[Editor's Note: This part 2 and final article on the GRMC Board of Trustees meeting on Feb. 28, 2023. it begin swith the report from CNO Ron Green.]

By Mary Alice Murphy

The second update at the Gila Regional Medical Center Board of Trustees meeting on Feb. 28, 2024 came from Chief Nursing Officer Ron Green.

Green said: "An update on our nursing resident program—all six of our residents passed the state boards and will finish their residency program toward the end of March and will be given the freedom to be out on the nursing floor by themselves pretty soon."

He said over the past month, the department didn't see any significant trends on the travelers, as they have been fairly consistent for the month of February. "Previously we had seen about a 30 percent reduction in our travelers, and we have sort of maintained that level."

For this fiscal year, which started July 2023, "we have hired 17 nurses, six of those our resident nurses, and we've had about 10 separations, so we are positive by one for this fiscal year to date."

Trustee Will Hawkins asked if any of the separations were supervisory positions. Green said one was a director, "our emergency director. It includes our former CNO."

Trustee Javier Salas asked if the department does exit interviews.

Chief Executive Officer Robert Whitaker said the department is just starting that process.

Green said: "A few were leaving the community and going elsewhere."

Salas said it is important to have the exit interviews.

Risk Management Director Denice Baird said the HR (human resources) does provide exit interviews, but only for those who want to participate. HR also keeps the records.

Health Tech Regional Vice President Scott Manis said the Joint Commission requests such a report at least once a year.

Chief Executive Officer Robert Whitaker said since the new Interim Chief Financial Officer Tim Johnson had only been at the facility for three days he would give the financial report.

Whitaker noted that discharges for January stood at 99, compared to a budgeted 124 and to 144 from the prior year January. "The level has been down for the past six weeks. But conversely, the outpatient visits have gone up to 5210 compared to 4834 for December and 4865 for the previous year."

Surgeries in January totaled 227, compared to 252 in December and 239 for the previous January.

ER (emergency room) visits were 1364 compared to December's 1351 and 1351 last year January.

Gross patient revenue brought $22.5 million compared to a budget of $19.3 million. With $15 million in deductions from revenue, the net patient revenue was $7.7 million compared to $6.5 million the previous year.

Total operating expenses for the month of January were $7.2 million compared to a budget of $6.5 million because of an increase in contract labor, physician fees and supplies, which include pharmaceuticals in the supplies number. For EBIDA (earnings before interest, debt and amortization) the hospital had a net operating surplus of $70,000 compared to the prior year of a loss of $261,000. Including investment income and other non-operating revenue, the net surplus for January stood at $197,000.

Whitaker said for year-to-date numbers, the hospital has an operating loss of $317,000 compared to the prior year loss of $1.746 million. "We had a huge loss in September and we're still working through that, but the overall surplus for January was $28,000."

Manis also noted the ERC (employment retention credit) $6.7 million funding that came in last year as a one-time payment.

Whitaker continued the finance report with key measures of liquidity. "Our accounts receivable (AR) days are trending well at 38 days. We have 144 days of cash on hand and our accounts payable (AP) are trending at 49 days. So all are doing well."

Hawkins asked what 144 days of cash on hand translates to in dollars.

"Cash is about $35 million, that's an all-in number," Whitaker said. "Some of that is not liquid, about $6.1 million is tied up in CDs and other investments.."

Johnson said that's not a true cash on hand number because of liquidity.

Salas said he had a round-about question. "How does a patient learn about the swing bed program that will bring in revenue? If I'm sent out to Las Cruces, for instance, how do I know I have the option to come back to Silver City?"

Whitaker said the swing bed program needs to be marketed. "We did one promotional item, but we need to work with the case management staff to develop a good robust swing bed program and develop good relationships with tertiary systems where people go."

Johnson said it is very underutilized, and "we'd love them to be here. One of the keys is reaching out to the larger facilities, so they know we have it. It's a very underutilized program, and it's very valuable and a great asset for such a small community."

Salas asked if a person could just ask for it. Both Johnson and Whitaker said yes.

Chief of Staff Dr. Colicia Meyerowitz said the swing bed program has been used for patients that were already at GRMC. "It has worked very well, but there are regulations. It has to be straight Medicare, not United Health for instance. It is more like skilled care than rehab."

Hawkins said a question he has been asked is what triggers sending a person elsewhere by flying them out.

Whitaker said it's usually because they need a higher level of a sub-specialty than Gila Regional can provide.

Meyerowitz said there are multiple factors. It may depend who is on-call at the emergency room. It depends if the on-call is comfortable dealing with the injury. It depend on what type of injury it is, and the mode of injury. "For instance, if it's a massive chest injury, we don't have cardio-thoracic surgery here or platelets. For orthopedic, it also depends on what tools we have."

Hawkins asked if the board could have a report on the number of outbound patients.

