[Editor's Note: This is part 2 of a two-part series of articles on the GRMC Board of Trustees meeting on July 27, 2023.]

By Mary Alice Murphy

At the Gila Regional Medical Center Board of Trustees meeting on July 27, 2023, Interim Chief Executive Officer Margie Molitor presented her report.

She thanked the trustees for their time and commitment to the trustee education sessions for 1½ days in Albuquerque and the GRMC facilities tour. "I very much appreciate your interest and engagement."

"We interviewed four very qualified candidates for chief nursing officer earlier this month," Molitor said. "We have received acceptance to our offer to Jessica Workman, who will begin on Sept. 18 here in Silver City. She had excellent references and is interested in leadership development. We are excited to welcome her here."

Molitor noted that Neil Todhunter, CEO of HealthTech, the management company aiding GRMC in its financial and overall recovery, would talk about the search for a permanent CEO.

She also said that Innova, the emergency room team, is leaving New Mexico due to its unfavorable malpractice environment. "We do have an approved contract with ESS, which currently provides our hospitalist services, to provide ER services."

The lighting replacement in the operating room is almost complete, thanks to a federal grant. "I have heard great feedback from the surgeons," Molitor reported.

She said that thanks to help from Southwest New Mexico Council of Governments Executive Director Priscilla Lucero, the hospital has received emergency approval to replace the operating room air handler. "Trane made a walk-through last week and will design the electrical and mechanical design. The plan must be approved by the New Mexico Department of Health and the replacement is expected to take about six months to complete."

"DoH has accepted our request for a space variance on the Maternal Child renovation," Molitor said. "That is the first step. We will now send the plans for a complete review. Once they are approved, we will move forward with construction. This project will not only upgrade our rooms to be larger with windows and handicapped-accessible bathrooms, it will bring all maternal-child services into one area. The architects are looking for contractors."

She said that under the recommendation of cardiologist Dr. Norman Ratliff, the hospital is working toward becoming a certified chest pain center by the American College of Cardiology. "Our emergency department director is leading the effort."

The MediTech Expanse upgrade is well underway, Molitor said. "The Go Live is scheduled for Nov. 7."

She noted that as the Interim CNO Cynthia Lewis had pointed out, the patient satisfaction surveys have shown the improvement from 13 percent of "definitely would recommend Gila Regional" at the beginning of the year, to reaching the goal of 55th percentile at the end of June. "Our new goal is the 66th percentile by the end of this fiscal year. We are maintaining our 4-Star CMS (Centers for Medicare and Medicaid) status."

In growth, Molitor noted that the hospital now has orthopedist Dr. Jesus Carreon as a GRMC employee and he has begun seeing patients.

Radiation Oncologist Dr. Arsenault's contract is completed, and he will begin his tenure at Gila Regional in September when Dr. Hayostek retires.

She said the hospital was proud to have an entry in the Fourth of July parade. "With the work of Julissa Alaniz and Dani Leingang we had a copper-colored Statue of Liberty. Some people 'got' it as the 'new' statue, and others didn't."

Todhunter then presented his HealthTech report. "Our hospital management company has been in business for almost 52 years. We do primarily hospital consulting, as well as management. This year, we have worked with a little over 100 hospitals. We've grown about 25 percent each year for the past four years. It's good for us, but it shows the issues hospitals are having. Currently, it is expected that about 600-800 hospitals will not be here in the next year to year-and-a-half. So, I feel good where we are with Gila Regional. I was reminiscing with (County Manager) Charlene (Webb). She called me about three years ago in February, and said: 'Can you come out and look at us, because I think we're in trouble?' At that point you had six days of cash and couldn't figure out how to make payroll. Your team has come a long way in three years. As Patrick (Banks, CFO) indicated, I think we're on the way to a pretty stable operation. One of the big things we did early on was we converted from a PPS hospital to a critical access hospital. That has benefited you by about $7 million a year. A critical access hospital can do everything a PPS can do. Cynthia came from a critical access hospital that was doing about $100 million a year and there's one on Whidbey Island, Washington, that's doing about $150 million a year. It's not about size, it's about maximizing the CMS reimbursements. I think the team right now is on a pretty strong recovery. The operation is going forward. You always obviously have challenges. I want to thank the new board. I know the commissioners have struggled to get a new board, but I'm hopeful this is going to work out well. We're here to help you, and we look forward to a long relationship. We have our people interacting with you. I have asked Patrick and Margie to do monthly reports on our interactions."

Board Chair Dr. Fred Fox said he was impressed with "this board's willingness to be involved and carefully handle problems. CMS has talked about changing from fee for service in some areas to a prospective payment for primary care to try to address the needs and shortcomings in communities such as ours. It includes New Mexico. It's based on a long 450-page document addressing the shortcomings in some states, especially in primary care. I'm working my way through that 450-page document. It remains to be seen what the state will propose to do about that. There are other states that are giving it a trial. It is important for all of us as a team to look at this and see how it could benefit us as a community."

Todhunter said these plans are often a way to keep CMS from paying as much, "but I think this shows up the importance of these small hospitals in the communities they serve, because you can get patients in here and care for most of them, but as far as transferring them somewhere else, there's no way to do it. I think it has shown the importance of the about 1400 critical access hospitals in the U.S. to show their role in the community. Critical access facilities always have challenges, but they're not going to touch it. It's really small potatoes for the government compared to some of the larger organizations."

