By Mary Alice Murphy

At the beginning of the Grant County Board of Commissioners work session on Tuesday, Dec. 17, 2018, Gila Regional Medical Center Chief Executive Officer Taffy Arias introduced the new podiatrist, Dr. Gregory Iwaasa, who has opened a clinic in Silver City.

"We moved here with our five kids from North Dakota," Iwaasa said. "We are excited to be part of the community. Our kids are loving it. We are feeling support from the community. I treat feet from toenails to bunions to biomedical issues and sports medicine."

Arias said the hospital has had a ribbon cutting for the new clinic.

GRMC Board of Trustees Chairman Mike Morones wished everyone a Merry Christmas. "We won't have a full board meeting this month, as it falls between Christmas and New Year's Day. We are holding a special meeting tomorrow (Wednesday, Dec. 19) at 8 a.m. to approve contracts that must be completed before the end of the year. We got our audit approved, so that's one of the biggest items. We welcome the positive approval. It was an unmodified report, so now we can move forward and make decisions. We did have one repeated funding issue that we are addressing. Representing the trustees, I will tell staff to continue to report to the public."

Commissioner Harry Browne asked about the repeated funding issue.

"Two years ago, when the item materialized, the concern was that the hospital is not moving fast enough to address funding," Morones said. "From the trustees, we told the finance department to move forward more quickly."

Arias expressed her appreciation for letting the hospital give their report at the Tuesday meeting, instead of the Thursday regular session. "I will be taking a few days off."

She gave an update on the transportation issue she had brought before the commissioners at the previous meeting of being unable, at the behest of Medicare, to use ambulances to return patients to their homes or other facilities. Payment of these services was not approved by CMS (Centers for Medicare and Medicaid). "Commissioner (Alicia) Edwards talked with HIM (health information management) to offer some plausible ways to rectify the situation," Arias said.

"I appreciated the meeting," Edwards said

Arias also reported on the immigration issue. "We are getting 12-15 patients at a time in the emergency room. Most do not need to be hospitalized. What rights do these patients have? They have the same rights as any patient has. As patients, we have the right to refuse treatment, transfer or to receive visitors. These patients have their own blockages and barriers. They come in under the control of immigration authorities. Just because they are in the hospital, does not mean that just anybody can enter their room. We protect the privacy of all patients. I've been invited to visit with the detention authorities in Lordsburg. I'm not sure what is going to happen at the first of the year. A congressional delegation is coming to Lordsburg and Tijuana. Dan Otero (Hidalgo Medical Services chief executive officer) has reached out to us to ask how we can join forces to address the issue together."

Edwards asked to return to the topic of transportation of discharged patients.

"We’re looking at options," Arias said. "One was a courtesy van, but we have to get legal counsel on it. Our risk department has reached out to other hospitals to see how they are addressing the issue."

Edwards asked if other providers could help.

"We've reached out to them, too," Arias said.

Browne asked how the emergency department was reacting to regular patients when 12 to 15 immigrants were arriving at once.

"We have a fast track, where we triage and expedite the emergencies," Arias said. "We have limited waiting times."

Browne asked if the hospital receives an advanced notice of the arrival of a group.

"Not yet," Arias said.

Edwards asked if the Border Patrol was picking them up and taking them to the closest hospital.

Arias replied that the immigrants are taken to the Border Patrol detention center in Lordsburg first. "If they have an injury or medical issues, they bring them to us."

She said the hospital is still working jointly with Tu Casa. "Several people from the hospital have discussed whether to hospitalize or return certain patients to the Detention Center here."

Browne noted that the hospital was losing the trauma surgeon Dr. Lamour. "Are you recruiting for his replacement?"

Arias said a candidate is coming in January to interview. "We have a full-time oncologist coming in January. As soon as he is licensed in New Mexico and credentialed, he will be moving here with his family."

Chief Financial Officer Richard Stokes said the hospital in October made a $595,000 profit. Year-to-date the loss is $281,944, as compared to October 2017 when the loss was $4.4 million. "We had a positive EBIDA (Earnings before interest, depreciation and amortization) of $1.3 million as compared to last year's $3 million loss. We have had a big increase in outpatient visits. We collected $5.1 million in cash and have 61.8 days cash on hand." He reported oncology continues on an upward trend. "For November, we were looking at gross revenue of $5.5 million, but we were challenged at the end of the month with numbers dropping. We ended without cash collection at $5.2 million. October was a strong month with $2 million greater in charges."

Stokes said he sat with the hospital's auditor, Tom Dingus. "I am glad to report that access to information was easier this year. During our most recent Financial Committee meeting, we had a discussion about whether we are on track. I have asked Tom to review the audit, so we can make any corrections."

Arias wished Happy Holiday season to the commissioners. "I look forward to sharing our progress."

Browne said he liked having the reports at the work session and asked if it would be possible to continue. Arias said it was fine with them.

The next presentation was by HMS's Otero and Chief Medical Officer Dr. Darrick Nelson.

"I will report on all the activities of HMS," Otero said. "I asked Dr. Nelson to join us today. We have the best chief medical officer. I thank all of you who attended the Tu Casa opening. We had more than 100."

