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Published: 24 March 2019 24 March 2019

Editor's Note: This is the second of a multi-part series of articles on the Grant County Commission work session of March 19, 2019]

By Mary Alice Murphy

The second presentation at the Grant County Commission work session on March 19, 2019, came from Gila Regional Medical Center.

GRMC Chief Executive Officer Taffy Arias thanked Commission Chairman Chris Ponce for spending time to get a tour of the hospital with the Chief Financial Officer Richard Stokes and herself.

"We hope to get an appointment set up with you, Commissioner (Javier) Salas," Arias said. "We are delighted with our new full-time oncologist, Dr. Antonio Fontelonga. He is working with Marvin White, the physician's assistant. They are getting patients in without a wait. Dr. Fontelonga has already expressed a desire to expand services. He suggested an interventional radiologist. When a woman comes in for a mammogram, if the radiologist sees something on the image, a test can be done right then while the patient is there. They can get into see a surgeon that afternoon or the next morning, then they can get treatment quickly. We don't want any delays in treatment. We want to be known as an oncology service line without a prolonged wait. Thanks to Rep. (Rebecca) Dow and Sen. (Gabriel) Ramos and (Southwest New Mexico Council of Governments Executive Director) Priscilla Lucero, they secured funding for a new PET scanner at the hospital, as well as renovation for the chemotherapy room at the Cancer Center. We got $200,000 in capital outlay. We have a new pediatrician, who will start as soon as he completes the credentialing. We are having to delay the opening of the Bayard Clinic, as it needed extensive renovations. The work is ongoing and we're looking at May. We have already hired a nurse practitioner and will hire another nurse practitioner or family practice doctor for the clinic. We have seen an extreme decline in the number of immigrants being brought to the emergency room. They now have a physician in the detention center at the border, so the people are getting care far more quickly there and at the Lordsburg Hidalgo Medical Services facility."

Arias went on to say that the RNs from the Philippines will begin to arrive at the hospital toward the end of March.

She noted GRMC had a bomb threat on a recent weekend. "We quickly had administrators, law enforcement and the FBI on site. They did a meticulous sweep. We all thought it might be a hoax, but they also did a sweep of packages coming into the facility and found nothing."

The hospital's attorney will do an in-service training for the Board of Trustee members.

Arias talked about a TV program on the previous Sunday. "One of the articles was about rural hospitals closing. "They were everywhere from Texas to the East Coast and from Arizona to the West Coast. The only place without dots of hospitals closing was New Mexico. Richard and I take it so seriously to make sure Gila Regional is sound financial now and in the future."

Stokes agreed and said: "A rural hospital closing is a devastating event for any community. In New Mexico, 32 hospitals are at significant risk of closing. We can't pat ourselves on the back. It is still a serious threat. The challenge is reimbursements. There are for-profit and not-for-profit hospitals that have closed. It is a difficult environment to survive. I'm really glad to be here. I made a commitment for a year. I talked with my wife to see what she thought about staying. Her response was that she just got settled and 'I like it here.' We really like it here. It's way better than in Texas."

He noted that the financial report to the Commission is always not in sync with the months. "Our board does not meet until March 29, so they have not seen February's report yet to approve it. They approved the January one at their February meeting. In January, we had $291,000 excess revenues over expenses and $3,035 year-to-date profit. We had in January EBIDA (earnings before interest, depreciation and amortization) of $529,000 and $1.6 million year-to-date. To give you a preview of February, we had a profit of $29,500 and year-to-date $32,000. We are continuing our march to profitability. We had 47.6 days of cash on hand. We are spending cash for one-time projects and capital projects. Our accounts receivable stood at 43 days and accounts payable at 39.5 days."

Stokes commented on the previous presentation on the census. "The census has a large impact on healthcare. We need to get the numbers correct."

The hospital has 483 full-time employees, "so we are a fairly large employer. We are deploying software that will work with MediTech. A patient when he or she walks in the door wants to know how much payment they will be responsible for. The Experian software will fire off while registration is happening. Another step we are considering is moving the physician care network to MediTech with an ambulatory module. Right now, the clinics don't talk to the hospital and vice versa. With the software, it would provide an opportunity to complete the patient's record for all the information. The continuation of care would be seamless. We look at it as a patient safety issue. The break-even point for the software would be five years."

"Last month, we talked about the problems we were having with Western Sky," Stokes continued. "To date, we have declined a contract with Western Sky. But finally Western Sky came around, and we anticipate we will complete a contract this week."

When patients come into the hospital, they will get a bill with the afore-mentioned software. "So much infrastructure can be leveraged to the clinics. For instance, if it's a $400 bill, a lot of families don't have that much money. This solution will allow them to select up to three months to pay or even from six months to two years to empower people to manage their resources without talking to a person. We're vetting it right now, but a lot of hospitals across the country are using it. We have also initiated an energy study with Trane healthcare energy savings. We want to figure out how to cut costs."

Stokes pointed out that the charges of many different services at Gila Regional are online on the www.grmc.org website. "We have comparisons to hospitals in Las Cruces."

Commissioner Harry Browne said he understood that Dispatch is losing the hospital as a member of the joint-powers agreement.

"We plan to join it," Arias said, "but we have some questions to be answered."

Stokes explained that when the hospital enters a contract it has to "really look at the language. We spent probably $2,000 in legal fees to figure out what the hospital could live with. Our corporate compliance officer is very particular."

County Manager Charlene Webb had a question for Stokes. "The loan you are applying for, how is the county tied to it in liability? What will be your guaranteed revenue sources?

Stokes said the bill out of the Legislature would result in a bond, managed by the Hospital Funding Act. "It will be paid by the Cigarette Stamp Tax Fund, with $860,000 guaranteedd. I've been told that insulates the county from liability. We have had numerous discussions with the New Mexico Finance Authority. It appears our board has the authority to issue the letter of need."

Webb said she had received a call from NMFA with questions, but she was glad to hear the county did not face liability for the loan.

Browne commented on the hospital audit. "The 2017 financial audit had three material weaknesses, with deadlines to clear them up – two by last December 31 and one in March this year. The significant weakness would be to have policies in place by the deadlines."

Stokes said they have been resolved. "We have a charity and indigent policy we have implemented. The other policies were in place, but not being implemented. We are in the process of rewriting a lot of policy, updating it and educating the staff on it."

He said the third weakness is on track to being implemented. "In smaller organizations the separation of duties is a difficult issue. It's always one that auditors look at."

Arias said Gila Regional is doing "fabulous, exciting things. Last year, we were treading water. Now we are doing great things. I thank the Commission and the community for allowing us to continue."

Commissioner Billy Billings said he was glad to see the positive $32,000. "Richard, you mentioned the integration of patients records. Will it include Hidalgo Medical Services and Silver Health Care?"

Stokes said HMS is on a separate system. "It and others can join our system. We're exploring the possibilities."

Arais said a smoking outlet had caused a flurry of concern the day before. "The Fire Department came out and assured the patient and the hospital that everything was safe."

The next article will address the presentation by HMS CEO Dan Otero and the annual presentation by the High Desert Humane Society.