By Mary Alice Murphy

[Editor's Note: This is the main part of the presentations. Questions and answers from the community will be covered in the next article.]

Gila Regional Medical Center presented its State of the Hospital meeting to about 80 people on Wednesday, May, 9, 2018. The leadership team addressed strengths, weaknesses, opportunities and threats. They also laid out portions of the strategic plan going forward to remain independent.

GRMC Board of Trustees Chairman Jeremiah Garcia opened the session.

"All of us have been born somewhere," Garcia said. "We're here for a reason. We continue to have journeys in life.

"We, as trustees, stepped up to the table to volunteer for the board of our precious hospital," Garcia continued. "We were born here, or we came here. Our journeys are not over."

He said he had just returned from four family funerals. "I was in a lot of hospitals, seeing my family members cared for by nurses, by hospice and by home health. These journeys in life teach us. We educate ourselves to try to do the best we can."

"Health care is one of the more important things in our lives," Garcia said. "We depend on caregivers who take care of our families and us."

He said health care is important, "especially in our communities. We're trying to bring you the best health care we can. So much has to do with running this hospital; we didn't realize how much."

Garcia said it was important to understand how rapidly health care in the nation is changing. "The journey for Gila Regional has been tough. This evening, we give our team the chance to show you where we're going. We ask that we come together and listen to what the hospital is about. We need to communicate what we're doing."

Board of Trustees Secretary-Treasurer Mike Morones said: "I'm excited to be here speaking. I asked to speak because of my passion for this community and this hospital."

"I was born and reared here," Morones said. "My ex-wife worked here, and our youngest daughter was born at Gila Regional. I appreciate everything that is done at the local level. I express my commitment to this hospital. I will be working hard to keep our quality hospital. Where we're moving is to make this great hospital great now and into the future."

He introduced Chief Executive Officer Taffy Arias, who has been on the job almost a year.

"I appreciate the opportunity to show you what we're about," Arias said. "This is not a meeting to debate what happened in the past. It doesn't matter. It's where we are and where we are going. We have a plan. A plan has to be defined, so we have timelines. The way we handle change defines us. How we are able to bend with change and flow with turbulence. You have to have a strong team around you and a strong community. The only way to adapt is to be prepared."

A short video that had also been shown to the county commissioners was shown to the audience. "Later, we will ask for question that focus on the future," Arias said.

The video gave some of the history of the hospital in Silver City, which, in different venues, has been serving the community for more than 130 years. "We have a spiritual approach to care. We serve our neighbors, our friends, our family, but it goes deeper. It's a place that has a lifestyle. A place this special deserves a hospital this special."

Members of the community who spoke on the video include Dr. Michelle Diaz, who said it was an honor and privilege to serve at Gila Regional. Paul Leetmae of Lawley Toyota and Ford said it was wonderful to have a hospital with this many services. Dr. Brian Robinson said it is important to have care here at Gila Regional, and it helps to make local decisions on health care.

The manager of Big O Tires said he wants the hospital to stay as a community hospital, because he has concerns about a private corporation.

Dr. Preston Maxim of the emergency department, said if it's a local decision, it addresses the local needs, instead of a far-away decision for local care. He noted the ranking of the hospital in the top 100 rural hospitals in the country and the four-star quality care.

From Roswell, retired Sen. Tim Jennings said his area got down to one hospital. He said the County Commission got tired of operating the hospital and put it up for sale. The private hospital now "air freights everybody out of town."

Western New Mexico University President Joseph Shepard said he is an advocate for local decision making, not corporate. "When I recruit, one of No. 1 reasons people choose to come here is because of this hospital. I want health care managed by the county commissioners we elect."

Cissy McAndrew said if the hospital goes to a corporate owner, "we will lose the personal touch. The hospital is a huge part of the community. If it's not broke, don't fix it. We need transparency. We don't need an outside group brokering this hospital."

Joe Runyan, a local farmer, said he flat-lined at the hospital, but Dr. Norman Ratliff "got me going again. I really support this local hospital setting."

