[Editor's Note: This is part 1 of the County Commission meeting on June 12, 2018. This article features the extended report from GRMC personnel.]

By Mary Alice Murphy

When it came time to approve the combined work session/regular meeting agenda on June 12, General Services Director Randy Villa requested that the public hearing be taken off the agenda. "The proclamations declaring extreme or severe drought conditions in Grant County and the imposition of fireworks restrictions are already in place. We don't need to add anything to them."

The next item featured Gila Regional Medical Center Chief Executive Officer Taffy Arias and Chief Financial Officer Richard Stokes giving their monthly report.

"It's been another good month for us for recruitment," Arias said. "We are extending an offer to a pediatrician. We have a new general and vascular surgeon who has accepted the offer, but the contract is not yet signed. He has already applied for his New Mexico license. We have completed our analysis on the wage index. We may be able to announce a wage adjustment soon."

Stokes began his financial report by giving the statistics for the end of April, which is the last full month's report that has been approved by the GRMC Board of Trustees.

"We had a $12,313 profit for the month, which brings the loss to date to $327,000, compared to a $6 million loss last year for the month," Stokes said. "The hospital held six town halls with the employees to have them talk to us and make recommendations to us. Last month, we met with the Joint Commission (on the Accreditation of Healthcare Organizations – JCAHO-pronounced Jayco). We switched to single patient rooms about the same time and received an A rating from Leapfrog in quality."

For the key performance indicators, "we collected $4.922 million, bringing our days of cash to 73, our days in accounts receivable to 69 and our days in accounts payable to 56. There is a correlation between the latter two numbers and we're trying to get them closer together."

Commissioner Harry Browne asked if Stokes was concerned about the inpatient census.

"In May, we were fairly steady," Stokes said. "In June, we have seen fewer inpatients. It's challenging. We are letting staff have extended weekends. That's one way we're managing it."

Arias noted that numbers notoriously drop in summer months. "We don't wait to make staffing changes when it hits. We look at it daily and sometimes three times a day."

Browne asked if it was affecting morale.

"It always affects it," Arias said, "but they like the four-day weekends and don't want to spend their paid time off. Even management may go to a 32-hour work week."

Commissioner Gabriel Ramos asked how billing was doing.

"We continue to find additional issues," Stokes said. "We will have a meeting this afternoon. We expect the major problems in the revenue cycle to be addressed by the end of the week. Last month, patients asked us for a different bill format. Starting in July, the bill will be more logically structured. Things are going how I expected."

Stokes said two employees had been placed back in the business office and one elsewhere in the hospital.

Edwards asked about the Meditech operations.

Stokes said at their 2 p.m. meeting that day, the lady from HRG (Human Resources Group, which is looking at the billing and revenue cycle issues) and two people from Navin Haffty, who are on site looking at Meditech issues) would be at the weekly meeting. "Like any major project, there are some things going really, really well and some things we need to do some work on. Up to a week and a half ago, we didn't have the parties aligned. Now they are. The No. 1 reason for the Meditech upgrade is patient safety and alignment to the revenue cycle. Meditech is going very well and on target for an August 22 go live."

Edwards said: "Meditech was not one of our happiest situations. It came in way over budget."

"We have estimated about half a million for this upgrade," Stokes said. "And we are right at that. We are adding limited assets to make sure for the August 22 date. The core pieces will be posted. Other items we want to add six months down the line. The staff has been ecstatic at the Navin Haffty expertise."

Arias said: "Remember when I had meetings with the community? Many people had concerns about billing. We took them to heed. We have resolved issues. Come to see us and discuss them and we will resolve them. Please come in. We are on track on billing very quickly."

Commissioner Brett Kasten asked what the days in cash and the accounts payable and accounts receivable are "today." When Stokes said they had not significantly changed from the April report, Kasten protested that it was hard to make a decision with 43-day old information.

"We manage our cash outflow based on our cash inflow," Stokes said.

Kasten asked what other departments in the hospital are run by outside companies.

