By Mary Alice Murphy

Toward the beginning of the Gila Regional Medical Center Board of Trustees monthly meeting on Jan. 22, 2024, Chair Dr. Fred Fox commented that he, the GRMC Chief Executive Officer Robert Whitaker and others would attend the Grant County Days the following week at the 2025 Legislative Session in Santa Fe.

"We will be advocating for heath care in the county and there's been some recent developments that might help move us in appropriate directions," Fox said while not explaining the recent developments.

Under recognitions, Fox noted that Jodie Giese has five years of service in case management; Gwendolyn Burns has 15 years of service in nursing; and Amedeo Ferruccio has 25 years of service in physical therapy. None was present.

With no public input, Fox moved to the Consent Agenda. It included the governing board regular meeting minutes draft from Dec. 18, 2024, theDec. 16, 2024 finance committee meeting minutes draft and the Jan. 7, 2025 executive meeting minutes draft.

Also part of the consent agenda were several considerations of approval of resolutions.

The first addressed disposition of an asset, the transfer of one ambulance to the city of Bayard. Whitaker noted the older ambulance would be used by the police department for storing investigative equipment.

The next resolution addressed renewal of the Microsoft Office 365 software and Active Directory, a cloud solution program through PC Connection.

The final resolution would accept the financial audit report, which had been presented to the board in public session in December.

Trustees approved each component of the consent agenda separately.

With no old business, the members continued to new business

The first item considered a master business agreement and sales order for Quality Data Analytics through Medisolv, Inc. Whitaker said the hospital has used it in a different structure, and the hospital will now contract directly with the company. The three-year contract allows the company to extract and submit data to various regulatory agencies.

The second considered an amendment to the applications for Employee Health Benefits Program, including Stop Loss Coverage with Blue Cross, Blue Shield for the next year.

"We've been with Blue Cross for a while now, and we looked at a few other carriers, and Blue Cross still seems to offer the best plans at the most cost effective rates for us. I recommend we continue with them," Whitaker said. "It is self-funded by the hospital, but Blue Cross Blue Shield manages it. It does have an increase in premiums of 10.7 percent."

To a question, Health Tech Regional Vice President Scott Manis said the hospital has been self-funded for about four years. "We did it during my time [as interim CEO]. That means we pay 100% of all the claims that come through under the plan, and Blue Cross just administers the plan on our behalf and administers the claims, but all the claims themselves are funded
by us."

Whitaker said the increase was what Blue Cross said the hospital needed to cover claims that are expected to come through the system. However, GRMC, as the employer, absorbed all that increase and took on more to give a significant decrease in the amount of what employees pay on their portion of that total premium.

He noted there are three plans, employee only, employee and spouse and employee with children. And every plan had a decrease in what the employee would have to pay. He also explained that by increasing the stop loss, which puts more risk on the hospital, it keeps the premium increase at just 10.7 percent.

The third item addressed the non-exclusive Elite 365 physician recruitment agreement for three specialties. "It's sort of a contingent search. There is a fee up front to initiate the searches, and then there is a placement fee at successful completion of the placement. We're looking to expand our resources in terms of recruiting positions and needed specialities. I have a meeting next week to look at their resources pf New Mexico Health Resources Group, which also does physical recruitment. We have a push for urology and we want to really get our senior care program up and going. We're looking forward to an adult medicine or geriatrics Nurse Practitioner that would focus on 55 years of age and above. We are also having some planning discussion, like a geriatric clinic, focusing on annual wellness visits, a lot of preventative screening exams, preventative diagnostic testing, a lot of care coordination and chronic care management. The provider can be a primary care physician as well.The program would involve a registered nurse in May to really kind of solidify and have a very comprehensive senior care plan, make sure that care within our health system and about our health system is continuous."

Fox noted that a benefit of the program, because of the shortage of providers in the community, with people going to multiple places for care, they end up on a real smorgasbord of medication, and so something like that can help with sensible de-prescribing and making sure that medications are appropriate for the patient.

Trustees approved each item individually.

Next came reports and updates.

Chief Nursing Officer Ron Green said the nursing residency program had begun the previous week, with three of the recently graduated nurses, having already passed their influx. "We're also working and trying to finalize the nursing student from the Dona Ana Community College as well, to get the nursing and residency program started the first of February."

"We" have already received 17 nominations for the Daisy Award," Green continued. "This just highlights our nurses, their care, their compassion and their commitment to our patients."

He reported that on Feb. 20, the hospital would be receiving 25 new hospital beds. "This will bring new technology and safety features to the majority of our beds, which we hope will help with our fall program and just provide better care to our patients as well."

