[Editor's Note: This is part 2 of a two-part series on the forum held to hear from Gila Regional staff members on April 26, 2018.]

By Mary Alice Murphy

Grant County Commission Chairman Billy Billings moderated the question and answer period from Gila Regional Medical Center staff members at a forum held Thursday morning at the Grant County Veterans Memorial Business and Conference Center.

"We appreciate the opportunity to hear from you," Billings said. "We also have a survey, if you prefer not to speak."

"It is vital for us to know what we don't know," Commissioner Brett Kasten said. "We totally understand the employer/employee relationship. Thank you for all you do at the hospital. This hospital is vital to our county."

Commissioner Gabriel Ramos said: "The heart and soul of the hospital is here. Any decision we make is for the public good, for the public best. We are facing the challenges with an open mind."

Commissioner Edwards, who gave a presentation to open the forum, thanked the staff members for their service to Gila Regional. The presentation can be viewed at http://www.grantcountybeat.com/news/news-articles/43929-grant-county-commission-holds-forum-to-hear-from-grmc-staff-members-042618

"We acknowledge this process has been stressful," Edwards continued. "Our intention is to address the long history of GRMC. We assure you that we want to go forward to keep the hospital the best it can be in the future.

"Our ultimate responsibility is to do the best for the community," she continued. "It is our responsibility to look at the changes and ensure the decision is the best for the community. Gila Regional has the ability to provide the best services. In our analyses of hospitals across the country, we see how challenging health care is and what the changes are over the past 10 years, especially the past five years. We are still doing our due diligence. No decision has been made. Part of our due diligence is hearing from you, from your input. Our responsibility is to ensure everyone has access to quality health care."

She explained that, as part of the process, "a lot of our meetings, because of competitive issues and market concerns, have been done in closed sessions at the request of the suitors."

Edwards invited anyone to contact any of the commissioners by email, phone or text with questions and input.

Billings acknowledged the GRMC Board of Trustees and their hard work. "And the administration for what it is doing to help Gila Regional. I'm not looking at this process from an operational standpoint, because my family and I have received excellent care here. As county commissioners it is our responsibility to make sure Gila Regional is viable."

He said access to capital is a big need, because of the age of the hospital. "For the revenue cycle, we have to be able to collect. We appreciate the top 100 rural hospitals award, the 4-star quality and the Leapfrog A rating. We want them to continue."

A woman, named Mary, said she has been a nurse for 45 years and served at 12 facilities. "The only one I returned to was Gila Regional Medical Center. I've served here 23 years. This process has been very demoralizing for all of us. We believe our new administrative team is the best ever. Any organization that doesn't have quality cannot be sustained. It is important we be sustained. Lifepoint has failed. It thinks it can buy its way into quality. Its primary value is money, not quality."

Octavia Djanquay Ve, who said she has recently been named Match Director, came from a for-profit hospital. "I have also been in non-profit hospitals. We have to be fiscally responsible. My responsibility was I wanted to be where people mattered and in a community where they matter. I am evidence-based, trained at Johns Hopkins. The recruiters made me want to come. They told me I should be going for vice president, but when the financial people came in at the same time as I did and created a plan, I knew we need a chance to bring it back. This is a group with a history of success."

An RN named Jim said he has worked at 23 different hospitals. "This is a very good hospital. Health care right now is a huge disorganized mess. Large organizations have big teams of lawyers supported by their financials. We don't have those teams to milk the system. The commissioners are trying to look out for the community and the caregivers. We can't go backward. The worst decision was the Cancer Center. Once you make a deal with someone else, you lose community control. Right now, we have someone to complain to. In my personal experience, it's not always good to be big, because the patient gets lost. We have compassion left. We may go down in bankruptcy and this is a hard spot for the new team. The major hindrance is not enough control over the administration. The Board of Trustees may not understand health care. The problems have not been the nurses or the caregivers. The cause of the problems has been previous lackadaisical administrators. We were in bad financial shape and the administration didn't even know it. There is a lack of oversight. The administration we have now understands systems. We got complacent about finances, so they got into total disarray. It's wasn't nursing's fault. It does make sense to partner with someone larger, but the trade-off is a loss of local control."

A woman, who said she is being laid off from the business office, said 50 percent of claims are denied by Medicare. "We are being laid off, because a group has been brought in. I have proof we brought in $60 million, which doesn't include Medicaid. It does include denials. When we don't get PFS (Physician fee schedules?) authorization, it's not our fault. It's not controlled by us. If the department doesn't charge, it doesn't get billed. If in the coding, the person doesn't put the modifier on, we don't get paid. It goes to IT. We have tweaked and pushed bills out the door. The revenue cycle starts the day you walk in the door, and we're the tail end. The system doesn't work. If a doctor doesn't give a right diagnosis, we don't have the coding. There is also human error. We've been collecting at 30 percent for the past six years. That's the usual percentage for health care. I don't see where we have lost the kind of money you are alleging (at a loss of $22 million). Why are you changing the logo? That's money. We're told we're bleeding $3 million a year. I don't think you have the right figures."

