[Editor's Note: This is the second and final of two articles on the GRMC Board of Trustees meeting on Jan. 24, 2024.]
By Mary Alice Murphy
After considering agenda items and hearing other reports and updates, Gila Regional Medical Center Board of Trustees at its regular meeting on Jan. 24, 2024, heard the Chief Financial Officer report from the outgoing Interim CFO Leonard Binkley, whose replacement, William Ermann, was also in attendance, having come on board two days prior. The transition was under way.
"As usual I will start with volumes trends," Binkley said. "We had good outpatient volumes in December, but discharges of inpatients was one under budget and seven below the prior year. Our OR (operating room) saw 242 surgeries, 10 below budget and 16 below the prior year. But, as I said, we had good outpatient volumes at 4,925, which was up 91 to budget and up 4 percent to the prior year. Our biggest growth was in physical therapy cases by 88 cases or 43 percent to prior year; Lab cases were up 11cases or 43 percent; occupational therapy up 69 cases about 34 percent; and the cancer center saw growth, too. Our cancer center saw 41 cases, which is 20 percent growth over the prior year. The emergency room saw 1,524, cases up 5 percent over the prior year. The daily rate for the ER was 49.2. Our usual rate is about 45 a day."
The December bottom line had a net surplus of $145,000, which was down by $800,000 budget. "Compared to the prior year, we are down about $5.5 million. If you look at raw numbers, we budgeted $1 million for that line. What that is is anticipated government grant money that we didn't realize due to government funding plays, quite frankly."
HealthTech financial representative Patrick Banks said it was a budget timing issue. The federal and state funding has been approved, but not yet disbursed.
Binkley explained: "So if you take that out and normalize operations, not taking into account this non-recurring funding, we had a budget of $7,000, so we're actually up $138,000, better than budget. Looking at the prior year, we had $5,578,000. That is CARES Act money, again non-recurring, unusual and large in nature. If you take that out, our actual prior year was $5,000, so if you look at prior year, we're better by $140,000. Looking at raw numbers, I wanted to put that in perspective. December is very much like November."
Year-to-date (fiscal year 2024, since July 1, 2023) in December, "looking at the net surplus line, Binkley said, "we're reporting a loss of $167,000, but on a budget of $39,000. "But normalizing numbers, we're only down $206,000 to budget. But looking at a prior year, we're almost $1.3 million better than budget. Looking at year-to-date operating revenues, they are up to budget by $3.5 million. On the total operating expense line, we're up to budget $4 million and to prior year's $3.9 million. Bottom line, we're doing well. The EBIDA (earnings before interest, depreciation and amortization) line is very strong."
Board Chair Fred Fox commented on the non-recurring CARES Act funding of $5.8 million. "That really helped the hospital back onto a solid footing. This year, only $28,000 of that came in. Even without those additional funds, we are doing well. Operating revenue and operating expenses are both up, and it shows the hospital is doing better on its own without the federal funding."
Binkley addressed the net AR (accounts receivable), which stands at 40 days, meaning agencies and entities are paying their bills. The hospital has 140 days of cash on hand, so "things are trending well. We had $33.1 million as a cash balance in December. Those are good metrics overall."
Board Member Seth Traeger agreed that the cash balance is holding steady, showing, as Dr. Fox said, the hospital is growing on its own.
Banks thanked Binkley for filling in until a permanent CFO could be hired.
The Chief of Staff Dr. Colicia Meyerowitz's report would be presented in executive session, after she got out of her scheduled appointments.
Chief Executive Officer Robert Whitaker next gave his report by video, as he was in Santa Fe to advocate for the hospital and take part in Grant County Day.
"One of the things I want to talk about in public session, because I think it's important the board and the public know about our financial audit, but the rest will be in executive session," Whitaker said. "Based on when the audit was submitted, the state has to review it and approve it before it is publicly released. Two people will be doing the review with board members in executive session. By February, we should be clear of those timelines and can present it in open session."
Concerning the residency program, conversations continue with the Primary Care Training Consortium, as well as with HMS. The discussions center around who is the best host for the program and what is the best path forward for the residency program, whether it remains at HMS as the sponsoring institution, or that the Primary Care Training Consortium, which already has a sponsoring institution program, takes it over. Whitaker said there is conversation about GRMC being the sponsoring organization. "However, we are not accredited to do that. And it would take about a year and a half to go through that process and the Primary Care Training Consortium wants to bring it back sooner than that. The hospital would get better reimbursement for residency than HMS. There are more discussions to be had. Based on timing, it looks like the program would not officially begin until July of 2025, and it's called a 1+2 program, with the resident spending the first year in Las Cruces and then two years in Silver City, and there would be two full-time residents. So we would see the full-time residents in Silver City in July of 2026. That's the timeline."