He presented a map, which showed health care access across the area before HMS came in 1995. "The community came together to provide health care to the community. We now have health care access within 30 minutes for almost every resident of the two counties (Hidalgo and Grant). We have 16 locations. We are a 501c3 federally qualified HRSA (Health Resources and Services Administration) facility. Our service area is greater than 35,00 square miles. We have more than 16,000 unique clients and 82,000 visits a year. We are a provider to veterans. We work hard to bring veterans to work for HMS, too." He cited the accreditations and associations HMS has received or is affiliated with, including being in the Fortune top 100 places to work.

"We're really clear on what residency means, too," Otero said. "Dr. Nelson is the director of residency. Our current services include medical, dental, behavioral health, senior services, and substance abuse treatment. We address community needs. We also have requirements to address things such as detox. We are doing well with the senior centers. We have only scratched the surface."

Nelson said he is a family physician, serving in the community since 2010. "We had a uniform data system, which every federal qualified health care center has to provide. We can compare ourselves to New Mexico facilities. We are doing better than New Mexico health care centers on 10 out of 15 standards. We do better in depression than the state and country. We are better than in country in 10 out of 15. We want to help provide care at the highest quality possible. We make sure the patients are taken care of in the most comprehensive way. We will do the same in Tu Casa. Suboxone is a better treatment. There is only one provider in Grant County certified to treat patients with it, and you're looking at him. We are seeing how motivated the patients are to address addiction. We are working to get more waivered to be able to use the treatment. We make sure to look at the whole patient, with cancer screening, dental and medical. We will treat you the same. Our overall satisfaction rate is 98.3 percent in thousands of surveys. Our referral rate is 81 percent and we think we will go higher. As a residency facility, we are the only one certified in New Mexico as a teaching facility not on the I-25 corridor. Fifty percent of all physicians are in Bernalillo County. Our residency program recognizes the need for physicians to stay in rural areas. Three of the seven who have studied here have stayed here and 60 percent have stayed in rural areas."

"When I came on board as CEO in early 2016," Otero said, "we had eight outmigration of physicians. We have had net 20 incoming providers. For every physician brought in, we see $1 million in economic impact to the community. We truly focus on our mission. How do we partner? We are partnering on Tu Casa and the senior centers. Who are we here for? We are here for everyone. We have to answer yes that we will benefit the community. We never lose sight of our values. We have to not only recruit, but also retain. We have 60 different professional titles.

"As a community health center," he continued, "we participate in 52 outreach events and sponsorships each year. We are very active in the community. Our family support services make sure you can access health care. We provide congregate meals and transportation for the senior centers. It's a big deal for us."

Otero said social determinants are the highest barriers to health care for many residents. They include transportation to get to appointments and economics. Family support helps them address the barriers they face.

"Our economic impact includes the $24.5 million in federal funding coming in; $80 million in patient revenue, which is $104.5 million to the community," Otero said. "We have 240 employees now and are projected to have 270 by the end of the fiscal year. Most of the new ones are in behavioral health. Our partnerships are a key success factor. They include partnerships with Grant County, Hidalgo County, Gila Regional Medical Center, the Center for Health Innovations and Silver City. We also have state and national partnerships. We partner with community physicians. This morning I had breakfast with Dr. Gregory Koury. All are committed to the same goal of great health care. We recently leased Dr. Sparks' building, where we will house 30 jobs for CareLinks. Any community member can walk in who needs services. We will be helping people navigate the health systems. The office will be open by Jan. 1."

About Tu Casa, he said HMS, which is the providers of services, has delivered to the state a letter of intent to get the crisis triage center opened 24/7. "The state will send the application and once opened, we will hire 20 more people. It depends on how long recruitment will take. We are investing cash and are committed to making it work. We are also working with the state on a clinically integrated network. We maintain our goal to improve the health of the population and reduce costs. We are working to get an optometrist to open up vision services for Medicaid patients and for those who need to manage diabetes. We are taking senior services to a higher level. Health care coverage for seniors is not necessarily holistic. Dr. Pedro Armendariz, one of our recently graduating residents, will remain as medical director for geriatrics. I give credit to Dr. Nelson. He stressed his total commitment to total health for every patient."

Edwards said she appreciated the report. "I would like for you to talk about the transportation issues and how you are addressing them."

Otero said the clinic in the Mining District is moving from Bayard to Santa Clara. "Some walked to Bayard for appointments. What options do we have to get clients to appointments? Some new laws allow HMS to provide transportation, but from door-to-door only, no shopping for groceries, for instance. The transportation for senior centers is different. We have to reach out to partners to fund the services. We can't advertise, but according to the Office of the Inspector General, CMS has loosened some rules. We are doing analyses and working with our legal counsel. The biggest challenge is mileage."

Edwards posed a hypothetical situation: "Say HMS in Lordsburg calls 911 and the patient is transferred to Gila Regional Medical Center, which cannot provide transportation home. Could your van pick your patient up at GRMC and take them home?"

"We don't know yet, but we don't think so," Otero said.

"In order to address the issue, how about if you create a partnership with GRMC and Silver Health Care?" Edwards asked.

Otero said he had hoped a van system would work, but he doesn't think it will.

"We really, really need partnership on this issue in a systemic collaborative way, not as a single organization," Edwards said.

It was agreed that HMS would also give its reports at the Tuesday work session meetings of the County Commission.

The next article will address a presentation by New Mexico Central Arizona Project Entity Executive Director Anthony Gutierrez on a proposed amendment to the entity's joint powers agreement and a presentation by the county's counsel on the proposed Great Divide Wind Farm.