waiting to be seen."
He also noted that the hospital has started the renovation of Pod 3 to house Dr. Carreon and the Orthopedic Clinic. "It will take two to three months to complete. Right now, Gila Foot and Ankle is sharing their space with Dr. Carreon, so it keeps them really busy."
Fox commented that he is proud of the Cardiology Clinic, because "it's very unusual for a community of our size to have a cardiologist. In big cities, they have interventional cardiologists. Dr. Ratliff does not do interventional. He does do procedures here at the hospital, but they are not interventional such as a cardiac cath. He is providing excellent care to our aging population."
The next report came from Interim Chief Financial Officer Leonard Binkley. "Our volume trends are good, especially for surgical and outpatient services in November. We had 260 surgeries during the month. We had 106 discharges for the month. Outpatient visits were 5,002 up to budget and up over the prior year by 6 percent."
The largest growth was in the Cancer Center, with 212 visits. He noted that physical therapy was up and the emergency department, which represented 43.6 visits per day, down from the average 44.2 was down a bit.
In November, "we had a good bottom line, with $215,000 surplus. We also did better about $100,000 than the prior year. That puts us with a $7.9 million operating revenue, with it being above budget and about $1.1 million higher than the prior year. Our total operating expenses were $7.4 million in November. up by $974,000 from the prior year. Our EBIDA (earnings before interest, deductions and amortization) sits at $558,000, well above last year's $425,000. All in all it was a good November."
Vega asked why contract labor expenses were up, especially in nursing. "What are we trying to do about that?"
Green said:It's not only in nursing; it's in imaging and other technical positions. "It takes a lot of time to recruit. Lowering it is a high priority. We have a couple of contracts we are not renewing next month when they expire. We want to find people who want to live and work in our community."
Binkley noted that contract employees are spread pretty much everywhere in the hospital.
He continued his report by saying that year-to-date the hospital has a loss of about $315,000, but that is compared to the last year's loss of $1.2 million. "That's about $855,000 better than last year."
Binkley also noted that September had been a bad month due to surgeon vacations and a drop in surgical procedures.
He said the total operating line was at $37.7 million, which is up $2.7 million to budget and up about $4.4 million to the prior year. Total operating expenses are at $37.2 million up $3 million over the prior year primarily due to contract labor.
Fox noted that expenses due to expensive cancer drugs and supplies also raised the operating expenses.
HealthTech vice president Scott Manis said: "When volumes go up, supply expenses go up, too."
McIntire said days cash on hand stood at 139 up from October. The average payment period, from billing to actually getting the dollars has decreased to 50 days, so bills are getting paid. "We're getting cash back faster than we had been. That's commendable."
Binkley agreed and said the accounts receivable are good at 40 days compared to 39 in October, due to the upgrade to MediTech Expanse, which has a large learning curve."I expect that to go down in December. We are certainly trending in the right direction."
Fox said the Chief of Staff report from Dr. Colicia Meyerowitz would take place in executive session, when she calls in.
The following report came from Chief Executive Officer Robert Whitaker.
"Thank you for approving the full agenda," Whitaker said. "We have a lot going on." He promoted the townhall, which was to take place Jan. 10, and he reported that he had done presentations at Mimbres, Bayard, Silver City and Santa Clara, with more to go.
"One of the messages I'm sharing is that I don't want the hospital to be thought of as a Silver City hospital, but we want to be Gila Regional Medical Center," Whitaker said.
McIntire said when she was practicing, she would see patients from Reserve, Rodeo, all over the place.
"That's what we are," Whitaker said. "We serve the whole region. I'm having a townhall with the staff on Jan. 4. It's not a one and done. We'll have more."
Manis said historically they are held quarterly.
Whitaker said the New Mexico Hospital Association has been working on legislation to benefit hospitals with better reimbursement from the state. "Part is working with local legislators to let them know how important it is, not only for us, but rural hospitals all over the state."
He said the NMHA has a newsletter addressing legislative issues.
Fox asked about Whitaker's position with the New Mexico Rural Hospital Network.
Whitaker said the network is made up of the 11 independent rural hospitals in the state. "It's a networking and educational opportunity. The board, which is made up of the CEOs, meets monthly, as do the CNOs, risk and compliance, HR and others. It's a group where the department directors can meet with and collaborate with their peers at other hospitals."
"In regard to the legislative session, the network is part of discussion with the hospital association," he continued. "The association has lobbyists. They are the big advocate at the legislative session. The rural hospitals work with their local representatives."
Fox noted that the priorities for larger hospitals are not the same as those of rural hospitals, "so it's nice you have this network."
Whitaker agreed, but said the hospital association president understands the issues of rural hospitals and he noted that about half the board of the NMHA is represented by some rural hospitals, but "we at the network let the hospital association know about the things that are important to us."
"At the Prospectors' forum, I presented a request for $1.6 million in capital outlay from this upcoming legislative session," Whitaker said. "It includes $1 million for replacement of the CT scanner and $600,000 for patient beds and an ultrasound machine. I got a call from DFA, so they know about it and I think things are progressing."