He said on the CEO search, "I know Scott (Manis, Health Tech regional vice president) and others are working diligently on the process. They are putting together a roster of candidates that I think will be coming fairly soon. I know they have three or four really good candidates right now."

Fox said the board has expressed its desire to be part of the process.

Trustee Mike Smith said he wanted to express his appreciation for Health Tech and "what you've done for Gila Regional."

"I thank Charlene for bringing us on," Todhunter said. "Early on, probably two years before we came on, we actually presented to the county commissioners, but at that time, nothing developed. The continued financial decline accelerated the need. When Charlene called us, we always knew this could be a very good hospital. You have a good population and a relatively good payer mix. There really is no reason why this hospital can't survive. In the last month, I have talked to three hospitals, two in Illinois and one in California. Since I talked to them the two in Illinois have closed. The one in California has already filed Chapter 9 and they're struggling and probably not going to make it. Covid gave a lot of struggling hospitals a sense of security. They got all this money, and without that money, they probably would have closed two years ago. I'm happy you have a good organization. The County Commission spent a lot of time getting through this process."

With no old business, the trustees went into executive session.

After more than two hours, they came out of executive session, having taken no action. The trustees then addressed the new business, beginning with a consideration of a recommendation from the Medical Staff Executive Committee (MEC) on provider credentialing. The trustees approved what they had heard in executive session.

The next item of new business considered the recommendation by the MEC to approve various items. The trustees approved items 2. a-w in one motion. Without any explanation by the members or hospital leadership, this is a list of what they approved:

a) Consideration to approve the Med Staff Bylaws (approved on 06.27.23) (moderate)
b) Consideration to approve the Rules and Regulations (approved on 06.27.23) (Executive Session)
c) Consideration to approve the Emergency Medicine Delineation of Privileges DOP (Moderate and Deep)
d) Consideration to approve the General Surgery Delineation of Privileges DOP (moderate)
e) Consideration to approve the Hematology/Medical Oncology Delineation of Privileges DOP (moderate)
f) Consideration to approve the Internal Medicine Delineation of Privileges DOP (moderate)
g) Consideration to approve the Ophthalmology Delineation of Privileges DOP (moderate)
h) Consideration to approve the Orthopedic Surgery Delineation of Privileges DOP (moderate)
i) Consideration to approve the Otolaryngology Delineation of Privileges DOP (moderate)
j) Consideration to approve the Pediatric Delineation of Privileges DOP (moderate)
k) Consideration to approve the Podiatry/Podiatric Medicine and Surgery Delineation of Privileges DOP (Moderate)
l) Consideration to approve the Pulmonary Disease Delineation of Privileges DOP (moderate)
m) Consideration to approve the Radiation Oncology Delineation of Privileges DOP (moderate)
n) Consideration to approve the Radiology including Teleradiology Delineation of Privileges DOP (moderate)
o) Consideration of the Focused Professional Practice Evaluation (FPPE) Policy
p) Consideration of the Medical Staff Peer Review Policy
q) Consideration of the Peer Review Committee Charter
r) Consideration of the Physician Self-Referral (Stark Laws)
s) Consideration of the Surgical First Assist Delineation of Privileges DOP
t) Consideration of the RN First Assist Delineation of Privileges DOP
u) Consideration of the Resident, Medical Student and APP student Policy
v) Consideration of the (Deletion of Surgical 1st Assist and RN 1st Assist)
w) Consideration of the Medical Staff Credentialing and Privileging Policy for Moderate/Conscious Sedation action

The next items addressed agreements and contracts, as well as resolutions. One resolution, No. 8, was pulled out for consideration by itself. It addressed the approval of the Open Meeting Act procedures for the Board of Trustees. They approved it and set the date and time of the regular meetings as 4 p.m. on the fourth Wednesday of every month.

Again the trustees without explanation of any item approved in a group the items listed below:

3. Consideration of the First Amendment to Chief Medical Officer Agreement – Dalton, Ronald P., M.D.
4. Consideration of the First Amendment to Practitioner Employment Agreement – Karen deGenevieve, FNP-BC
5. Consideration of the Second Amendment to Practitioner Employment Agreement – Jesus Roberto Carreon, M.D.
6. Consideration of the Master Services Agreement & Statement of Work for Professional Services – Genesa Reimbursement Group
7. Consideration of Scope of Work for Services and Software License Agreement for Forms – Interlace Health
9. Consideration of Resolution 2023-19 – Approval of Southwest New Mexico Council of Governments Special District Member Agreement
10. Consideration of Resolution 2023-20 -- Approval of Master Subscription Agreement for Software License for EHR Security
11. Consideration of Resolution 2023-21 -- Approval of Scope of Work for Data Extraction & Archiving
12. Consideration of Resolution 2023-22 – Approval of Software License Agreement for Transcription
13. Consideration of the First Amendment to Practitioner Employment Agreement – Iwaasa, Gregory B., DPM
14. Property Disposal Committee Formation

[Author's Note: I failed to add that the members of the Property Disposal Committee are Will Hawkins, Seth Traeger and Pat McIntire.]

After the approval of all the above items, the board adjourned.

For the previous article, please visit: https://www.grantcountybeat.com/news/news-articles/79760-grmc-new-board-of-trustees-holds-first-meeting-072723-part-1