[Editor's Note: This forum took place on Nov. 28, 2017. However, the holidays and other issues prevented this author from writing the forum up for the Beat. This is part 3 and covers the healthcare presentation.]
By Mary Alice Murphy
The Grant County Prospectors held their annual Legislative Communications Forum on Nov. 28, 2017 at Western New Mexico University's Light Hall.
The purpose of the annual Prospectors Communications Forum is for the area legislators to hear from community entities on their needs, not only for capital outlay and appropriations, but on policy.
The area legislators, who listen and ask questions, include District 28 Sen. Howie Morales, District 38 Rep. Rebecca Dow and District 39 Rep. Rodolpho "Rudy" Martinez.
Gila Regional Medical Center representatives, Chief Executive Officer Taffy Arias, Interim Chief Financial Officer JoBeth Vance and PACS (picture archiving and communications system) Director Robert Holguin, presented.
Arias said the hospital has three projects for which it is requesting capital outlay. She asked Holguin to present the first one.
"We send all our images, such as MRIs, CAT scans, nuclear medicine, X-rays into our picture archiving and communications system," Holguin said. "We can replicate images and share them with other physicians, such as radiologists to read the images for continuing care of our patients.
"Too often, we would lose images, when patients took them home, or something else," Holguin said. "With the advances of technology, the digital systems made it easier to save things. That was the first step. I will tell you where we want to go with our system Now, with advances, technology has grown so fast, we can put in images from other parts of the hospital, such as endoscopy, knee arthroscopy. With a CAT scan added, we can get a truer picture."
He said the system was purchased eight years ago, and the system is no longer serviced by the manufacturer. As well, it is starting to have "issues. We are at the end of life of this system. We lost a drive and it took out the system for a month."
With newer technology, the hospital will be able to transmit the images to other locations where patients can get higher class care.
"It's an outreach to the community to realize they have a great healthcare system here and we are working constantly to keep them here by staying on the cutting edge of technology and installing the things that help us continue to grow and support the community," Holguin concluded.
Dow asked for an update on the Cancer Center.
"We have started seeing patients again," Arias said. "We've been working with UNM, who is bringing in a provider every Friday. Because they are new patients to this oncologist, he is seeing seven to nine patients every week. We have a combination of patients who were already part of the Cancer Center and new ones. We are also working with private physicians to make sure the patients' ports are cleared and other things that don't need to see the oncologist. In January, UNM will put an additional provider on every week to get us caught up, until a full-time oncologist is hired to live here and be part of the community."
She said with 90 days of no services in the Cancer Center, the hospital had a financial loss. However, because of Vance and her team's efforts in accounting and billing, "we are cleaning up processes in our accounting systems. When the Cancer Center is back in full force at least by February with the radiation portion, we expect to be strong financially."
Dow said she had heard that the hospital had to do emergency contracts for the transition. "Have other contracts been done that way?"
Arias replied that the hospital did not do the transition contract on an emergency basis, "and I know of nothing that has been done in that way."
"For our next request, we are asking for anesthesia machines," Arias said. "They are out of life. We are asking for $116,000 for two, with four more needing replaced over the next two years. They are essential."
Vance said: "Also, we need the Cancer Center software. Mosaic takes in the electronic medical records, and the ray station is where the X-rays go to the server. We need another server. That is $832,000 for the Cancer Center. We are in the process of purchasing it to install early next year. It has to be done."
Southwest New Mexico Council of Governments Executive Director Priscilla Lucero said if the hospital purchases the item and then comes back with a capital outlay request, "it cannot be reimbursed, unless there is an emergency clause in the capital outlay bill. And for capital outlay, we don't usually see it until August or September."
Morales asked if there were leasing opportunities for the PACS software.
"We won't own it," Holguin said. "We will lease it from a managed services company. When it comes to updating, the company will do the updating process. The only things we have to provide are the servers and storage. We are making changes to how we are storing the information. We will have multiple backups. The request is for the hardware."
Vance noted going forward the hospital would have an annual cost for maintenance.