She said she wasn't unhappy at getting laid off because she will get more money on unemployment and Medicaid. "But we have many years of knowledge going out the door. We're happy to go on a six-month vacation. I'm sad, because it's not our fault. This year we've brought in 29 percent of the bills. Why wasn't the money, the co-pays, collected at the front of the process? I asked the CFO what will be the percentage if the hospital becomes critical access. I was told 30 percent. We're already bringing in 30 percent."

A man said the charts didn't give him enough time to read them. "I request they be made available to us. I saw positives and negatives. Have we done predictions if we remain as is or if we sell? What will it look like?"

Edwards said the commissioners are doing their due diligence and the presentation would be posted on GRMCforward.org next week (this week).

She also addressed the $22 million loss over six years and said the numbers came from audited financial statements.

"We were elected to be commissioners," Billings said. "That was when the hospital came on my radar. It was good to hear the CFO tell us how broken the system was. It was refreshing, because if you can't identify the problem you can't fix it."

A woman asked if there would be increased oversight over the administration. "There hasn't been accountability and transparency," she alleged. "Will there be transparency, so it's not who you know rather than what you know?"

Billings said the Board of Trustees wants to see the board and the commissioners working together. "That has been lacking. I look forward to working with the trustees, too."

Kasten gave a brief history of the hospital. "The Hospital Funding Act was how the hospital was set up, in the 1930s, I think. Grant County bought the land and sold bonds for the hospital. Since then, and under the act, it has been run by the Board of Trustees. The commissioners' only responsibility was the funding with bonds. The commission cedes the responsibility for running the hospital to the Trustees. Over time, it was running well on government money, about $10 million a year in sole community provider funding. It busted through zero to losing money in about six months when the sole community provider funding ended. We felt the management was not doing a good job, but we don't tell the Board of Trustees who to hire. Things went up temporarily, then the hospital was losing money again. And then it lost the Cancer Center at about the same time. We don't know how it happened, but it was in March or April last year. I said I want to study the hospital, so we hired Juniper Advisory Services. We aren't health care experts. It took three months to get Juniper on board. We created a task force and it blew up, so we took it over ourselves. By then the hospital was losing money again, but it has turned around. Some people think it may be sustainable, but is it good enough to be sustainable and have the services the community needs? Don’t you caregivers deserve a thriving hospital? I'm not an activist. I'm just doing my job."

Commissioner Harry Browne said: "I am a long-time activist. The question in front of us is future-looking. We know the history, we have a structure. Can the commission name Board of Trustee members to oversee the hospital? We are seeing accountability, but how do we ensure accountability? Maybe the Trustees should hire an internal consultant. I believe, in the past, the trustees have not gotten full information from the administration. We want this hospital to last as long as for our grandkids."

Margie Gray said she has worked at other places, in addition to Gila Regional, out of her 18 years of service. "I would see dysfunction. They would bring in systems' organizers to figure it out. When I talked to the CEO, they are like the best CEO and CFO who know what they are doing. They are holding people accountable. I think we're heading places. When, several years ago, the hospital brought up the general obligation bond, it was handled badly. I don't think people know how important a community hospital is. We want the money to remain here. I work for hospice. When the hospital kicked hospice and home health out of the hospital, saying it could be done privately, people didn't get the care they need. It's not the same as when it was in the hospital. The community doesn't realize it."

"I'm seeing good change," she continued. "People are working together. I think there's progress. I hate to see changes made now. Home health and hospice shouldn't have been let go from the hospital. We have hard-working people."

A man, named Sam, said he is a nurse and has been at Gila Regional for four years. "I want to give back to the community. It's a fairy tale working at a local hospital. I am blessed to be here. I don't want to spread negativity. I’m now more confused. Financial says there's a breakdown. Caregivers have had no raises in years. Most people, who are here, want to be here. How many times do the administration and caregivers sit down in a room and hash it out? Is the information correct? Are we making the right judgments? We're in a little ship on a high ocean. I would like to get us in a room to see where we're at. It's frustrating not to see money. We're here because we want to be here to give back to the community."

Another man said he is director of case management. "Way back when, Grant County took a chance on me. I came to work here for the summer while I was in college. At the end of summer, I was ready to quit and not go back to college, but I did. I was an orderly at Hillcrest Hospital. When I graduated the University of Arizona, I got six classmates to join me here. As a nurse anesthetist, Aloha Corp recruited me. My heart was still here, and I took care of my parents and grandparents. It was a sheer delight here. I am passionate about what my department does. We intersect the clinical and financial sides. We make sure the patient gets care when it needs to after the patient leaves the hospital. We offer rides to the doctor and make sure they get their medications. I ask you to take a risk on us. We get approached by headhunters all the time, but we wouldn't get the satisfaction of serving our community. One more request. I know you're doing due diligence. You've heard the strategic plan. It's hard for us to keep our passion going when we are uncertain about our future. Let us keep on doing what we want to do."

