[Editor's Note: This is part 3 of the work session and regular session meetings of the Grant County Commission on Feb. 19 and 21, 2019.]

By Mary Alice Murphy

Grant County commissioners heard presentations at the Commission work session on Tuesday, Feb. 19, 2019.

The first featured Gila Regional Medical Center Chief Executive Officer Taffy Arias and Chief Financial Officer Richard Stokes.

Arias said her administrative assistant, JoAnne Holguin, was arranging for the two new commissioners to have an orientation and tour of the hospital.

"The role of the CEO is primarily recruitment," Arias said. "It is very difficult to get physicians, especially new physicians and ones with young families, to come to Grant County to practice. Shopping and education can be issues. One of the things that came up recently is the proposal at the legislative session to cut funding for charter schools. If you don't go to Santa Fe or don't keep up with what's going on at the Legislature you don't know their viewpoints. We have a county-owned hospital, but decisions are made in Santa Fe where the majority of the legislators have no vested interest in our county. I received a message from a friend in North Carolina, who said that three small hospitals in the state had closed. No hospital is safe from legislative issues that affect us."

On the subject of recruitment, she reported that offers had been made to three surgeons. "Two have accepted and we're waiting on the third. It is important to have general surgeons, so residents have a choice. We also want surgeons with different specialties and interests. We want one with oncological expertise. The new full-time oncologist for our Cancer Canter is in orientation right now and should start here the first part of March. We have interviewed for a pediatrician and for nurse practitioners. One will open the Bayard Clinic, and another will open a clinic in Deming."

Arias noted the hospital has seen a decrease in patients to the hospital for a variety of reasons. "We are striving to improve our clinical services. We are looking for an ENT (ear, nose and throat physician) and one in urology and a gastroenterologist."

"Our CNO (Chief Nursing Offier) resigned," Arias said. "Kelly Rodriguez is the interim CNO while we do a national search."

Commissioner Harry Browne said he was saddened to hear the CNO resigned. "I was highly impressed with what she was doing. Are you engaged in the process to find out why physicians are making referrals outside the area?"

"We are rebuilding relationships," Arias replied. "They are important. Sometimes, it's hard to get a straight answer to questions, such as yours."

Browne asked if cuts to the UNM Cancer Center would impact Gila Regional.

"Yes, but the bills that would do that are so convoluted, it's hard to know how much," Arias said. "I learned long ago not to make a knee-jerk reaction. We have to do a deep dive into the bills. Richard and I are looking at the UNM cuts. And they weren't really 30 percent."

Commissioner Alicia Edwards asked about local service lines. "I hear that a lot of folks with heart issues are being shipped out. What is the future there?"

Arias said the hospital is expanding cardiology services. "But if invasive services are required, we don't have a cath lab or the possibility of doing stent procedures. We have to look at whether the volume is enough for a permanent cath lab. The cost of investment for that is large. We have to make sure we have enough volume."

Edwards said if Deming has a cath lab, it sounds like a partnership opportunity.

"The cath lab in Deming is not presently functioning," Arias said. "And we always want to send our patients out to the best care available."

Stokes said the cuts proposed for UNM are, in essence, a cut in the cigarette tax proceeds to reallocate them to other programs. "The tax was put into place to fund rural cancer centers. If the bill passes, it will divert half of the funds away from rural hospitals. And the liability insurance issue at the legislative session is to remove a cap. It is driven by plaintiffs' attorneys. It will cause insurance costs to rise."

He gave the financial report for December, as it has been approved at the January Board of Trustees meeting. "We had a $160,000 loss, bringing the year-to-date loss to $279,000. However, the EBIDA (earnings before interest, depreciation and amortization) added $1.1 million to the organization. Last year at this time, EBIDA had a $2.3 million loss. We have stopped the losses there. For the future, I have a snapshot of January. We expect a profit of $3,035 and an EBIDA of $1.565 million. We are continuing to make improvements. We collected 111 percent of collections in December over the preceding month. And we expect 108 percent in January over December. Our collection rate is hovering around 30 percent. Our goal is to get above 30 percent."

He said he had recently read an article called: Denial Chaos, which related to the denials by insurance companies to pay for services at the hospital or to physicians or clinics.

"United Healthcare is a huge offender," Stokes said. "They make up their own rules. Presbyterian greatly uses line-item denials, and Blue Cross Blue Shield less so. We are dealing with how payers are choosing to pay. We have put solutions in place, which will allow us to identify the denials and prevent them. But, with the exact same data on a claim, one last week, United paid, but one this week, United denied. It is not a problem unique to us."

Browne asked if days of cash would improve from the 47 in December.

"We actually moved to 46 in January, due to a quantity of disbursements," Stokes reported.

Edwards asked about the aggressiveness at not paying claims. "There has got to be a way for physicians, the hospital and practitioners to come together to combat it."