Dr. Ratliff said everyone has to realize "what a special place Gila Regional is. It's a community hospital, owned by the community. As soon as you take it away, it won't come back."

Dr. Gregory Koury said a lot of the doctors who practice at the hospital are "independent physicians. If a for-profit comes in, several of the doctors have said they will leave. When we recruit doctors here, they and the spouse have to like it here."

Robinson said: "Let's start being a community. If you are not part of the solution, you are part of the problem. If we have the possibility to make this hospital sustainable, let's do it."

After the video, Arias said: "Our mission is simple: To provide exceptional quality, patient-centered care in healing environments. You won't find this quality care anywhere else. It's care that comes from the heart."

She then started a slideshow of business goals, starting with a health system that will continue to provide health care.

"I came in June of 2017," Arias said. "We were nearing the end of fiscal year 2017. Most companies have a strategy. This hospital had had none since 2016. When I got here, it was a hot mess. The change in cancer center providers was a mess. Any time, you are void of care, it's a problem. The Meditech upgrade went live the week I got here. It was a mess. Peggy White (chief nursing officer) can attest that I was on top of it day and night.

"Our business is patient life," Arias continued. "We don't get many times to mess up. Patents come into the hospital as delicate, special beings. They are all alike to us.

"We had a tremendous revenue cycle problem," she said. "Most of the steps were broken. There were processes that had not been upgraded and updated. My main priority was to restore the Cancer Center. But I was also thinking about the clinic operations and how they were collecting revenue. All the while, thinking, how do we service our patients. I started doing a competitive analysis, among local health care, Deming services and Las Cruces. Why were people going elsewhere? I did a retail analysis of what we have in the region—Mimbres Medical, Memorial Medical Center, Mountain View Hospital and Silver Health Care among them. I analyzed the top five payors that manage the revenue side and the contracts by actual revenue. Our hospitalist program is a contracted group that come in to take care of our patients. That costs $1.4 million a year. Peggy will give you an Emergency Department overview."

White said she has been in Silver City since 1989. "I got into the medical field in 1995 as an EMT. I've seen health care from a lot of perspectives right here in this community. I've done home health, long-term care, acute care; I've even been with OMI investigating some deaths. I've been humbled by the privilege of being chief nursing officer for about three years now. I know there's a huge concern in the community about our emergency department."

She showed a map of the trauma centers around New Mexico. "As you see down in the bootheel, there's a little bit of a void where there are no trauma centers. The state trauma coordination has approached Gila Regional to become at least a level-4 trauma center." She explained the levels, with UNM being the only level-1 trauma center in New Mexico. She said Gila Regional has taken the request on as a responsibility, but it's a process.

About the emergency department, she said in 2017, a little over 16,600 people were admitted. Even though many think every time the helicopter flies it's flying someone out, that is not the case. Last year, 564 patients were air-flighted out, making it 3 percent of the patients.

"Every time the helicopter lifts off, it is not necessarily taking a patient out of here," White said. "That helicopter covers the whole southwest region of the state. They go down to I-10 and pick up car accident victims. It might be picking up someone in Deming. They also do lots of training flights, so every time that helicopter lifts off, it's not necessarily that we are flying people out. A huge percentage of those we fly out are cardiac patients. They need to get to a interventional cardiac center, with a cath lab, so they can be taken care of immediately. Out of those 564, we sent out 60 for surgery, the majority for abdominal surgery. They had severe co-morbidities, severe health conditions, that if they had gotten in trouble on the OR table, we could not have taken care of them. The safest place for them to be was somewhere else, where they had that back up."

White said the hospital needs an ENT, because 27 percent of the surgeries were ear, nose and throat. Dr. Twana Sparks recently retired. "We have a huge focus on getting a new ENT."

She showed a list of the top 10 physicians and a P.A. The latter was recently hired to start getting patients back into the Cancer Center, as quickly as possible.

