This letter is an attempt to clear up some of the misconceptions surrounding the hospital issue. By state statute, the Board of Trustees of Gila Regional Medical Center (GRMC) is not accountable to any entity, including the Grant County Board of Commissioners (GCBOC). The lack of a path for accountability and transparency is worsened by the New Mexico Open Meetings Act, which does not require hospitals to conduct their business in public. Under New Mexico’s Hospital Funding Act, the Commission appoints trustees, but the Act specifies that, “after their appointment, none of the members of the hospital governing board shall be removed except for cause specified in a written charge and after full public hearing on the charge.” In effect, the Commission has no recourse to address mismanagement – even when it threatens to bankrupt the hospital – other than to consider changing the ownership structure of the hospital.
The Commission instigated a partnership evaluation process primarily due to four major issues, 1) ever shrinking days of cash on hand, 2) the mill levy not passing, 3) how the cancer center issue was handled and 4) the amount of money it cost and is still costing to properly implement Meditech (electronic medical record system).
There are three proposals the Commission is currently considering for GRMC: Remaining a stand alone hospital, a member substitution partnership (which would require GRMC becoming a 501-C-3) with Cobre Valley Regional Medical Center in Globe, AZ and a lease and convey agreement with LifePoint, a publically held company based in Tennessee. Since the majority of the community conversation is centered on LifePoint, those concerns are what I will address here.
Non-profit vs. for profit. There is no inherent advantage to one or the other of these forms of ownership when it comes to hospitals in the United States. Both are capable of siphoning money out of a community, and both are capable of running high-performing operations. Any hospital, regardless of tax status, must have more revenue than expenses in order to care for patients, maintain infrastructure, invest in new equipment, and recruit and train its employees. While non-profits must prove that they are fulfilling their charitable missions, there is nothing in IRS regulations that regulates organizational culture, and there are hundreds of examples of charities, big and small, that abuse the trust and intent of their donors. For profit hospitals generally follow the same charity care policies while also paying local, state and federal taxes.
Fear the hospital will be stripped and sold. LifePoint has 71 hospitals, many of them in rural communities with demographics very similar to Grant County. They were established in 1993 and continue to be committed to providing high-quality care to their communities efficiently. LifePoint is and has always been focused on providing excellent healthcare in rural communities.
Fear over the loss of local control. If an agreement were to be reached with LifePoint, there would still be a local board that would have a significant voice in how healthcare was delivered in Grant County.
LifePoint is being considered because they have the expertise and resources necessary to support GRMC and its patients. LifePoint is known for reinvesting profits in the company’s hospital operations, meeting and exceeding charitable and capital investment commitments. LifePoint has invested tens and hundreds of millions of dollars in capital improvements for partner hospitals and their communities. The company has never been sued by a hospital partner for breach of contract—meaning they keep their promises. LifePoint is dedicated to high quality care and was awarded the John M. Eisenberg Innovation Award for Patient Safety in 2017.
A typical lease and convey contract with LifePoint could include things such as retaining employees and doctors for a designated period of time, maintaining current levels of charity care, and covenants designed to ensure the relationship with LifePoint is positive and productive for both parties for the foreseeable future. The Commission has engaged a leading healthcare attorney to be sure the county and the community’s best interests would be represented in a contractual agreement.
From the beginning, the Commission’s process of evaluating our hospital’s situation has been characterized by thoughtfulness, probing questions, significant research, contemplation, a clear understanding of how critically important our hospital is to this community and a sincere desire to do what’s right for the future of healthcare in Grant County.
Unfortunately, the process has often been characterized by mistrust, finger pointing, willful misinformation, opinions freely given with very little basis in fact, fear of reprisal for truth telling, lack of transparency and personal agendas. All of which I believe has led us to our current dilemma—the inability to talk honestly about the state of healthcare today, locally and nationally, and how it threatens the future of healthcare in Grant County.
Our hospital is a web of complex, small systems (revenue cycle, policies and procedures, EMR/Meditech, clinics, frontline care providers, accreditation, regulatory, and contractual just to name a few) that must fit together and function efficiently as one system. To succeed, GRMC’s systems must operate at the highest level possible, and also fit into the larger, extremely complex system of healthcare today. Focus has been on the financial condition of the hospital but the financial condition is actually a symptom of how broken many, if not all, of the other systems in the hospital are.
The questions before us are: do we have the time, money and expertise to fix all of these small, broken systems while trying to keep our heads above the rising tide of razor thin margins, rapidly escalating capital requirements, massive regulatory changes and a fundamentally dysfunctional national healthcare system? Do we wait and risk bankruptcy—a catastrophic infrastructure failure? How much risk will local taxpayers have to shoulder if we continue alone? Do we acknowledge that the current structure may not be conducive to a thriving hospital in the future? Will aligning with a partner mitigate these risks?
My hope is that we set aside our past actions, personal agendas, and our fears and look thoughtfully, with open minds and open hearts, at the options in front of us and do what is truly best for the future of healthcare in Grant County.
Alicia Edwards, Vice Chair, District 3