Trustee Gail Stamler asked: "How long is the residency program?"

Green said it is tailored to the student, but runs from four to six months, but once they decide on their final placement, "we may extend it to a full year. They will still have a mentor and support for them after they're out of residency as well."

He noted that the daily inpatient census at the hospital is about 10, and emphasized that the 17 Daisy Award nominations for that small patient population speaks very highly of the quality and compassion of the care that those patients are getting, that the patients and their families can identify that many different individual nurses."

Interim Chief Financial Officer Leonard Binkley presented the financial report for December 2024.

He noted the trends for December showed a good month, with strong outpatient volumes. "Our outpatient revenue for December was up to budget about $1.8 million and up to prior year $1 million. Outpatient numbers were 5, 291, about 171 per day. Surgical volume was down by 70 with 192, as we had a number of physicians taking time off for the holidays. ER volume is up to budget, also. We had 1,472, about 47.5 a day about two a day better than prior year. For the inpatient discharges, we had 113 discharges in December. That's down to budget by three or 3 percent and down to prior year by 10 or 8 percent."

Before Binkley gave the financial numbers, Whitaker noted that the 2024 legislative session with Senate Bill 161 had allocated reimbursable funding to rural hospitals. In addition the hospital received HDAA (Health Delivery and Access Act) funding.

"We received the first quarterly payment," Whitaker said. "Due to auditing regulations, we will report it as other operating revenue. We want to normalize our financial reports, without those supplemental funds to show how we are functioning without those funds."

To report monthly results, Binkley started at the bottom of the page, where the normalized surplus stood at $268,000, better than budget and better than prior year. At the top of the page, he reported gross patient revenue of $22.3 million, up $1.3 million to budget and up $1.5 million to prior year. "The drivers there are the outpatient volumes." Net patient revenue is $7.9 million up to budget by $575,000 and up to prior year. Other operating revenue, as mentioned above, was $1.3 million.Total operating revenue was $9.1 million. Total operating expenses were $7.9 million. EBIDA (earnings before interest, depreciation and amortization) stood at $1.2 million, with a $1.2 million net surplus."

Binkley noted the primary drivers for the increase in other operating expenses are the market adjustment for salaries, which included cost of living adjustments and insurance increases.

For fiscal year-to-date numbers from July 1 - Dec. 31, 2024, the normalized surplus is $2 million, which is better than budget and better than prior year by $2.2 million. "Last year at this time, first six months, we were negative $166,000. so quite a bit of improvement."

For year-to-date, gross patient revenue is $138 million, up $6.2 million to budget and up $11.8 million to prior year.

Total operating revenue is $51.1 million, which is up to budget by $1.7 million and up $5.6 million to prior year,

Total operating expenses YTD are $46.1 million, up $717,000 to budget and up $2.6 million to prior year.

The drivers are the same as already mentioned, he noted. "That gets us to a $5 million EBIDA for the first six months. That's up to our budget by $948,000 and up to prior year by $3 million, giving us a surplus of $2.8 million, which is up $229,000 to budget and up $3 million to prior year."

On the key measures of liquidity "looking at AR (accounts receivable) days at 46, which is better than budget and up a little bit to to prior year; still very good."

Net cash days cash on hand, 162, better than budget and better than prior years significantly.

Trustee Will Hawkins said: "It looks like we're seeing a reduction since July of the cash on hand. from July to December, we're seeing a steady decline. Is that just due to investing more into the hospital resources?

Binkley explained: "We funded our capital. We spent over $6 million in capital during that time."

He said the current ratio in the hospital is a lot stronger than in other critical access hospitals. "The higher the ratio, the better. The math on that is total current assets divided by current liabilities, and it measures the ability of a company to cover short term obligations with its short term assets. So, it's a good position."

He also noted that "we have made progress on the audit findings. We hope to have all that complete by the end of January." He said the auditor had recommended they enhance the reporting for their capital assets, so "we engaged a firm that came in last week and went through the hospital, the clinics, the storage area and reported on all assets over $5,000. We had sent them our list and a blueprint of where they would need to go. They went everywhere. So we're still reconciling the assets, and we'll have that done as well by the end of January."

Trustee Javier Salas asked Binkley if he had done the breakdown for what was spent for travelers.

Binkley said he thought the trustees wanted it before the next finance committee meeting, and Whitaker echoed it.

Salas said it can be presented at the next board meeting: "I just didn't want it to get lost in the cracks. I wanted to know what everybody was paid, you know, for housing, for travel, for everything, so that we could see it for future planning. Would it behoove us to think about getting something on our own? We're paying a tremendous amount for housing.Will it behoove us to plan to get some kind of housing into the plan? I just wanted us to take a look at the whole scope of things."