Arias replied: "The emergency department, the hospitalist service, radiologist and pharmacy. The anesthesiologists are not under contract as a company, but as individuals."

"And, of course, the cancer center by UNM," Kasten said, which Arias confirmed.

"Do you have plans to outsource any other departments?" Edwards asked.

"Not that I know of," Arias said. "And I want to underscore that we sent out the billing to get it fixed, so we can bring it back in house."

To a question about the cafeteria, Arias said only three employees are from outside and the rest are GRMC employees.

"Were you in the black in May?" Kasten asked. "I won't ask for a number."

"When I prepared the look-ahead for May, we determined the indicators would be similar to April," Stokes said. "We have not yet closed out May. Clarifications on the out-sourcing, things we have with outside companies, other than billing, are regularly outsourced in small to mid-size hospitals like ours."

Commission Chairman Billy Billings said he remembered Arias saying the billing office was a mess. "Can you give us an idea of what was being collected and what your target is?"

Stokes said: "We were hovering around 30 percent. Our calculation says it should be more around 35 percent to 36 percent."

Billings read a quote from Stokes in a Daily Press article where he said, if he thought the hospital should sell, he would tell them. "I've done it at hospitals before. But there are just so many opportunities they haven't take advantage of. There is so much potential here. We can have a bright future here." Billings asked Stokes to comment.

"I have had the occasion to make the recommendation to a hospital in South Carolina to sell to another organization," Stokes said. "The last hospital I was at in South Carolina, the state Legislature allocated $45 million to study all rural hospitals in the state to determine who could stand on their own. It just so happened that the hospital I was working at was the only one that could stand on its own given the volume. However, the board had instructed me to position the hospital for potential acquisition, which I did.

"My responsibility here is not just to Ms. Arias and to the board and commission, but more importantly my responsibility is to the citizens of Grant County, because that's who we work for. We have to do a good job at what we do. That's why we take the responsibility we do. We work many, many hours to correct the deficiencies. I know what revenue leakages there are. As we get new eyes on the revenue cycle, almost daily we are finding new issues. We are working on plugging those holes. Part of it is Meditech and part is how some departments perform their functions. We are approaching it from a holistic approach and not from a very narrow focus. We haven't yet tapped into other funding sources, with USDA a prime example. There are opportunities here we can and will be taking advantage of."

Ramos asked about the Cancer Center. Arias replied that the oncologist wanted to talk to her again that afternoon. "There are a lot of things on the table. It's most important to keep things in alignment and to recognize where the true value of our organization is. In our strategic plan, a lot of the strategy went into the oncology service line. The general and vascular surgeon we have recruited also does vascular oncology and breast-saving surgery. We are going full force, until you tell us not to, to get these physicians in. We are holding our own in the Cancer Center, and we have seen greater profit even with the reduction in services than we did a year ago."

Edwards asked about the vascular surgeon and if he was also the reconstruction surgeon.

Arias explained there is a difference between breast-saving and reconstruction. "We will be trying to get a reconstruction surgeon in part-time. The general and vascular surgeon will do the breast-saving surgery."

Kasten asked about the oncologist. "Currently he is employed by UNM, right?"

Arias said the full-time oncologist would be a UNM employee. Stokes clarified that the oncologist would be based in Silver City.

Kasten said he saw a comment that it was UNM that had to find "our physician."

"It is also my responsibility to get one here," Arias said.

Stokes said the financial piece of the Cancer Center at Gila Regional still has some issues, "but we are addressing them. Compared to last year, as the Cancer Center improves, it will float our bottom line, and we are almost break even now. How do we serve as an affiliate with UNM? We already have an existing relationship with UNM. It's part of our job to vet our affiliated partners. They have things to offer us and we have things to offer them. We'll be moving to expand our affiliations. The last hospital I served at had specific affiliations with partners. It's not a one-way street. We can each help the other."

"We have affiliations with many schools for training," Arias concluded.

The next article will cover the public comment heard during the combined work session and regular meeting. It lasted about an hour or so.