By Mary Alice Murphy

After the usual opening of the Gila Regional Medical Center Board of Trustees meeting, with having members read the mission, vision and values, Chair Dr. Fred Fox introduced the newest member, Gail Stamler, who filled a vacant position.

He then recognized Susan White for her five years of service in patient financial service and Lalena Maynes for her 15 years of service with Beginning Years. Neither was in attendance.

With no public input, the trustees addressed and approved the consent agenda, which included the minutes from the July 25 regular board meeting and the July 22 finance committee.

The next item on the consent agenda approved the purchase of an Osage ambulance F450 Warrior 4X4 from JK Ambulance Sales and Services with $220,320 from the NM EMS Fund Act to replace a 24-year-old ambulance, with an expected delivery in the summer/ fall of 2025.

Also approved on the consent agenda was a supply purchasing master distribution agreement for a three-year term with Medline for July 1, 2024-June 30, 2027.

With no old business, the trustees approved the new business item to amend the GRMC board of trustees bylaws to stipulate a Grant County, New Mexico residency requirement to serve as a board member, which must also be approved by the Grant County Commission.

The first report came from Chief Nursing Officer Ron Green. He said they had started a nursing group review committee, which would hold its first meeting the following day. "We have about 20 nurses coming in and we'll have them fill out some applications, so we can pare it down to a more manageable number less than 20. "But it's nice to have the support from our nursing staff and their showing interest in this committee. It will play a vital role in evaluating the performance and professional conduct of our nurses, through assessing clinical practices and identifying areas for improvement. We're excited about it. We did put an offer and received an acceptance for a surgical services director, and she will start in September. We've had an interim for almost a year. We are also in the process of interviewing a permanent emergency director as well, so we're hoping we can finalize that in the next couple of weeks."

Board Member Pat McIntire said the original advertisement for nursing personnel went in the New Mexico Nurse, which is for New Mexico nursing, a publication of the Board of Nursing, and this publication goes out to every single registered nurse and LPN in that state. "Congratulations."

Fox said: "I'd also like to say that I like the idea of the nurse peer review committee. I think we have some excellent nurses here, and the more they are involved in peer review and medical management, the better it is for patient care. In the last year, there been several articles, some appearing in some of the medical magazines about the improved quality of care when nursing is involved, both within their own evaluation, but also within team approach and with providers and physicians. And I think that's a good step in that."

Next came Chief Financial Officer report from Leonard Binkley. "The volume trends beginning with the fiscal year 2025 in July 1, show that outpatient and surgical are both up, with inpatient and emergency visits a bit down, but overall fair volume.
Looking at discharges, we had 104 discharges in July. That's down to budget by 14 or about 12% and down to prior year, 29 or 22. Our surgeries were 253, up to budget, 2% up to prior year; 65 or 35% . We had good volume in outpatient visits. with 5,259 that's up 426, to budget, or 9% the budget, so very strong there up to prior year. We had Emergency department visits 6%, a little down and flat to budget. And prior year, we were flat. We did have 1,335 visits, which equates to 43.1 visit per calendar day and our run rate last year, fiscal year, we did 45.7 so we count about two and a half fewer.

"I'll move over to the financial. For the month of July, looking at the bottom line, $505,000 surplus. so, we're $115,000 better than budget. Compared to the prior year, July, we had $48,000 positive bottom line. So we were $457,000 better than prior year. The reasons for the better than budgeted performance and better than prior year is, if you look at the other operating line, there $612,000 that is a hospital value based program, quality program, the state of New Mexico quality program. We have $340,000 disproportionate share money. We got the first quarter payment on that $166,000 out of $600,000 so that's the vast portion of $612000 down at the bottom. Under other non-operating revenue, you can see $884,000 so that's entirely made up of the telephone system enhancement grant related to that. So looking at the net revenue line—$7.3 million in net revenue compared to a budget of $7.5 million so we were down at $231,00 to budget. And prior year, we did $6.8 million. So we were up little over $500,000. In other operating revenue, $7.9 million in this budget, compared to prior year, we did $6.9 million in total operating revenue. A big piece of $700,000 of the increase is we had four providers that got bonuses—productivity bonuses in February, and we did a market adjustment and a cost of living adjustment for another $116,000.We had some increase in cancer center volume, up about 34%.

"We had some big operating expenses compared to the prior year. We were up $421,000 we had some big invoices there for repair and maintenance.

"For the first month of the fiscal year, we'll talk about liquidity, which are all trending in the right direction. Net AR (accounts receivable)days doing very well at 30. Current ratio 3.8 is trending. The average payment period is 66 days, nothing unusual for critical access hospitals."

Chief of Staff report from Dr. Colicia Meyerowitz would take place in executive session.

