CEO uses a different format for her report

By Mary Alice Murphy

The Gila Regional Medical Center Board of Trustees meeting held May 31, 2019 began with a safety moment.

"We continue to try to remain aware of who is in our building," Chief Executive Officer Taffy Arias said. "A man in a suit asked to be let into the ICU. I asked him who he was. He replied: 'I am a vendor going to the different units.' I asked him why he didn't have a visitor tag that was required. He left. All of us need to be aware of people who are in our hospital."

The trustees recognized Deborah Tellez for her 15 years' service to Gila Regional in registration. After receiving her award, she headed back to work.

Board Chairman Mike Morones said it always impresses him how many employees the hospital has kept for 15, 20, 25 years. "I'm pleased to see how many there are."

Chief Quality Officer Tanya Carrasco introduced Chris Chavez, who has taken over as safety director. He served 11 years at Mountain View and at Mimbres Memorial hospitals.

"He comes with a wealth of knowledge in security," Carrasco said.

Chavez said he was born in Silver City at Hillcrest Hospital. "I've spent most of my life in this part of the country. Twenty-four years ago, I got into the hospital industry. This opportunity came up, and I wanted to be part of the success of this facility. I want to help this be the hospital to want to come to."

In public input, Chris DeBolt, retired GRMC educator, said: "It's clear that conflict continues, but No. 1, we are all colleagues and partners, not opponents. What I would love to see is the hospital being represented in the newspaper every week to tell the wonderful things that are happening here. I want to see a positive campaign to see great stuff. When we had Planetree for a time, we had an education department, which stressed the seven habits of highly successful people. I taught it enough that I think it is a win-win. I would like to see us moving away from the older ways of communicating. The community needs it. What can I do outside of the old patterns to find a win? Let the negative stuff leave the room. It's all about moving energy. Move the energy past you."

Under board input, Trustee Joel Schram said his term is about to end. "I intend to reapply. I think good things are happening here, and I want to be part of the positive interest in this hospital."

Trustee Jeannie Miller said she has been doing a lot of stuff and thinking a lot. "I think we should bring out this hospital, so it is not part of the county. We are already independent of them. I believe it is time for us to become completely independent, not county-owned. I'm thinking maybe a 501c3. I think it needs to be said that while the county appoints us, they are not running the hospital. It's probably time. I see it as a positive. We would get more community help and input. Businesses do not tell everything they do. We have to do things without competition, knowing what we're doing."

"Speaking for myself," Trustee Tony Trujillo said, "I'm here because I believe in this hospital. I value it. I was born in Silver City. I want this hospital to succeed for my family and my community. All of us care about this hospital. There are a lot of good things at this hospital. We've reached out to bridge the trust factor with the county. Whatever we do, we have to keep moving forward. Those who don't support us, you can try to understand why they don’t. I don't understand why they don't support us. On recruitment, I get asked about the rift with the county. I always talk about it positively. One of my relatives quit a job here because of the uncertainty of what they read. To Chairman Morones and to Mr. Schram, I will lobby to get you reappointed because we are a great team. With your financial backgrounds, you have made financials transparent. We need stability on the board. We need to continue our vision. People keep talking about needing new ideas. Now is not the time."

Trustee Ed Wilmot said he would talk in executive session.

Trustee Dr. Victor Nwachuku said his position will continue to do what he can to make sure the hospital does well.

Morones said he appreciated Schram wanting to be reappointed. "I appreciate that Tony wants me to be reappointed. I feel proud of my three years of serving Gila Regional as trustee. It's still a community hospital, which was a huge win, I'm extremely proud of. We have stopped an enormous amount of financial bleeding. This is a very volatile environment to work in. Taffy and Richard (Chief Financial Officer Stokes) have done a world of work to keep this hospital community-owned. I will do my best to make sure Joel gets back on. But my personal life is almost making my decision for me. I will not be reapplying for the appointment because of my personal and business life. But this decision does not reflect my pride in this hospital. I'm going to talk to everyone to keep Joel. He has had hospital board experience before this. He was always asking good questions about things I didn't have a clue about. He probably got us moving more quickly in a positive direction. He has to be here."

