By Mary Alice Murphy
The Gila Regional Medical Center Board of Trustees held its monthly meeting on Dec. 15, 2017 at noon in the hospital conference room.
Each month, someone brings a safety moment to the table. Chief Nursing Officer Peggy White said the hospital is looking at safety and security in the emergency room.
Chairman Jeremiah Garcia recognized that County Commission Chairman Brett Kasten was in attendance and would stay for the executive session to bring some information on a project.
Garcia asked that Kathleen Murch be recognized for her 25 years of service in discharge planning. She was unable to be present.
In public input, Chris DeBolt, county resident and former GRMC employee, said she had happy things to report.
"I bring positive remarks from a patient," DeBolt said. "She asked me to extend to Dr. (Victor) Nwachuku how kind and compassionate he was during her recent hospital stay for surgery. She also asked me to tell you how much kindness and compassion she received from the nursing staff."
DeBolt also talked about how great it is to see the administration making efforts to be out in the community. "We have representation on the Tu Casa advisory committee. I thank (Chief Executive Officer) Taffy (Arias) for coming and for agreeing to be part of the Stepping Up Program Steering Committee. And lastly, Shelly Carter, your new Cancer Center director, gave a great uplifting story to the University of New Mexico Advisory Committee. I just want to tell you how proud I am of you."
Simon Ortiz also gave public input. "I am a resident and I came to share as a taxpayer and as one who has served on this board. My deep concern is what has happened over the last year. My doctor asked for three lab tests. The staff told me Medicare wouldn't cover one of them. That was good that they told me, but they told me I would have to pay $109. I asked the doctor to send the lab order to Tri-Core, which told me I would be on the hook for $21. As a consumer, I'm pissed. As a taxpayer, I'm really pissed. Why is there such a huge disparity? The $109 tells me something is excessively bloated. My wife told the doctor she had discomfort on the right breast. She came to Gila Regional with the order, but they wouldn't do the test because she wasn't hurting. So we went to Sun View Imaging and they said they love people from Silver City. My wife had an MRI, which would have cost $4,000 at Gila Regional, but cost $550 at Sun View. The hospital is seeing revenue walk away. Why can't we capture some revenue to at least pay the technician? You are not bringing in revenue from people who are leaving Silver City when they should be staying here. You seem to be doing things that make it impossible to get services here. I call it excessive bloated overhead."
"Where's it going to end?" Ortiz asked. "Those are my concerns and I suspect they are yours, too. I'm not sure you as a hospital and community have time for studies. You have to jump outside the box on how to increase revenue and to find common pricing ground. Instead of seeing no revenue, find a way to keep people here."
In reports and updates, no one was present to represent the Gila Regional Medical Center Auxiliary and no one had any questions on the report.
Arias presented the CEO report.
"Dr. (Tariq) Ibrahim (the newly hired surgeon) is seeing patients in the clinic, talking calls and also visiting people in Deming. He has identified a physician who wants him to bring in patients for surgery from outside our community," Arias reported.
She said the hospital continues to look for a building to accommodate several physicians. "We need about 3,500 square feet. On the Cancer Center, we are still recruiting for a full-time oncologist."
"Items have been reported that are not quite accurate," Arias said. "UNM does not manage the Cancer Center. We have a contract with UNM to provide the physicians. When we presented to the Prospectors asking for equipment, it was reported that if funding were not approved, it would be an emergency and that we might have to close without the equipment. We have the money. We will cover our bills."
She said all clinics are looking at increasing their volumes and revenue.
"For marketing, we will interview another candidate," Arias said. "We will also be interviewing another candidate for family medicine and for an occupational therapist in January."
She said Vance is working with the clinic managers on third-party payments. "We are also looking at dietary to see if we need to alter hours and foods."
"I want to compliment all those who participated in the quality drill in the ER to enhance our response on a potential active shooter scenario," Arias said. "I want to express my appreciation for law enforcement from the city and county."
She addressed what had been a concern that the hospital would lose its 4-Star quality status. "We have been informed that we will maintain our 4-Star Status."
"We are also working to improve the metrics in timeliness and security measures in the ER," Arias said.
Trustee Tony Trujillo said he attended the Prospectors session. "The hospital gave an exceptional presentation. They (Arias and Interim Chief Financial Officer JoBeth Vance) had to answer a lot of questions. Arias did an excellent job."
Trustee Jeannie Miller asked why nursing is leading the movement in quality metrics. "Nursing does a lot of stuff. Is it normal for them to look at quality metrics?"
"In any organization in health care, especially direct patient contact, everything revolves around nursing," Arias said. "They are the ones there, who provide timely and quality care. They need that leadership role, so they can tell other people what they need in order to deliver care."
Trustee Mike Morones said the hospital is still searching for a full-time oncologist, "because we want full-time coverage in the Cancer Center. UNM is going through its process of searching as well because of their role as provider of physicians, but we are not waiting on them. We are searching ourselves to get an oncologist as soon as possible to get the coverage."