A man said he didn't envy the commissioners. "If you don't make a decision soon, will there be an end game with no suitors? If you do take another road to take a suitor up on their proposal, there is no going back. Here we have a voice, and we're a strong team. We hit an iceberg. We were listing, but we weren't bailing. JoBeth (Vance, interim Chief Financial Officer) came on. She jumped in the water and sealed the boat. Taffy Arias (Chief Executive Officer) came on. We're in agreement that we have an excellent administration. What would fit the commissioners? If the hospital gets to 'this' level? We can thrive. We see consistent activity. What would it look like to you?"

Billings said the great presentation from the CFO presented the numbers to the commissioners. "He said he would make Gila Regional thrive and he stood by his numbers. I share the concern about where we will be in three years or six years. I realize there is no accountability under the Hospital Funding Act. When I say administration, I'm talking about past administrations. We know Meditech and the Cancer Center were drains on revenue that Taffy walked into. This isn't about money or the rumor that we will sell the hospital. There are caregivers here who took care of my grandmother a few years ago and my grandson a few weeks ago. I get care here. I am encouraged that there can be more working together with the Board of Trustees and the County Commission. Several comments I've heard make me optimistic. I think (CFO Richard) Stokes wants to be held accountable. If the plan works, eventually there will be money for salaries. I hear the issues of low morale, and some comments on the uncertainty. I hope we will get input in the survey."

The previous man said he does purchasing. "Stokes has brought wisdom and clarity to us. He enlightened us on benchmarks and savings. Stokes is vested in us."

Kasten said, in his opinion, "at least if we choose to remain independent, we will ask you to not hold it over our heads. In a year, if things are not better, we would have to start over. We're not done yet. That's why we're here now, tonight and last night. We are going to do it as fast as we can, but we're going to do it right. We're not going to be remiss. If you have information we need, then you are remiss."

A previous speaker asked if there were a possibility of a referendum of voters.

Kasten said the worst piece of legislation every written by New Mexico was the Hospital Funding Act, which gave very little direction to commissioners. "There is a lot of information about the Board of Trustees, but no accountability. The commissioners are accountable because we run for office. We're looking for insight from you."

A man declared: "If we remain independent, we can do well."

A woman said: "If we remain independent, the billers will not be there, the ones with experience. If not for our knowledge, the consultants will have to take on the knowledge."

Ramos said he has lived in the community his whole life. "I thank you, everybody, for being so pleasant to me and my family. I'm here with my family. I'm not going anywhere. This Commission is spending lots of hours getting information. Listening to you creates mixed emotions. I've gone through three hospital administrators. They asked you to get an attorney to ask for information. What we've done now has opened a lot of eyes. I thank the Trustees. They have a difficult job, and we have a difficult decision to make. We want to make the best decision for the community."

A man asked how the community would know if the administration stays. "I don't blame the commissioners. They have had wool pulled over their eyes—three times. There has been a lot of turnover. Recruiters are looking at us. It matters to us how invested you, the administration, is in the community. I don't plan to leave. Are we guaranteed to have the dream team?"

A woman, who said she is new to the facility and serving in Human Resources, said: "I'm from the community. I started at Fort Bayard Medical Center for 13 years. I went to Deming for 11 years and was recruited back here. I was scared, but I've never been happier. I feel energy in the facility, energy I haven't felt in many years. It's who running the facility that builds morale."

Another woman asked: "If the current system is collecting 30 percent, why change to another that collects 30 percent?"

Billings said that was a management question.

Gray asked what insight the commissioners were gaining.

"With the doctors, we went into executive session," Kasten said. "It was very productive, with give and take, good ideas and bad ideas. I feel good about the process."

Browne said he appreciated the closed session, the meetings and the overall community comments. "I moved here because of the sense of place. We hear stories that ring true to me. I have a deep suspicion of corporate control, but I can't ignore the benefits it can bring. We have to sort through the concerns. Corporations are beholden to their stakeholders, so you lose local control. I have lots of concerns about saving the hospital."

Edwards said hearing the comments has been "powerful. I know it's hard to put yourself out there and speak. I appreciate it. We love this place. We recognize that money may not be the driver. This place wouldn't be this place without the hospital. We have to ensure the hospital is viable, vital and sustainable and that it has the capacity to provide the highest level of care when the firestorm of changes comes. All of us have a tendency not to face the future until we have crises. We have to take the proactive route forward in looking to the future. We have to demand accountability, transparency and participation in the process. We have the responsibility to the community to take care of the community."

 

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