The awaited "financial assessment" of Massena Memorial Hospital by St Lawrence Health System (a.k.a. Canton-Potsdam Hospital) was unveiled to the MMH Board of Managers at a special meeting on 15 May.

Unfortunately, this "preliminary" assessment reveals nothing that hasn't already been detailed over and over during the past 5+ years and certainly offers no new insight or details as to the nature of the "tough decisions" that MMH Board Chair, Loretta Perez indicated would have to be made.

Based on a copy of the SLHS presentation provided to the public...

(1) Declining "core service utilization" have had a "corresponding degradation of financial performance".

(2) Performance since 2011 is the "consequences of a declining local economy".

(3) While necessary to employ providers, "as typical, practice expenses far outpace revenues".

Under-utilization, specifically inpatient census, has repeatedly been cited in each monthly fiscal report for as long as I can remember. The report does not detail any causative factor(s), or how or what is being done to reverse this trend.

It’s the economy – stupid! Once again we are reminded that the loss of manufacturer based industries has had, and continues to have, a declining impact on not only our hospital’s profitability, but those of our community-based businesses. No action plan as to how to adjust operations to compensate for this economic decline is provided.

The hiring of medical providers as direct employees of the hospital has been a controversial topic. The report correctly notes that in today’s healthcare market – it is a necessity. What it does not address is why diagnostic testing (lab and radiology) have not grown exponentially and why in many cases these two large revenue generators have seen declining utilization.

So after six weeks we have yet another outside agency, assessing and preparing a report that essentially details and graphs what already has been stated over and over for the past 5+ years. No concrete goals, objectives, or road map to actual fixes.

Equally disturbing is that the "next steps" outlined in the assessment seem to be vague, with no definitive timelines provided:

(1) Management Agreement and Supervisory Agreement which will require negotiation between MMH and SLHS and approval from NYS Departmet of Health

(2) Determine level of near-term NYS financial support.

(3) Finalize liabilities quantification.

(4) Develop actionable Turnaround Plan while "making near-term changes".

In the introduction page of the report, SLHS notes "it was immediately evident that the Hospital had virtually no funds with which to continue operations". It notes that current cash on hand (money in the bank) is at an all-time low of approximately 10-days.

So what is the proposed negotiated Management and Supervisory agreements going to cost – and who is going to pay that cost? MMH, Town of Massena, or State – certainly not our new “partners” SLHS. The report hints at financial support from the NYS Department of Health, but provides no details as to how much, when, and what constraints will be placed on that support.

I also note that the report offers nothing specific on how the hospital is expected to immediately remain sustainable for the period of time (not defined) required to complete either the liabilities quantification or the Turnaround Plan. The report notes “near-term changes” and Mrs. Perez hints at “tough decisions” – but, neither provides details as to those changes or decisions.

So we have another assessment by another outside entity that regurgitates the same old data. The so called “actionable” next steps are vague and appear to require time that, by its own content, our hospital does not have. What is needed is action on items that should be immediately addressed:

(1) The accounts payable situation is deplorable – 7 million in revenues owed to creditors. Continued supply, service, and contracts are at risk with credit holds. At 120+ days your exceeding the typical 90-day payment window.

(2) Utilization is a local problem. Utilization trends are not running parallel with population trends – so the institution has to address the community as a whole to determine why they don’t utilize their community hospital. Those concern have to be identified and effectively addressed.

(3) Diagnostic testing (lab and radiology) are not running consistent with the noted increase in employed provider performance. Provider utilization of these services should be trended and providers engaged on any performance / quality issues with these services in an effort to maximize their utilization.

Over the past 5+ years, there has been many outside entities and outside assessments performed, some at great expense and time. With the Town Supervisor’s recent direct interference and involvement – we have essentially started over, kicking any true improvement farther down the road – while SLHS reassesses and regurgitates historically worn-out data.

It also appears that the NYS Department of Health will be assuming greater operational control and oversight over the future of our hospital. Maybe this is what is needed – provided our hospital has the time and sustainability to survive the process – but, time is not on our side. Only the future will bear fruit as to the gains and losses as we move forward with these new “partners”. I only hope that we don’t lose our hospital and community identities as well.

Bob Elsner

Massena Town Board candidate