"Although UNM has the contract for the physicians for the Cancer Center, care is solely on us," Arias said. "Our administration is making sure we do everything possible to find an oncologist to live here to provide the care for our patients."
For the CNO report, White said that all 15 nurses impacted by the nurse compact licensure have applied for a New Mexico license to practice nursing in the state. She said they have not heard back on their status. "The signing of the bill in January will relieve our angst."
Trujillo said Sen. Howie Morales, along with Sen. Gay Kernan, would be spearheading the bipartisan effort to get the bill through and signed within the first four days of the legislative session. "They are beginning to pre-file bills today (Dec. 15, 2017). We'll stay on top of it."
Miller noted that the grid shows a lot of completion dates coming up and asked which are critical.
"Many are JCAHO (Joint Commission on Accreditation of Healthcare Organizations, which is pronounced jayco) items," White said. "They are the priority before the end of the year. JCAHO, which is just called the Joint Commission nowadays, could walk in any day. We are being prepared for JCAHO. Patient safety and care are always our priority. We are working on quality measures and safety measures. Preferably all these will be completed when the Joint Commission arrives. If we are not complete when the Joint Commission arrives, we have lists of risks and plans, so we can show that we have identified them and are working on them. The accreditation is so we are in line with CMS (Centers for Medicare and Medicaid) regulations."
"You have mentioned that you are trying to create a culture where the hospital is always JCAHO ready," Morones said to White. "Do you feel comfortable once we are JCAHO ready that we can maintain it?"
White said: "It would be a fallacy to say I’m comfortable, but we're daily getting things done. We are working on our policies and procedures, which have been neglected. I feel confident once we get to the point of readiness, we can maintain it at all times."
Trustee Nwachuku said sometimes the accreditation team talks to board members to find out what they've done to be ready.
"The Joint Commission will find something," White said. "We don't want them to find anything egregious or, heaven forbid, a safety issue."
Garcia asked Interim Chief Financial Officer JoBeth Vance to introduce the controller, Alfredo Pacheco, in his new position.
"He was at the last meeting our interim controller. He is now our full-time controller," Vance said.
Garcia asked Pacheco to tell the trustees about himself and how he feels about the job.
Pacheco said he is originally from Alamogordo, where he spent half his childhood. "This job has lots of challenges, it's lots of work. It jumps to the deep end of the pool, but that's fine. I can swim. It's daily identifying processes and procedures to make us better. We want to equip the staff with the tools they need. We focus on a team approach." To a question about his family, he said: "We very much have plans to bring my family here." He noted that health care finances are never easy.
He said he also lived south of Tucson during his growing up days. "I am a graduate of New Mexico State University. I got into health care with home care and hospice. I had great opportunities for consulting work. I've had a lot of great mentors. I also worked in Alamogordo. Health care has been good to me, and I enjoy working in it."
Morones said he has heard in passing that it may be hard to discern the problems through the negativity that percolates to the top. "As Alfredo and JoBeth have pointed out, we at Gila Regional outperform a lot of our peers. We underperform some, too. But we have a solid base to start from, and we have the opportunity to make some money in the short term. Maybe we got fat and sassy when we were being subsidized. I feel comfortable with how the CEO and CFO have performed. It will get better in a relatively short period of time."
Vance gave her CFO report. Inpatient volumes remained about the same, surgeries were up and, "for some reason," ER visits were down. The Cancer Center saw 132 visits in November. The hospital had 28 births and the clinics are seeing more patients. "In November, we had patient revenue of $14.8 million gross, with a net $6.3 million as compared to last year's $4.8 million. Expenses are dropping. We still had a loss in November at negative $80,000. But that is compared to a negative $465,000 in October, and a negative $1.2 million the month before. We are seeing improvements. We have 50.4 days of cash, 47.5 days in accounts receivable as compared to 50.4 last year. Our daily expenses are down to $186,000, compared to $202,000 last year. Our average daily census is 15.9, with an average stay of 3.9 days."
"It is so encouraging to see the numbers going in the right direction," Arias said. "They are the result of cleaning up accounting processes. JoBeth, we thank you so much."
"You didn't blame me when we were losing money, so I can't take the credit for improving," Vance said. "It is truly a team effort. It touches every part of this hospital doing their part to fix these financials."
Miller said that Vance is wonderful and spends a lot of time answering all her questions. "Thank you."
Morones noted that the trustees had input about the prices of services versus other entities. "I had the understanding that we base our charges on our chargemaster (a comprehensive list of every service and procedure done in a hospital to make billing move more smoothly). It's probably not where it should be. Have we revisited it?"
"Yes, we have outsourced a review of our chargemaster," Vance said. "Hopefully, in four to five weeks, toward the middle of January, the consultant will tell us where we are too high or too low, so we can bring back charges to a reasonable number. We have talked in the past about bad debt. We are working on a process on how to negotiate at least a partial payment. We are already looking at that price."
Morones noted that with the prior CFO, the hospital was aggressively increasing prices for insurance purposes without consideration of the negative byproducts. "I'm glad to see it is moving forward."