Morales commended them for getting on the nursing compact issue so quickly. "We want to assure the nurses that it has to be passed in the Legislature during the first two days. I ask Peggy (White, chief nursing officer) to be available for questions during that time. It is our priority to pass it immediately. This will be the first bill passed and signed."
Arias thanked him and said she believes it is 17 nurses who are impacted. "We have offered to pay for them to get New Mexico licenses, but many people don't want to do that, and those who do are dealing with delays."
Martinez said Gila Regional is important to the community. "Was the linear accelerator software change as result of the change in provider?"
Arias explained that the previous provider had its own software and controlled all the patient medical information. "We need our own system, so we can share with patients and physicians. With Mosaic, Gila Regional would own the information even if we changed providers."
Martinez asked for an explanation on what an anesthesia machine is.
Arias replied: "These are the machines that provide the oxygen and the medications that the anesthesiologist needs to put the patient to sleep for surgery and to wake them up. They are operated by the anesthesiologist."
Martinez also asked about veterans' services and the contract with the V.A.
Vance said the hospital is switching from United to Tri-West, and is also talking to two other branches of the V.A., so veterans continue to have coverage and "we can provide services."
Martinez said he appreciated that because it is sad to make a 94-year-old World War II veteran have to get on a van at 1 a.m. to go to Albuquerque and then get back home at midnight.
He asked about the proposed expansion of the labor and delivery rooms, as well as the recovery rooms.
"We have several phases," Arias said. "We want to convert many of the rooms in one pod to private rooms. In high traffic times, we could convert them back. We want to give each individual as much privacy as possible, as well as less potential for spreading infections. It has less cost. Also, we want a section for orthopedic patients that is more conducive to therapy. The renovation of Pod 1 is our labor and delivery department update. The next phase will increase the number of recovery rooms.
"We want to expand, we want to grow, but it takes time and winning over our physicians to see a community that wants us to grow," Arias said. "The expansions are on hold until we have a better bottom line."
Martinez asked about the new surgeon and how far in advance providers are credentialed.
"The credentialing is for the hospital," Arias said. "No one can work in the hospital before credentialing, but he can work in the clinic. Also, the credentialing allows for reimbursement from third-party payers. In the clinic, a physician can be credentialed for Medicare and Medicaid, but not third-party payers. When a provider gives us the paperwork for credentialing, it goes through three levels of approval, including to the Medical Executive Committee, and after that to the board."
Martinez asked if EMS is fully staffed for transports out of town and for local calls.
Arias said she has been working with Alex Brown, Silver City town manager, on the EMS issues. "Sometimes, we didn't have trucks available and the city got there first. We would meet them there. We are supposed to answer 911 calls, but we discovered that sometimes a truck has to transport out of town, but that is not our main business. We learned that in the ER, someone might have cardiac issues and would need to be transported. They can go out by helicopter or ground transport. It could be a nine-hour turn-around time. We hired up on drivers and staffing, so we could accommodate both 911 and transports."
Martinez said he is concerned about a shortage of nurses.
Arias confirmed that some had gone to Deming, Las Cruces, El Paso or Tucson to get $6 an hour more. "We are county-owned and not a private facility. We are self-sufficient. We want to create an environment so pleasant that they will have pride in where they work. I think we are recovering, with the changes in administration. They want job security. We have to reassure them that we will be here for them."
Martinez said he thinks there is fear in the staff because of people leaving and rumors the hospital may be put up for sale.
"I don't know that for a fact," Arias said. "The commissioners have put out an RFP to do an analysis and to make recommendations and multiple options. The decision will be made between our community and the commissioners."
Dow asked what Mosaic is and what the annual fees would be.
"It's a chemo and radiology oncology software," Vance said. "Both together are $556,000 and the ray station is $229,000. The annual fees are about $30,000."
Dow also asked what percentage of payments to the hospital are with state and federal dollars. Vance said Medicare and Medicaid pay for about 60 percent to 70 percent of Gila Regional's patients at a low rate, and the hospital also has some commercial insurance payers.
The next article will begin with non-profit organizations.