Arias said the hospital did a SWOT (strengths, weaknesses, opportunities and threats) analysis so they know what to mitigate. "For our strengths, we are the only acute-care facility within 120 miles. We should have the market share. We have outstanding staff and physicians, who care. Weaknesses start with the revenue cycle, Meditech, and the Cancer Center, which is ramping up. We need to have a lot more accountability for our employees and administration. We owe it to our commissioners to be accountable to them because they have the responsibility for the hospital. We need clear communication with them. They appoint the board of trustees to help lead this hospital."

She said the hospital has lots of opportunities. "So many opportunities, I almost get goosebumps thinking about how much fun it will be tackling these things. We can expand; we can grow; we can improve our revenue cycle, and we've started to do that. We have started addressing the opportunities. We could not wait until the fiscal year starting on July 1. We also have threats. The threat of competitors coming in; the threat of physicians that may not be employed by us sending their patients elsewhere. We have threats all the time."

The hospital also did a SWOT analysis for the medical staff. "I have never, never, ever in all the years I've been in the medical field, seen such an engaged and dedicated medical staff. They are truly here for this community; they truly want the hospital to be successful. They even want their competitors to be successful, so that if everyone is successful, the whole community benefits. Weaknesses include the need for more specialists. We need another urologist; we need another pediatrician; an ENT. We need family medicine. For opportunities, we are going to expand our clinical services, not just in Silver City. As for threats, we don't know what the federal government is going to do. We have to be prepared."

Chief Quality Officer Tanya Carroccio led off the next discussion. She said she was so excited to be at Gila Regional. "It's a great place and it's also nice for me because my parents are in Deming." She said she had been in health care for many years, including as a chief nursing officer. "I worked in rural hospitals in Washington state."

"We have to have great quality and great experiences," Carroccio said. "We have to make sure it's safe. Gila Regional is exceptional." She noted HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) has been doing the surveying for the Centers of Medicare and Medicaid (CMS) for 20 years. "We get reimbursed for quality. How would you rate the hospital?" She said that only choices of 9 and 10 for services get points for ranking a hospital and yesses are better than nos to get a high score. She listed a list of items that hospitals are scored on. "We are meeting national benchmarks here at Gila Regional."

"We watch turnover trends closely," she continued. "I would like to see less staff vacancy, which stands at 14 percent. The national average is 7 percent."

Another short video showed some of the major initiatives for FY 19, including growth strategies.

"We want to exceed national benchmarks for our quality initiative," Carroccio said. "We want to maintain our 4-star rating and would love to get 5-star."

She noted one of the benchmarks is readmission. "It is very important we make sure people don't have a reoccurrence. We have formed a patient management team to monitor patients after they leave the hospital."

"We want to be the center of excellence in everything, the pain center, the joint center, stroke," Carroccio said. "A few more things include a robust patient experience, which is multi-departmental. We want to bring in the community to talk about patient experience and what they expect."

A culture of safety is important. A survey is being done with staff asking they if they feel like "we're doing things safely. We want everyone, patients and staff, to feel safe."

White said nursing initiatives include continuing the evolution of the emergency department services to become a CSA preferred provider for emergency care. "We want people to get through the ER as quickly as possible. Another focus is bringing back the nursing residency program. When I came on as CNO, we had 27 travelers. We developed an internship to bridge new nurses straight out of school to full nursing. We want to improve the fast track process. Sixty-three percent of new nurses quit in the first year. We, with the internship, eliminated all 27 travelers. We had to get rid of the program, but the residency was truly positive. We are again providing private rooms to our patients because we have the right staffing level. We will continue implementing the level 4 trauma center. It's a two-year process. We have the application ready for Taffy to sign."

Arias said patients like the quietness and privacy in private rooms. It makes patients happy.

Other initiatives include developing cardiopulmonary services, recruiting a second general surgeon. The Cancer Center will be renamed, because oncology touches many sections of the hospital, including radiology and labs. "We have to expand to an oncology service line."