Trujillo said that last month, he made the comment that the hospital was seeing the bottom of the barrel and could consider putting the chairs on the Titanic away. "Now with a negative $80,000, I think we can put the chairs away. We don't want to forget where we've been, but we've been working on this transition for almost a year, since the interim CEO, and then the hiring of a permanent CEO. It's been six to seven months since the full-time CEO. I'm very optimistic going into the new year. We have a team very committed to this hospital. I thank every one of you. It's a good Christmas present."
Trustee Joel Schram said contractually it seems the hospital has a better handle on costs. "I'm happy not to see the big swings up and down that we were having. Even though we're seeing $4.6 million down this fiscal year, our days in cash are down only 2.4 days. It is telling us that we are doing better collecting revenue and managing our cash better."
Garcia said, compared to the $5.1 million loss at this time last year, "we knew we were dealing with Meditech and a transition. We now have the ship turning in the right direction. We continue to challenge our CEO and team to continue moving in this direction. We have money in the bank and zero debt. I compliment everyone, include our board. We've been tough on the interim and new CEOs. We have a strong foundation that we may not have had in the past. Accountability may not have been there. We got the right team in place working on this. We challenged all of you and we're seeing the return. Thank you for being transparent on putting everything on the table. I am happy to see the direction you are moving. Thank you for your hard work."
The next report was from the Chief of Staff, Dr. Gregory Koury, who however, was working in the emergency room, according to Nwachuku. Kari Lane, the director under Koury, said it was a brief report and would be more comprehensive next month. "We have rules and regulations to approve.
Lane said the change included the addition of protocols for pre-operation lab tests.
"It was being done, but this now makes it formal," Nwachuku said. The members approved the change.
Under board reports, Garcia said the Executive Committee met and approved the agenda.
Schram said the Quality Improvement Committee consisted of him and Dr. Tsering Sherpa. "We spent a great deal of time on the dashboard drilling down to specific scores. Taffy has tasked everyone with making sure we have plans in place to address low scores."
Nwachuku presented the financial requests for renewals of agreements. Dr. Colicia Meyerowitz was approved to serve on the Ongoing Professional Physician Evaluation Committee and to serve as a physician consultant on the Bylaws Committee. Dr. William Neely was approved to serve on the OPPE Committee; Dr. Ronald Dalton to serve on the Credentials Committee; and Dr. Gregory Koury to serve as the Emergency Medical Services medical director.
Schram reported on the Plant and Facility Committee. "We noticed an uptick in security stand by, including for an 8-year-old child that required supervision. Clearly, we need pediatric psychiatric care. The new plant and facilities director Emory Coleman has identified things in the hospital that need attention, money and repairs."
Nwachuku asked if there is discussion on the security needs. Schram replied that yes, there is a lot of work to go.
Morones said he was very impressed with Coleman. "He already knows about this hospital. He brought up some issues that we need to work on, but he already has game plans for them. Every question we had, he had an articulate answer."
Garcia noted on the security issue, that "as our world changes, a lot of us had to be part of Homeland Security."
Kasten said: "In transportation, we're all over it."
Morones said security was a key part of the conversation. "We're part of a good piece of disaster and security planning."
"In utilities, we had to address disease," Garcia said.
"We have a lot of plans and are always putting contingency plan on disease," White said. "Remember our planning for an Ebola outbreak? Every flu season, we lose staff to the flu while getting more patients, so we need to have plans in place. We're required by the federal government and by the county to be part of drills. County Emergency Manager Gilbert Helton was part of our active shooter drill. We have monthly meetings."
Miller said she had a lot of questions for Helton on emergency readiness. "He will bring the answers back to the committee."
Trujillo said the Human Resources Committee met and went through the dashboard through November. "We saw the total number of caregivers leaving."
"We have lost a few nurses and housekeepers," White agreed.
Trujillo said the committee saw an increase in overtime hours and a big increase in contract labor.
Garcia said the increase was tied to having to get travelers.
White said some of the nurses were on family leave and some are leaving.
Trujillo said it was still a challenge.
Garcia said some part-time employees had to increase their hours.
Nwachuku asked if there were any talk about balancing overtime and travelers.
"House supervisors are always looking at that issue to make sure we give overtime to our own nurses," White said. "A traveler, per contract, has to work a certain number of hours and then be put on call. The supervisors all know that."
"We also had bad news for HR," Trujillo said. "The director, Barbara Barela, is looking at retiring. The good news is they have hired an assistant to be trained under Barbara."
Schram asked if the hospital were looking at reasons why the nurses are leaving.
"We do exit interviews," White said. "Several had babies and decided to stay home with their babies. We have retained them in a PRN, as needed, basis. We do exit interviews and HR does exit interviews."
Trujillo asked if fewer would leave if they were paid better. "Please bring us some proposals to look at."
Nwachuku said the Board Bylaws Committee would bring changes in the new year.
Miller said she would bring them up in January.
At the very end, Arias said she had two other corrections, she would send to reporters.
[Editor's Note: If the Beat receives corrections or clarifications, they are added to the pertinent article and usually have Corrected or Clarified added to the original title.]