Stokes said all have to be careful not to run afoul of fair-trade practices. "I can tell you what Mayo Clinic does. They just don't accept insurance assignments. They accept payment only from patients. Most rural hospitals cannot play that game. We contacted the New Mexico Insurance Commission and he said the issue is not under their purview. That was the first time I had heard that. United is aggressive at not paying for cancer treatments. We are putting a lot of effort into providing good care, only to be denied, sometimes for years."

"I forgot two things," Arias said. "We had a meeting with multiple law enforcement agencies about the increasing violence in the hospital. Law enforcement was very concerned. We see them as a partner in this issue. And in 2019, we are evolving from a rocky 2017-18. Our fiscal year ends in June. We are looking at the strategic plan that we presented to the commissioners. We had a certain responsibility to come to that point by the end of the fiscal year. I'm not a political person, although I’m being drug into it. I am hoping from the bottom of my heart, in the interest of a positive outcome of our local health care system, that we put aside all ill feelings. I'm one to forgive and forget, and I ask the same of you."

Because Hidalgo Medical Services CEO Dan Otero was unable to attend, no HMS update was presented.

The next presentation was from Seth Wold of Zuercher Technologies. Lt. Mike Burns of the Grant County Sheriff's Department said the department has an opportunity to collaborate with the town of Silver City and the Dispatch Authority to gather store and retrieve information received through the agencies, using technology.

"We work for law enforcement," Wold said. "Law enforcement gathers a lot of information. Historically, it was stored in filing cabinets, but that has changed with the emergence of technology. We are the current software provider for the Sheriff's Department. We are the best and largest software provider for keeping this information safe and accessible. Public safety has been underserved by technology. We serve 11,000 small-to-mid-sized departments, with about 240,000 officers. With Zuercher Technologies, we save you time, increase your safety and increase the intelligence. We fit the way you work. Silver City, Dispatch and Grant County would share the same system, one vendor, one database and one action. We also want to bring the Tri-city municipalities into the system. Five neighboring counties are also looking at this system.

"We manage the servers and replace them as needed and we keep it all up-to-date," Wold said. "We support you 24/7. We have hammered down the price to you as a long-standing customer. It will save you hundreds of thousands of dollars. We have a very high customer retention rate. Our software works and is scalable. We can create the reports and forms you need. We can create customizable forms quickly."

Edwards asked how Silver City, Dispatch and Grant County would work with State Police.

"We can share as much as the three agencies determine they want to share," World said. "Our system runs license plates through the state system and drivers' licenses, too."

Cindy Blackman of the DWI Program asked if the probation system could have access.

"It's up to the city or county, but yes, generic information can be shared," Wold said. "We are the second largest public utilities company, so we also have the most accurate address database."

County Manager Charlene Webb also discussed the public hearing set for the Thursday regular meeting on Feb. 21, 2019. She said Hilltop Securities, which is handling the bond issue for the Great Divide Wind Farm would have Luis Carrasco and Lalleh Daleny at the meeting to talk about the red-lined documents.

Carrasco was on the phone at the work session. "These documents are not in their final form, although they are substantially final. We will work to get the optimal rates. The substance of the ordinance you will vote on at the regular meeting is to improve the sale and issuance of bonds. It delegates certain authorities to the manager. The general obligation bonds are secured by property taxes, with the County Treasurer as the registrar and payee, as well as an alternate."

He noted that section 7 of the document was new, setting out how the bond revenues are allowed to be spent and certain timing for the payments and expenditures. It also contains protective covenants. "We think the approval of the voters started the time line. The document provides $100,000 for reimbursements prior to the approval. Four million each in bonds tracks the language approved by the voters. Statute requires the bond has to be issued within 120 days of approval of the ordinance. We expect the bonds to close around April 2. There will be a 30-day challenge period. One of the documents approves the form for the marketing of the bonds. The certificate of final terms provides for the form of continuing disclosure."

Browne asked when the commissioners could expect the bond rating.

Carrasco said the bond funding public offering statement was expected in early March. "I have sent the document. I ask you to review it and determine the obligations for disclosure. Then you will consider the ordinance."

Although it was anticipated to have the public hearing at the Thursday regular meeting, because of the change of venue for the meeting to the Grant County Veterans Memorial Conference Center and the expected crowd to address other issues on the agenda, Webb, at the regular meeting, asked to remove the public hearing from the February meeting and hold it at the March meeting. To a question from Edwards, Webb said changing the date would not affect anything, except to allow the commissioners and staff more time to get the documents completed.

The next article will continue the work session review of the agenda with interspersed decisions made at the regular meeting. These will not include the public input from the regular meeting nor the decisions made on the mining and Second Amendment firearms decisions, which were covered in the article— http://www.grantcountybeat.com/news/news-articles/49441-grant-county-commission-at-regular-session-022119-votes-in-favor-of-three-of-the-resolutions-that-received-public-input .