[Editor's Note: This is the final article on the Gila Regional Board of Trustees meeting on March 20, 2024. It begins with the chief nursing officer report.]

By Mary Alice Murphy

The second report from Gila Regional Medical Center administration to the Board of Trustees at the March 20, 2024 meeting came from Chief Nursing Officer Ron Green.

Green said this year Nursing is bringing back the annual nursing staff skills fair, with about 20 educational stations, which range from centralized to blood transfusions. "Basically, it's a refresher course for skills that aren't used every day, but refreshes knowledge so we're ready to go when we need to. "

He reported the construction of the new women and newborn service department area for labor and delivery continues well. "It remains on schedule, so we're hoping for a completion date toward the end of May. We received grant funding to update our nurses' call bell system and will revamp our telemetry system."

Green said the new pediatrician, Dr. Herr, joined Gila Family Medicine in February, "and he has quickly proven that he is instrumental in our team down there. He demonstrates a deep commitment to the well-being of his patients and the community. We're excited to have him."

He noted the nursing residency program is finishing up, with five going to the Med Surg (medical/surgical) department and one to the OR (operating room). "They will still have monthly educational programs and monthly meetings with their mentors or directors. I'm very proud of all the residents and our preceptors for the care they provide."

"Overall, staffing remains a challenge," Green said. 'We have 12 travelers, but that is a 50 precent reduction from three months ago. Most of the travelers are in the OR, ER (emergency room) and ICU (intensive care unit). For the past month, we've been working with HR (human resources) to recruit new nurses in the New Mexico Nursing Magazine and the Student Nurse Magazine. There are ads out there for Gila Regional."

Vice Chair Betty Vega, who ran the meeting, asked what the recruitment rate was for the Western New Mexico University Nursing Department.

Green said he didn't have an exact number, but he believed that last year in December, they graduated 13 and "we got six, so almost 50 percent. I don't know what last year's graduating class numbers were but we had 12 students join us last year."

Board Secretary Pat McIntire said the New Mexico Nursing Magazine goes to every nurse in the state, "so it has a wide coverage... if they read it."

The next report came from Interim Chief Financial Officer Tim Johnson. "I love being here. It's a great hospital with great people and a great community. It's been awesome. It's very special. But there's a lot of work to be done. Today I'll stick with the script, but going forward I won't be sticking to the script because I think the board needs to get some insight into some of the challenges we face. One that Mr. Dingus brought up [in the audit report in a previous article] is the Covid-related funds. the ERC (employee retention credit) that we had last year. There's one reason and one reason only that we did well last year and that's the number. We don't have those numbers anymore. We've got some work to do to keep ourselves financially stable."

He reported that gross revenue in February was $1.2 million better than budget and $1.9 million better than the prior year. Net patient revenue for February was $142,000 lower than budget and $376,000 better than the prior year. Total operating revenue for February was $1.2 million better than budget and $1.6 million better than the prior year. "Operating expenses frankly are way too high right now. The total operating expenses for February were $962,000 higher than budget and $1.3 million higher than the previous year. February had 109 discharges versus 124 budgeted. If you look closely at our utilization numbers, you'll see they are down and that's the lifeblood of the organization. We're passionate about engaging the community and Robert (Whitaker CEO) has done a great job, but we've got to do a better job. Average length of stay was 3.6 days compared to 3.1 budgeted. The ER visits totaled 1,364 versus 1,451 budgeted. I've spent a lot of time in the ER, and I've spent a lot of time with EMS, too. Total outpatient visits were 5,154 versus 4,834 budgeted. February's ending cash balance was $35.4 million versus $33.9 million at the beginning of the month. I don't know what next month's balance will look like. We've done a lot of aggressive payroll increases, which I think are awesome. We've done a lot of recruiting at much higher rates than in the past, which is extremely positive. We're excited about it, but we've got to be able to pay for it. Right now, I would like to see the cash balance stay where it is next month, but I don't expect that. EBIDA (earnings before interest, depreciation and amortization) was $655,000 versus $352,000 the prior period. Net surplus for the month was $326,000 versus the prior period of $59,000."

Johnson said he didn't know if the members realized that Dingus had really emphasized that ERC component, so what has happened nationwide since Covid, "is a lot of our expenses have gone up. Just like at your house. Inflation pushed up our expenses, as well as our payroll costs. So now, when we look at where we are today, our expenses are very elevated. The impact of that was masked by these supplemental funds that we got. So, now, we have some work to do to keep ourselves fiscally healthy. Lots of rural hospitals are struggling because they have not adapted to that. We have a great team here and so far so good. We're going to keep ourselves healthy, and that's what we're going to do."