Whitaker noted a great turnout at the Jan. 10, 2024 Townhall, with about 75 people attending and "we had to make room for more than anticipated. We had great feedback, so those will continue to happen. I need to visit more communities, but these are not one-and-done activities. They will continue as part of our efforts on who we are in community outreach."
He said he would discuss two items in executive session, as well as an update on the the compensation survey and feedback from the employee engagement survey.
On legislative items, Whitaker noted that the Health Care Delivery and Access Act would be coming out that week. "It replaces the previous program, the safety net care pool, which ended about five, six years ago. It was replaced with the HAP (hospital access program) program, which is also an assessment program that provides state funds to New Mexico hospitals through the Medicaid CMOs (care management operations). That program has run its course. CMS is putting more quality metrics in, so this new program was developed with our Health and Human Services Department and the governor's office. In our meeting today with Governor Michelle, she spoke about it and what it is, as well as giving her support. One thing that is important to remember, there are no general revenue taxpayer dollars going to this program. It's an assessment on the hospitals that goes into the fund and it allows the federal government to match those funds and those funds come back to us. Forty-three other states already have this program, so we're just sort of catching up. Another bill that is related to us, because we own EMS, is a bill related to ambulance mileage. Currently, reimbursement does not pay the first 15 miles of an EMS run. When we have in-town runs, we don't get reimbursed on any of the mileage, so there's a bill to correct that."
He said he talked to one of the deputy secretaries at HHS, and he said a lot of bills focus on Albuquerque, not realizing the impact on rural areas, so there's a lot of support on that, too.
Whitaker noted a lot of legislation is focused around workforce education, workforce training, care provider training, but there's a lot of bills to support workforce development and health care is part of that.
"I just want to say how happy I am to have William on board as CFO,"Whitaker said.
Fox said a headline a week or so ago said that the governor was asking for funding for the Health Care Delivery Fund. 'Was there any talk on that?"
Whitaker said he hadn't heard anything on that. "There have been side discussions, but I haven't seen it come up. I have a few ideas that would impact us and get us started on some things."
Banks gave the HealthTech report. "I have a couple of items; one is for the Congrats on the Patient Experience. I've been part of working on that for the past couple of years, so I know how hard the team works at that. It's waiting to see the score come in (92 percent) and to see it validate all the work the team does is gratifying. That score is so indicative of the good work going on in the hospital. And it impacts everything we do. We should be proud of that and keep it up. And hearing about the labor and delivery department project having broken ground really warms my heart. Finally, this month's results showed why I tend to focus on operating margins. Of course, the bottom line to budget is important, and it needs to be monitored. We need to bring in the grants we've targeted, but healthy operating margins provide a platform for doing the kind of careful growth we need to do for the community."
He noted that on the HealthTech website (https://www.health-tech.us/), they had published their 2024 webinar program. "I will be doing a financial training for managers and another for boards."
HT regional Vice President Scott Manis was online. He said Cheri Benander, clinical and compliance consultant, would do a webinar on leadership. Faith Jones, care coordination and lean consulting, will perhaps continue some training on social determinants of health. "I might do one in June, I'll be working with another of our hospitals talking about nursing career ladders and how they successfully put together their career ladder and how they are rolling it out in other departments. It's a very solid model."
Banks said the webinars will be delivered live, but they will also be recorded and made available. "Not every webinar is for everybody, but hopefully there are some that will help leaders of the hospital. We're also holding our Community Health Leadership Conference in Tennessee in early May," he said to the board members. "From what I hear, spaces are filling up in the hotel, so if you haven't booked and you're interested, make your reservation for the conference."
"The last note from us is that we are rolling out a budgeting software program," Banks said. "Even though on only his third day on the job here, William joined us today on an introductory call. It will help Gila Regional through the budgeting process to provide systemic approaches to budgeting direction for year after year. It also provides for manages to be involved more in what matters for departments, instead of just populating data. We also continue to work on our data warehouse, and are grateful for Leonard and the IT here. It means they will be among the first to get the insights from the program."
The board members went into executive session.
Following the closed session, the members approved the three items, B,E, and G, which had been tabled earlier in the meeting. [Editor's Note: Please see part 1 at https://www.grantcountybeat.com/news/news-articles/82575-grmc-board-of-trustees-met-012424-part-1 for details.]
Other items approved included:
Medical Staff Executive Committee recommended provider credentialing;
Radiology Partners Delegated credential and privileging agreement - Schedule 1;
Medical Staff Service Physician OPPE (ongoing professional practice evaluation) forms;
Medical Staff Services Focused Professional Practice evaluation;
Medical Staff Services low volume/no volume practitioner OPPE hospital competency assessment evaluation form;
Physician OPPE evaluation form;
Nurse Practitioner Delineation of Privileges; and
Physician Assistant - Certified (PA-C) delineations of privileges.
To read the previous article, please visit: https://www.grantcountybeat.com/news/news-articles/82575-grmc-board-of-trustees-met-012424-part-1