Trustee Seth Traeger said: "I'm assuming that'll be on our agenda for when we meet in February. Yeah? thanks."

Fox said Chief of Staff Dr. Colicia Meyerowitz would present her report in executive session.

Whitaker presented his CEO report. He first shared part of a letter he had received. He read; "It is my pleasure to inform you that whenever I have been at GRMC for any reason, I want to compliment the people who have taken care of me. I visited the ER recently with some scary issues. I fainted and was shaking. The present crew was absolutely wonderful. I hope you will give them some recognition." Whitaker reported that she told him she had been treated with kindness and compassion and understanding.

"I asked Ramona (Wilson, Chief Quality Officer) to please contact the patient and tell her thank you for recognizing those who took care of her."

He then reported that several ongoing projects are in various stages. The phone replacement project is almost done and will be switched over in a few days of the following week by disconnecting the old phones.

"There should be some exciting things happening," Whitaker said. "The governor in her state of the state address announced that she wants to set up a fund that will help with medical malpractice coverage within the state, and that was exciting to hear. I know that public health is going to be a big part of what she's looking for from legislation and what they're doing."

He also shared that the New Mexico Health Care Authority announced that they are partnering with behavioral health organizations throughout the state to create a certified community behavioral health clinic program, and there are five that are started and set up that they're working with, and they're looking for partners in other areas of the state as well. He said no one has reached out to him yet.

The second item is that the New Mexico Hospital Association in its branch called the Hospital Services Corporation received a grant from the Health Care Authority to provide behavioral health transport. And so they're setting up some regional systems that will transport behavioral health patients from rural areas to more central locations.

A trustee asked about the 25 beds allowed in critical access hospital and how they are actually calculated. How many are nursery, intermediate, nursery, ICU, whatever?

"It is specified on our license,"Whitaker said. "We have two Level two nursery beds, six ICU beds and 13 are med surge beds."

He also explained that swing beds are also in those med surg beds. "That's where there might be some some confusion. We are licensed for 10 swing beds and that license means that at any given point that we can actually bill for 10 swing bed patients, and they don't count against the 25.You can put a swing bed patient in one of the six ICU rooms. You can put a swing bed, patient in one of the 13. If those 19 beds were full, you could technically put a swing bed patient and be okay in one of the labor and delivery rooms. So the 10, the 10 swing beds that we're licensed for are flexible, and we can put them in the 25. We can't go over the 25, but if a person is in for observation, that is considered an outpatient."

Manis presented the Health Tech report. "I'll save some comments for executive session. I've mentioned a couple of times, the Health Tech, community, hospital leadership conference registration had opened up for hotel rooms. JoAnn (Holguin, executive assistant to the CEO) has that information. It's the time to start thinking about whether you want to attend or not, and she can make reservations. That's September 7-10, in Louisville.More information will be coming about the agenda and speakers and things of that nature."

He continued: "One of our colleagues from Health Tech, Marcella Wright and Faith Jones are involved in the care coordination program, which is strictly an outpatient program. I think we've talked about it here a few times before, but it's a mechanism to coordinate care of patients, both in the rural health clinic from a family medicine standpoint, as well as in cardiology and oncology, and as we get into other things like senior care. We might even look at another care coordinator person, but you have two of those people in the organization now who provide care coordination services for the hospital and the clinics Those are separately billable from the face-to-face encounters that the providers are providing there. They're time based around various illness categories or other outpatient acute categories. And so Marcella and Faith are going to be focusing, when they come around, on annual wellness visits and then chronic care management, chronic care, as we were talking about a little while ago. You know, when patients get on all these different medications,, one person can kind of filter and make sure that the left hand and right hand are talking about those patients, weights are being monitored, blood pressures and things like that. Marcella and Faith will be working a little bit more closely with the team here. I know Ron's had experience with them over the past three or four years. They are going to be training people here, or if you already have people here that are your care coordinators, they can even work with them to make sure those programs are working the way they should be."

The trustees went into executive session.

When they came out of executive session, they approved the Medical Staff Executive Committee provider credentialing reports; a new three-year employment agreement with Stephanie Leslie, MD, in the family medicine rural health clinic; a three-year renewal agreement with general surgeon Dr. Laurence Gibson; a three-year renewal agreement with Dr. Tsering Sherpa as infection prevention medical director; and a three- year renewal agreement with Dr. Gregory Koury as EMS medical director.