Board Member Seth Traeger asked about the increase in the operating surplus and what it could be attributed to.

Johnson replied: "We got a cost report settlement. If you look at the other operating revenue, that was really the big increase. So, what happens, is once a year, we typically get a settlement."

Whitaker said it was noted in the fiscal year 2023 financial statements for a little over a million dollars, because it was earned in that period, but the cash didn't come until last month.

Johnson also said the hospital got a payment for the value-based purchasing program that Ramona (Wilson, chief quality officer) does "that is really outstanding."

Vega said the Chief of Staff report would be in executive session as Dr. Colicia Meyerowitz generally requests.

Whitaker presented his CEO report. "I want to talk about some more details on the board conference in May. JoAnn (Holguin, executive assistant) and I will be working on details and firming up the arrangements." He said he would send out some details on the New Mexico Hospital Association strategic planning session. Those dates are June 12-14, Wednesday through Friday in Taos.

He also said he would be holding another Townhall Thursday, May 28 for the community from 5-7 p.m. at the Grant County Veterans Memorial Business and Conference Center. "Transfers will be a big part of the discussion." He said he would be talking about how it works and some of the myths surrounding the transfers. "We also will schedule employee forums during May. The GRMC Foundation has talked about an employee picnic and a Gala in October."

He noted back in 2022 when the county commissioners were the hospital governing board, they developed a strategic plan. "We would like to refresh it and evaluate where we are. We'll do that sometime in the fall. We want as much participation as possible, with maybe a full day or two mornings or two afternoons to schedule what is best for the board, with about an 8-hour stint.

In terms of legislation he talked about the $5.7 million. "I, with U.S. Sen. Martin Heinrich, did request some federal funds for things like the MRI. I'll wait to hear back from their office. At some point, we'll come back with a resolution on it."

Member Jason Amaro asked if there were anything he could do. "If I can do anything, I will. I have good contacts with Sen. Heinrich."

"I put in five projects," Whitaker said. "So my contact here is Ms. Meyer."

Whitaker said he hopes to see the OR HVAC system start soon when paperwork is completed, "hopefully within the next 30 days."

Board Member Javier "Harvey" Salas asked about the status of the state funding of $5.7 million.

Whitaker said no one can do anything until July 1, but the governor signed and approved it. "The NM Rural Hospital Association CEOs are working on what has to be done. We will have to submit an annual application and then quarterly reports showing the costs to provide the services, and then the Health Care Authority will reimburse us for those costs. The details of the reporting are being worked out now. It will start the quarter of July, August and September and that's when we will begin to keep the records. So we wouldn't look to get the funding until Octoberish or November."

County Manager Charlene Webb, board ex officio member, asked about the Health Care and Delivery Access Act and when the hospital would see funding from that.

Whitaker said any changes to Medicaid program have to be approved by CMS (Centers for Medicare and Medicaid) and nothing will happen until those get wrapped up. "The latest I've heard from NMHA is that the change doesn't become effective until next fiscal year in July, because we are still in the current program, so we wouldn't see funds until late 2025 or early 2026. Those two programs are not correlated, so whether we get funds from one will not affect the other one."

Salas wondered if there were anything the hospital could do to get more people to attend the May townhall.

"We had a turnout of about 70," Whitaker said. "We hope for 100 next time. We'll do a lot of marketing and talk about it at the chamber, Rotary and other places."

Carolyn St. Charles, chief clinical officer for Health Tech, presented the next report.. She gave a couple of updates. The first addressed the upcoming Health Tech conference in Nashville in May, which brings together administrators and board members from the hospitals that Health Tech manages.

"The conference is always well received with lots of great speakers and the chance for a lot of networking," St. Charles said. "As Robert already said, Health Tech's Sherry Gander, myself and an environmental life safety surveyor will be here the end of April. I will be back for the April board meeting."

The board went into executive session to address the Medical Staff Executive Committee provider credentialing report and hear the risk and compliance legal report.

The board came out of the executive session. approved the credentialing as the only action item, and then adjourned.

To read the prior articles, visit https://www.grantcountybeat.com/news/news-articles/83696-grmc-held-board-of-trustees-meeting-032024 ; and https://www.grantcountybeat.com/news/news-articles/83726-grmc-held-board-of-trustees-meeting-032024-part-2