He did a presentation on telemetry, where he presented for the federal economic recovery grant for mining areas in the state. "We applied and received $900,000 in funding. They will go toward replacing the telemetry system. We have to wait for the grant agreement and requirements."
Whitaker said he also met with Sen. Ben Ray Lujan's Las Cruces representative Melanie Goodman, and she let me know that they are still working on the funding for a new MRI. "As soon as it clears through, she will let us know."
On another federal project that "we used part of the funds to replace the roof, the rest will go toward the OR HVAC project. We have sent that on to the USDA. She sent a long list of requirements that we and Trane must comply with. We don't want any missteps."
"Our labor and delivery start date is Jan. 15," Whitaker said. "We'll see some activity before that. It will be at least six months. We do have to have inspections from the state."
Manis said: "This is one of the projects which we can say: 'We've never been closer.' It's been going on ever since we've been here."
Whitaker also pointed out that the courtyard was closed to public access because of roots uprooting the concrete. He said after winter they would be redoing the concrete and "maybe taking out some of the forestry that's causing the problems and make it nice."
He talked about recruiting and retention, and how happy he was to see the approval for Tiffany Maxey and for Dr. Jobe, general surgeon who is at Fort Bliss with the Army. She will cover a weekend a month. "It's good for us and good for her, and after about a year and a half she may join us."
On the people front, "we have extended an offer and gotten an acceptance for a CFO from William Ermann. He starts on Jan. 22. It will be good to have a permanent CFO in place and someone who's going to move here, with his wife and one daughter still at home."
Manis said there would be overlap with Binkley.
Whitaker said the employment engagement survey was completed. "I want to highlight and celebrate the positives. The HR department has been busy with several surveys, so we'll have the highlights at the January meeting. And also at that meeting some highlights of the compensation survey that was recently finished. It takes a while to get all our data together with it. and we will evaluate the markets study to make sure we can recruit and retain competent staff."
"A project was approved that we got funding for that we will share with Presbyterian Health system to have pediatric ultrasound for our area," he said. "There will be training and equipment through the Presbyterian Health System for that."
Fox said that he believed UNM was also part of it, so that infants that need the cardiac ultrasounds can have it done and interpreted at Gila Regional instead of being sent directly to Albuquerque, sort of like a videoconference.
He also commended Whitaker for all his outreach, and asked what role the board might play to assist him in the legislative matters.
"Advocating with our state legislators is important to make sure they help the important bills go through," Whitaker said. "If you want to make a trip to Santa Fe and knock doors that will help, too."
He said he would be calling in for the January meeting, because he will be in Santa Fe for one of his two planned trips to the session.
Vega suggested some talking points for the board members to talk to local legislators. Whitaker said he would write them up.
Manis gave his report. "Carolyn St. Charles, Health Tech chief clinical officer, was here a couple of weeks ago. She spent some time with several staff members, such as Ron and his team. She makes sure they have the resources they need. She is working with Ramona (Wilson) and the quality team to schedule a mock joint commission survey."
Green said: "She's been great to have her support and knowledge."
Wilson said it also supports other directors of rural hospitals. "She's very experienced in the joint commission survey. She does a very in-depth survey so we can learn from it and be prepared."
Manis said they would be launching "a new budgeting tool here in late February or early March that will help with the financials that you see. We call it data acuity rather than the homegrown spreadsheet that you've been working with. We've contracted with a company to pull all our hospitals, so they don't have to rekey data that's already in there. Plus if you have one broken formula it can mess everything up. And we won't be worried about a broken formula somewhere that doesn't tie departments together so the numbers don't add up the way they should."
He also said HealthTech has been working behind the scenes on a business intelligence tool. "We've been collecting information from Gila Regional for a while with data feeds that lead into an electronic data warehouse that resides in the cloud. It's been pretty easy here and with another one of our hospitals because they are both on MediTech and that's our platform to collect the data. We're going to pull in our other hospitals. It would be easier if they were all on the same platform, but they aren't. It's quite complex. In the next few months, we'll be doing a demo here for you. This is not an extra cost to the hospital, but it will be a powerful tool for the future."
The HealthTech conference is coming up May 5. "We would recommend you all attend if you can.It's usually well attended by other boards from other hospitals, and then applying here what you learn there. There will be some AI on the agenda. We should have a schedule for you next month or the month after. We're very pleased with the appointment of (CFO) William Ermann. Patrick (Banks) will be here in my absence next month."
The members went into executive session.
When they came out of the closed session, they approved the Medical Executive Committee recommendations for provider credentialing; the credentialing and privileging by proxy policy draft; and the Rad Partners Schedule 1.
To read the preceding articles, please visit: https://www.grantcountybeat.com/news/news-articles/82205-grmc-held-board-of-trustees-meeting-122023-part-1 ; and https://www.grantcountybeat.com/news/news-articles/82231-grmc-held-board-of-trustees-meeting-122023-part-2 .