He continued by saying that his personal and business life are great, but "I have to perform in both areas. We have to have strong candidates. Dr. Sherpa will not be reapplying, so we need another doctor. And we need Joel's experience."

In report updates, Auxiliary President Jennifer Yost said the number of hours worked by volunteers was up this month. "But we have no change in membership. Everyone is working harder. We need more volunteers. Cancer Center meals are up. We gave out 10 receiving blankets last month, which brings us to 750 blankets so far. We held elections. The new president will be Marilyn McCracken, vice president Irma Trejo, a new secretary (didn't get the first name) Fischer, and the treasurer will be Eileen Smith. They will take over in July."

She noted the tree in the front lobby has been decorated for Cinco de Mayo for May. "We held a successful jewelry sale, and we are planning our awards banquet for September, when we will celebrate the 50th anniversary of the Auxiliary."

Allen Townsend of the GRMC Foundation reminded the trustees that the fundraising golf tournament would be the next day, June 1. "We have some good teams. We are accepting applications for director and will work on that after the tournament."

He said he wanted to talk about the hospital on a personal level. "A friend of my friend picked him up. He looked bad, so he took him to the ER. He's about 6 foot 1 inch, and he weighed 130 pounds. Volunteers got him registered. Brad came out and put him in a room. The staff were all trying to diagnose, when my friend said he had insurance. Brad said: 'I don't care if you have a penny. We will take care of you.' They put him in ICU, then had to transport him to El Paso, because he was very ill. The whole transition was flawless. Thank you!"

Arias said it was a concern that the public was not getting information on the activities going on in the hospital. "There are so many people in this machine who are working and keeping it going. I will introduce some of them, who will give updates on the activities because they are the experts."

Rennie Mariscal is the administrator over the hospital clinics.

"I am so proud to be part of this organization," Mariscal said. "We have a lot of activity with our outpatient clinics providing an increased access to quality care. We have expanded the hours from the early morning into late afternoon. We will have them open six-days a week. We want to be positive 100% of the time. We are focusing on the segment of the community, who are going to outside areas for their health care. Those who are going to Tucson, El Paso or Las Cruces. Everything else is falling into place."

Miller asked if the hospital has different expectations for the time a person spends with a specialist.

"Those who are seeing a specialist are generally sicker and need more time spent with a specialist than in a primary care clinic," Mariscal said.

Miller also asked about how established patient encounters are kept track of, for instance, when they are brought into the Cancer Center.

"An encounter includes every encounter with a clinic, the center or the hospital, according to each person's individual plan of treatment," Mariscal replied. To explain the ups and downs at the Cancer Center in March, he said, at the beginning of the full-time oncologist's arrival, there was a backlog of patients. "He was initially very busy, and now the center is continuing to build its base. The numbers will climb." To address a drop in radiology visits, he said it depends on the modality of treatment for each patient. "Sometimes, it's chemo. Sometimes, it's radiology."

Wilmot asked what kind of performance metric was being used. "How do we know if the clinic is successful?"

Mariscal said he has been meeting with providers and looking at how they are coding how sick the patients are. "From feedback we are receiving, we have dialogue with the providers on how best we can help them be more efficient."

Stokes said the hospital has recently gone through contract renegotiations to make them standard. "I don't want physicians to have to worry about pay. They need to take care of the patients. They will earn their way through a report card. We work with MGMA (Medical Group Management Association) to drill down to the number of visits and how much they charge on average. The gross charges should have a Bell curve. We're going to communicate with the providers on where they stand."

Arias noted the hospital does an RVU (relative value unit) study so it knows the salary thresholds where physicians should lie. She said the RVUs ramp up with time. "Our pediatrician will be starting from scratch but should see an increase in visits each month. We measure every month to see the steady incline. It also drives our marketing to make sure the physician is in the public eye."