Johnson said it's called "outward migration, and for whatever reason we're not serving them here. One of the things we're doing is a health needs assessment plan which should be part of our financial strategic plan, so we're looking at five years and what level of care we need here. What we should be doing is caring for the people who are here, but there are certain things. We can't do open-heart surgery or certain types of transplants. We cannot accommodate them financially. We have to look at the outward migration and it's super critical to take care of them here, if possible. If we are looking at a new facility, what are we going to offer?"

Hawkins said sending someone out to El Paso incurs large fees. "A person asked me about it, because he was transported out, and then after it was taken care of, he drove home."

Meyerowitz said she would present the chief of staff report in executive session.

For the CEO report, Whitaker said he had a few things. "I want to remind trustees that the Health Tech leadership conference will take place Mar 4-8. The New Mexico Hospital Association will meet in June in Taos. I just got the information, so I will get it to you. We have talked to two vendors for the Community Health Needs Assessment. I've gotten one already, and I'm waiting on the other."

For a marketing update, he said the hospital is going through a website refresh. "We're doing some marketing projects. Digital is the way to go. We have five videos that we've created. We just did one on pediatrics with Dr. Herr. We have a YouTube channel. Two of the videos are also on Facebook as well as YouTube. We will keep promoting Gila Regional."

On construction projects, he said the Maternal-Child project is progressing toward an anticipated completion by the end of May. "We'll have a ribbon cutting." The orthopedic clinic was also moving toward completion at the end of April.

"On the OR (operating room) air handler, we're still waiting on federal permits, but we're closer to starting," Whitaker said. "Because it's a federal grant, there's a significant amount paperwork to get through."

Hawkins asked if the funding is locked in or reimbursable.

"We have to go through the process before we get any dollars or even issue a permit," Whitaker replied. "We appreciate (Southwest Council of Government Executive Director) Priscilla Lucero for helping us with compliance with the contractor and with the EDA (economic development administration) grant."

Manis said Health Tech is working on a business intelligence tool, which will provide an electronic data warehouse, primarily for financial records, for all the facilities they manage. "Once it's completed and ready to roll, it will be provided to all our hospitals, without additional cost. We're pulling in information from our various medical record platforms, your is Meditech, but there are three others. None of the information will be shared among hospitals. There may be some best practice targets. More to come. Once we get it we'll give you a short demo on the power of it. It will be amazingly powerful."

Trustee Seth Traeger asked it if was targeted specifically at the executive level.

Manis said he didn't think it would be accessible even to the director level. "We're building it right now, working on our common descriptors."

Trustee Jason Amaro asked if the data remains on premises or is available through UPI or is it being sent.

Manis said the data has been being sent for a while. "The data came from here fairly early on. I think we'll have a fairly high level of the product within a couple of months."

"We are not sharing it back just yet," Manis said. "We have a monthly meeting with CEOs, and we hope to have a demo for next month's meeting. Some hospitals are not even sending data yet. Some have older systems that need a special contractor to work on it."

Hawkins asked about where security stands.

"At this stage we have no concerns," Manis said.

He said Carolyn St. Charles will be at Gila Regional next month. "She looks at the quality data and best practices. She'll spend probably at least a day or two with you, Ramona (Wilson, Chief Quality Officer). She does mock surveys and provides a written report back."

Whitaker said she looks at the hospitals policies, procedures and outcomes and says: "Here's where you need to improve. It's a preparation for the 'for real' Joint Commission survey "

Wilson said St. Charles usually brings a couple of other people with her. "When she's here I partner with her on the clinical and also on the HR. I asked her to look in every area, so we can find the opportunities and where we need to focus. I appreciate when she's here. Our last joint commission survey went very well."

Baird said staff has expressed their appreciation for the experience and practice as preparation for speaking on issues when the real survey is here.

Whitaker said CMS (centers for medicare and medicaid) has a huge list of conditions for participation. All these conditions are what the Joint Survey will cover. "I'll do an education on it next month."

Chair Dr. Fred Fox asked how long the accreditation lasts. The reply was three years. "There are always changes and the mock survey prepares staff for them."

Manis said on swing beds, St. Charles has been hosting a series of webinars, and the second one is coming up on swing beds on March 8.

Traeger said he has had connection issues trying to get into the webinars. Manis said each one is recorded and available on the Health Tech website. "I appreciate the kind of information the chair shared with us on critical access information."

The board then moved into executive session. After the session, they approved the credentialing report, the risk and compliance legal report and after discussion in closed session, approved items D and H.

Please see part 1 for the items mentioned above at https://www.grantcountybeat.com/news/news-articles/83077-grmc-board-of-trustees-meeting-held-022824-part-1

To read the first part of this series, please visit https://www.grantcountybeat.com/news/news-articles/83077-grmc-board-of-trustees-meeting-held-022824-part-1 .