Chief Executive Officer Robert Whitaker said he would just go through a few items, some construction updates. "You'll notice on 32nd street, the three monument signs, the signs themselves, have been replaced. We still have some work to do on two of the bases and just to make them nice, and so that's still going. We have work we're doing over at Billy Casper Rehabilitation and Wellness Center. We've done some landscaping, and we're going to move to the inside, both exterior and interior work for some concrete work on the outside and some exterior painting, and a few other things, signage, as well as things on the OR HVAC here. This project's been out there a long time, and I'm happy to announce that the EDA has approved all the language in the agreement and the documents, and so those have been signed and we can get started on that project. Then there's another construction area. We looked at the registration offices for the emergency room as well as the outpatient area, and are looking at changing it up so there's better a better workflow, better patient experience with those two areas. So there'll be changes happening with that,. On equipment updates on the MRI, I did get a notice of award, which came this week, So, we had to register with the HRSA website, and then we'll get that going. And then phones, our phone project is still progressing. We're about, kind of midway through that project, Dragon software for dictation, that's happening next week,. And then telemetry, we're getting started to work on our telemetry project. So the vendor is going to be on site pretty soon, September. And then after we do that, we're going to replace the nurse call system. I just want to let the board know we made our monthly and annual recognition of employees. Every month we do a service star recognition, there is clinical employee as well as a non-clinical employee that we recognize every month, We're doing a big kind of celebration where everyone comes into the courtyard cafe and the directors can read the kind of the recognition, and employees there, and there's some goodies and snacks. And then we want to have an annual dinner to recognize years of service for staff that they have in increments of five. We will have a nice annual dinner recognizing those individuals for the years of service and go through that. We don't have a date yet.

He said he wanted to talk about GRMC Friends and Family day. "We've got some football games which are free to attend. The first one is we'll talk about WNMU. That's on Saturday, September 14. It's a 6pm game, 3pm tailgate. We'll have a bunch of food and drinks and the big GRMC tent out there. And Friday, September the sixth. So this is not this coming Friday, but next Friday, Silver High School versus Deming. That game is going to be free for anyone who wants to attend. Doesn't have to be a GRMC employee, but just anyone who's coming into town and then, and we'll be out there with just a bunch of stuff, just recognition of things and having a good time. And then Friday, October the fourth, with Cobre High School and their homecoming game. So I know the Cobre school board made mention of us in their school board meeting and had some really nice, positive kind of partnership and collaboration type things to say. For our community health needs assessments, we've concluded town halls and focus groups and so now Holleran, our consultant, are working through that gathering all those things together. They do plan to present the community health needs assessments and the findings and everything at the October board meeting.They would like to take some time to present the community health needs assessments and findings, and then the next following day, they'll be a group of individuals who will set some priorities, and then from there, the next day, we'll have a working session group with the folks to put some parameters and plan around those priorities on October 23. On Senate Bill, 161 to update the $5.7 million, I did submit our financial plan for that. It has been received. I spoke to someone today, and they have it, and everything's okay. I need to make one small tweak to it, but they said everything looks good. So again, we have to submit quarterly reports to show that we did expend funds, and then they reimburse those funds for a period of two years.

Patrick Banks of Health Tech said they are progressing with the strategic planning process and interviews have started for that. "We're looking at a retreat date in November 15th and 16th. We'll make sure that we keep communicating about that over the next couple months as this process goes through. I'm excited for the board and Robert, all with about a year under your belts and the ability to take some time to put into context what you see and what you need to really work together on for the future. You can come out of this with, you know, a lot of different things depending on what the goals for the hospital are. But the main theme is that you all get on exactly the same page as far as what the expectations are and what you need from each other to be successful, and so we're thrilled to facilitate that process moving forward. I also know that we have a leadership conference coming up in the spring. Stay tuned for details on that. I've heard only rumors, so I don't want to announce yet, but I think you'll be happy with the location once it's announced. And then, you know, finally, for me with a chance to come back here after some time away, and I might make my comments on where things are. I guess I'd be ducking if I didn't talk a little bit about election season and some of the noise in an election year. I don't think anybody can incredibly say exactly what Washington, DC is going to look like, and who's going to be running CMS (Centers for Medicare and Medicaid), and exactly what the platform as it relates to healthcare is. What I do know is that 41 states at this point have adopted Medicaid expansion. Medicaid expansion has proven durable and popular and hugely beneficial to patients in both rural and urban areas. And so I would caution people to sort of let any noise blow over you. And don't listen too hard this election season. Worry about the country as much as you want. Certainly vote, but don't worry about the hospital. This year, I don't think Medicaid expansion is going anywhere immediately. Saying that, you know, I try to come up with an excuse to talk about days cash on hand every quarter. And this is certainly it. There's always going to be some uncertainty in health care. So much of our funding and so much of what we do relies on support from governments, but in the form of Medicare reimbursement, Medicaid reimbursement, direct subsidies, grants, the like, the difference between a risk and an uncertainty, as the CPA is defining, is that a risk is a little more identifiable. You know, something might break, and we might have to fix it. You can ensure a risk and uncertainty in the world, as it relates to healthcare, could change in a hurry. We don't know how, but we know it could. In the face of uncertainty, you control what you can control so you provide really high quality care, which I know we're doing. That's important, because generally, people that fund hospitals that take care of their community, but you also make sure that your cash balance is, you know, able to support challenges and still fund capital needs going forward. And so as hospitals go, you have done an incredible job over the last three years of building up cash balance to point where, you know, frankly, it's past the minimum threshold for everybody, really safe and comfortable, and to start planning the kind of capital budget that Robert's gotten for the year. But that, you know, it's a minimum target for reason and really encourage everybody to, not just at Gila, but in the community, to look at financial resources held by the hospital as the only true form of insurance against uncertainty of a critical piece of public infrastructure that you can have, and with that, I'll turn it back over to you."

The board went into executive session, and when they came out, they approved the medical staff executive committee (MEC) provider credentialing reports and the privileges, policies and forms of the MEC. And three, they approved a consultant to conduct a facility replacement study.

Adjourned.