Mariscal noted that the podiatrist Dr. Iwaasa is out in public and with providers to talk about his services. "His podiatry numbers are steadily increasing. He's aggressive to build his practice."

"I attended a Bootcamp," Mariscal said. "It was intense. We all have our struggles. We are ahead of some, but still have a lot to learn. It's not just a matter of statistics. We must have passion and empathy for the patients."

Trujillo noted that numbers of visits to the clinics seem to be going up. Mariscal agreed and said that is the projection. Trujillo asked about the Bayard Clinic.

"Because the building is not usable as is, someone approached us with an alternate site," Mariscal said. "We will work with the architect to learn the feasibility of the site."

Trujillo said he hears people accusing Gila Regional and saying that it should not be competing. "I, as a consumer, like competition."

"We are not trying to take anyone away from his medical home," Mariscal said. "Our target is those going outside the area for medical care."

Schram noted that the Finance Committee is still asking for a clinic performance reports on buy ins and expenses. "We will hold the administration to holding the clinics accountable."

Mariscal agreed and said they need the report cards to improve.

Miller said she thought the hospital had been in a vacuum. "Richard is working on filling that vacuum. One of the questions about salaries is, we budget for them, but especially for startups or is it overall?"

"They have upfront costs, as they are actively growing," Morones said. "Are we expecting collections to ramp up?"

Stokes said with the process that Delicia Dimberg, director of medical staff services, is doing, "it gets physicians to a certain level, and then they are handed over to us. We have had physicians for a year but not credentialed with payers. We're in the process with the ones coming on board to having them already credentialed for Medicare and Medicaid. From a system perspective, it's much better, but we still have opportunities."

Arias said the surgeon Dr. Rosser is starting, and the pediatrician Dr. Worrell would start June 1. "As of this morning, we signed on a new family practice physician. The comment she made was that it was obvious how happy people were who were working at Gila Regional. That was a real affirmation for us."

Morones noted that "we have always had issues with understanding clinics. We've had good popular physicians, but we have had issues with understanding them. I appreciate your efforts. I think we've never had the systems for us to know how they work."

"Relating to the clinics," Stokes said, "we are still renegotiating payer contracts. We just received the Western Skies contract. As we renegotiate, we're wrapping in all our service lines, addressing oncology, EMS, family practices, and the hospital."

The next speaker introduced by Arias was Eloy Medina, GRMC Emergency Medical Services director. "We are a non-traditional ambulance service. We don't just pick up and drop off at the hospital. We do rope rescues, cutting people out of a vehicle. My staff is expected to be trained up to that level and exceeding that level. We are the only PRC-certified ambulance service in the county to perform these sorts of services. We cover 3,961 square miles. Our call volume annually is about 4900. That's 14.5 a day. When we do an ambulance ground transfer, it takes us round trip about 7.5 hours, and we do about 40 a month. I'm happy to announce we brought paramedic training in house last January. We brought in three new paramedics who were just certified. It takes them almost two years of training from day 1 to when they can jump on a truck at the level of quality we ask for."

Trujillo asked if patients ever refuse ambulance service.

"Sometimes, we get calls and by the time we get there, they don't want service," Medina said. "We charge $136 a refusal. When law enforcement calls, we don't charge them. We still get refusals. We have a lot of people in really rural areas, who will call my staff and ask questions. You can't get away from refusals."

Stokes said he thought it was an opportunity to talk about how the hospital is considering the community paramedicine program.

Medina said the paramedicine program does visits. Albuquerque did a pilot program. They identified frequent users of the ER who came in often with minor complaints, such as non-compliant with medications, small rash. The insurance companies and the hospital got together on a plan. When EMS goes out on a call, sometimes it's on a non-emergency basis. Albuquerque identified the top 40 people, many using Presbyterian. The insurances would use dispatch. Someone would go out and do an assessment on the individual. They would check what the problem was, how did the house look, was it dirty, did it not have water.