"We will have a full-service line, from diagnosis from the doctor to the lab to the surgeon," Arias said. "(Chief Financial Officer) Richard (Stokes) is our superman.

"A lot of us say, I want, I deserve, I feel, I desire, but there has to be substance in the plan," Arias continued. "We have to prove we can remain independent. 'I want' doesn't provide a future. We have a responsibility to the community and the region, and our 600 employees."

Stokes said he has been at Gila Regional for three months. "I did a quick assessment prior to my arrival. I did a financial analysis. The commissioners have brought us a sense of urgency. This is the fifth hospital I've worked at. I've worked as a CPA and am a fellow of the Health Care Management Association. When I was at a hospital in South Carolina, I recommended they sell the hospital while it was still an asset. They didn't and now it's gone. Another one I recommended it could remain independent and it did."

"As for the future of this hospital," Stokes continued. "If this hospital can remain financially viable, we can't do it all today. We have to improve the revenue cycle. I have four focuses: 1) increase wages and benefits for staff; 2) improve the building infrastructure; 3) build the necessary capital for routine maintenance and capital equipment; and 4) improve the days of cash on hand.

"Why is this important to you?" he asked and answered. "We want to improve current care and make sure we have high quality equipment."

He said when he saw increasing net revenue, but decreasing cash, it was the first indicator of issues within the revenue cycle. "Usually there is a correlation with finance and quality. Gila Regional had virtually no correlation. We have quality, but finance was a mess."

Several items are up for consideration including becoming a critical access hospital, of which there are 5,534 in the U.S., with 10 in New Mexico.

"Every hospital I've been brought into had significant issues with revenue cycles," Stokes said. "If you don't have highly qualified leadership that is looking to the future, you have to change it. The first thing is to manage billing correctly."

He looked at financial trends at Gila Regional since 2015. "It is already a critical access hospital by operations. Inpatient care across the nation is declining. I estimate if GRMC became a critical access hospital, it would benefit by a cost-based reimbursement of $5.6 million."

Other potential items to achieve higher reimbursement including having a practice become a rural health center, breaking even on Medicare, restructuring the pharmacy and managing drug supply, and spending less on general supplies. Overall in implementing revenue cycle improvements, the hospital could net an additional $4.5 million annually. Meditech optimization is critical, Stokes said, in order to net revenue improvements. He said it's very common to bring in a company to optimize the management system. "We have contracted with Navin-Haffty out of Boston, which specializes in Meditech optimization. We are moving ahead to move to the next version of Meditech in August, because there are more than 2,000 changes from the version we have now."

He outlined initiatives, such as a swing-bed program, which is moving a patient from acute to skilled. The patient stays in the same bed but is moved between two reimbursement worlds. A labor management system would match the number of employees to the work load, with them being placed where most needed. "I think the nurse residency program, called an internship, is really exciting. It could provide a savings in cost avoidance." He said he would be renegotiating contracts.

"Every job I've ever had, I've been happy," Arias said. "I'm very blessed to be here at Gila Regional. It's amazing what one can do when surrounded by great people. As soon as I got here, I had to begin forming a team to make me look good. We have an extraordinary Board of Trustees, who are so supportive. I have a huge appreciation for the decision the commissioners have to make. They are taking it very seriously. They have given us the opportunity to remain independent. They are coming to us to get a better understanding of health care. Another of our major initiatives is our marketing strategy."

Doug Oakes, director of marketing asked why the hospital needs to be marketed. "This is a very good hospital that hasn't done a good job of marketing itself. We have only 36 percent market share, which means 64 percent of residents are leaving to go elsewhere. How much better are we as a hospital? We need to build relationships, so people can realize we are a better choice. We need to do a better job of telling our story."

He said he is already doing TV advertising, print advertising and improving internal communications. "We have to celebrate why we're good. I'm doing more social media. We are doing recruitment, so we can get great talent to come and stay here. We want to capture some of the lost market share."

Arias thanked the presenters and opened the session up to questions.

They will be covered in a subsequent article.