"There are still some houses we go to that don't have water,"" Medina said. "So, the EMT would report to the insurance companies, and they will send out resources, such as social workers or the medic will help the person with medications, talk about chronic diseases or whatever they need help with. Sometimes, people just need an ear to talk to. This will cut down on ER visits. Albuquerque now has 16 community paramedics. We will pilot a program. We are waiting for a contract, but it will be a real benefit to us, especially toward the Mimbres and in the Gila Valley."

He continued that the EMS would become a hub for resources, even as a follow-up to tie the people into services. "Blue Cross Blue Shield has a care coordinator in this area."

Stokes said there would be some revenue from the program. "It's what's best for the patients. We will see a decrease in the ER, but it's a better outcome for the patients."

"We are a community hospital," Arias said. "We are focused on the patients. What if they can't get to you? Sometimes the person in an EMS uniform means a lot to them because they already trust them."

Medina said when he met with Blue Cross Blue Shield representatives, "we are asking for three at first. I think they will benefit the community a lot."

Schram noted that EMS is statutorily required to be provided by the county, not necessarily by the hospital. "It is a service we feel obligated to do. We do it at a loss."

Medina agreed and said the GRMC EMS has an agreement with the county to provide EMS services. "If a private for-profit company comes in, it would ask for a subsidy from the county. Gila Regional does not ask for a subsidy from the county. We get fire tax funding from the county and use it to pay for an ambulance."

Arias introduced Roberta "Bertie" Barry, who is working on the trauma program.

"In October, I will have been at the hospital for 15 years," Barry said. "I hope the community sees what the trauma program will bring as a strong benefit to the community. What is a level 4 trauma designation? Why are we doing it? Level 4 trauma will not make us a level 1 trauma center. We will still be rural. We will see the same patients. We will just see them better. It will allow us to be part of the trauma system, which will give us the benefit of working with other trauma centers. I've done training and have more to come. The basic requirements are for a 24/7 emergency room staffed by a physician. We got it. Requirements also include education for the providers and nursing. We have received tremendous support from the hospital. Also required are radiology, laboratory, and a blood bank. We have them. There are a lot of deliverables. We received the level 4 trauma letter last July for $8,552. We met certain deliverables. I just submitted my final invoice May 15. I'm very proud of what we've accomplished. We've developed lots of policies and procedures. April 1, we activated the trauma team and developed criteria. We have educated EMS, Silver City Fire and Hidalgo EMS. We do amazing things in this hospital. We treat really critical cases with great outcomes."

For community outreach, the team has begun an initiative called Stop the Bleed. The original program was in response to the Sandy Hook Elementary School shooting. "It is a program to teach lay people simple techniques on how to stop the bleeding. It is truly in my heart to do this. The person who often saves you is a person right next to you. We want to stop preventable death. I will be scheduling a class to train the trainers for first responders. Then we will take the program out to the public. Falls are part of the trauma we see. We will work toward a fall prevention program. I have gotten to 23 departments in the hospital. All the nurses in the ER have obtained their trauma care certification. Every Tuesday morning from 7-8 a.m., trauma education is going on."

A branch of the Region 2 EMS Retrac program is being supported by the Grant County Training Advisory Committee. "We will monitor trauma treatment and processes within our local region. Gila Regional is part of it, as are EMS, Native Air, Dispatch, and Silver Fire.

To Miller's question on the Association of Automotive Medicine, Barry said it developed a method to determine the accurate severity of injury, based on the correct coding, although it doesn't have anything to do with autos now.

"I will be reaching out to schools, the large corporations, such as Freeport McMoRan, PNM, the government buildings," Barry said. "We have already trained some trainers. The Silver City Police Department has already trained officers and the Grant County Sheriff's Office is in the planning stages. I want to go out to the volunteer fire departments, really anyone who is interested."

Schram suggested reaching out to the veterans' groups.

Chief of Staff Dr. Brian Robinson said he appreciates all the hard work. "It's a good characterization of formalizing a process." He got emotional. "I appreciate what you're doing. I was a recipient of your care for severe trauma I had four years ago. I appreciate all your work and my being here. So, thank you."

The next presenter was David Peck, director of dietary services. "We not only feed the patients and serve in the cafeteria, but we also do outside catering for the mines, for banks, for weddings, memorial services. We have received for these extra services $22,000 so far this year. We went through a period of staffing issues, with four in FMLA (Family Medical Leave Act). We have replaced the three who couldn't come back."

He noted the cafeteria is running a lot of new menu items. "You will see more. They are very popular. Lately, we've been working with the Southwest New Mexico Food Hub. It's a two-way street. We take the peelings and left-overs that we can't use. We freeze it and farmers turn it into compost and for feeding livestock. For our high-quality garbage, they bring us organic produce that gets delivered the day it's picked. Our patient menu is new, with higher standards for micro-nutrients, requiring 40 micro-nutrients a week. The requirements for menus for patients are very strict. It's tricky when people like bad foods. We can't put salt into anything, so it makes it tricky. Salt is a flavor enhancer. We have to find other ways with spices to enhance flavors."

Morones said everything he hears from the hospital, "everything we're doing is collaborating with the community, but the community doesn't hear about it or see it. I wouldn't have expected the dietary services to be collaborating with the community."

Peck said a lot of the community comes into the cafeteria for breakfast or lunch. "Three or four come almost every day for lunch."

Nwachuku noted that "we miss your Sunday brunches."

Peck said it was difficult to continue the brunches, when it was not paying its costs. "We are working on other programs that may replace it. We had maybe 20 to 25 who came to the brunches and they were possessive of the program. They didn't like the price raises and they shouldn't have been going home with four boxes full of food."

Stokes asked about after hour access to food.

"We have a night shift," Peck said. "We are looking at a refrigerator that can be opened with a credit card. We will have food inside and whatever leaves, the card gets charged for the fresh food."

Arias noted that Peck sits on many of the hospital committees.

"My paycheck comes from Morrison, but I say I work for Gila Regional Medical Center," Peck said. "This is my home."

Miller asked about diabetes training.

"We are working with Bonnie (Stone, dietician, who reports to the chief quality officer, and Mariscal) and nursing," Peck said. "We are working on the new standards and what foods are on a diabetic tray. We are trying to get the information to nurses."

Interim Chief Nursing Officer Kelly Rodriguez noted that many patients want high protein, low carb food. "We always ask the person what type of food they want."

"We are happy to provide what they want," Peck said. "We try to keep their diets as consistent as possible."

The final presenter was Frank Gramer, Billy Casper Wellness Center director.

"I am trained in direct rehabilitation and occupational therapy, with a lymphedema specialty," Gramer said. "We have really increased our marketing. Last year, we were averaging revenue of about $6,000 a month. Now we are over $28,000 a month. I am working with the Cancer Center and physician's offices. We are keeping the momentum going. We have a new program, called pelvic floor women's health. It's for those who have incontinence and leakage. We have a physical therapist, Elisa, who treats both genders. The program is bringing in $13,000 a month average. We are also hoping to start a pulmonary health program, with Dr. Stinar's help."

Miller asked if the revenues were net or gross. Gramer replied that they are gross. "The overhead for the lymphedema and pelvic floor programs is very low cost. We have one full-time physical therapist and three part-time. We're going in the right direction."

Robinson asked if there were a referral person. "Is there some way, I can do it directly?"

"Call me directly," Gramer said. "I will take care of any problems."

Arias thanked the presenters for what they do. "You are doing good things for the hospital and the community. When you hire the best, they hire they best. Now he has a flourishing department," she said about Gramer.

"That concludes my report," Arias said.

The rest of the meeting will be covered in a following article.