Some 36 staff positions and several key services were cut from Natchez Regional Medical Center’s 1999-2000 budget on Monday in an effort to save the struggling hospital.

The hospital’s skilled nursing unit and and the Miss-Lou’s only level II nursery fell victim to the budget cuts.

&uot;We were unanimous in our decision,&uot; said Dr. J.R. Todd, local physician and member of the NRMC board of trustees.

&uot;It’s nothing I’m happy about. We have to do what we have to do to make sure the hospital survives,&uot; he said. &uot;I regret that these things have to be done and I don’t know if that’s going to save it.&uot;

The 36 positions that will be eliminated do not mean that 36 people will be laid off, said Karen Fiducia, interim CEO at NRMC.

&uot;Less than 30 people will actually be laid off,&uot; Fiducia said. &uot;The rest of the positions were never filled and dropped from next year’s budget.&uot;

The layoffs have begun and will be complete by Sept. 1, Fiducia said.

Letting go of good employees is a hard decision, Fiducia said, but a necessary step for a hospital struggling to stem the flow of red ink.

&uot;It is the only fiscally responsible thing to do,&uot; she said.

&uot;We’ve got to be ready for the BBA,&uot; she said, referring to the continuing cuts in government reimbursements to hospitals from the Balanced Budget Act of 1997.

&uot;What we needed to do was to put the hospital in an economic position so it could continue to pay its bills,&uot; said Billy Gillon, president of the NRMC&160;board of trustees.

The projected net revenue under the new budget is $27,850,000. After expenses, that leaves the hospital with a relatively thin profit of $1,060,000.

&uot;If we had not taken this action, we probably would have had a $1 million loss,&uot; Gillon said. &uot;We have adopted a budget that lends itself to showing a profitable bottom line and in doing that we’ve had some reductions and changes in some of the services and personnel.&uot;

In evaluating services of the hospital, individual department managers have considered the number of patients served, the dollars brought in from each service, and what the service costs to provide, Gillon said.

&uot;We also ask, if we didn’t provide this service, what does it do to quality of care and what does it do to the patient census?&uot; he said.

Cuts to services include closing the skilled nursing unit, a 17-bed intermediate care unit that cares for patients between an acute care setting and regular hospital room.

Also cut is the level II nursery, which provides care for babies who are sick at birth or require additional treatment outside of well baby care.

&uot;A level II nursery requires two RNs on duty regardless of the number of patients in the nursery,&uot; Gillon said.

Gillon said a decrease in the number of infant births at NRMC has caused the nursery to cost more money than it brings in.

A third area that will see staffing reduction is the operating room.

&uot;We’re changing the OR schedule up,&uot; Gillon said. &uot;In the past, we’ve had OR rooms stocked with folks with no one operating.&uot;

Fiducia said they’ve worked with local surgeons to develop a modified schedule that provides surgical personnel at only the hours requested by surgeons, reducing non-productive time for surgical teams. On-call staff for emergency surgeries would still be maintained.

Three other service lines under evaluation, but not cut in the next budget, are cardiac rehab, hyperbaric medicine, and physical therapy. Those services are being evaluated over a six month period before any final decision is made regarding them, Gillon said.

NRMC’s competing hospital, Natchez Community, has just completed its budget for fiscal 1999-2000, and is anticipating no cuts in services yet, said Rosemary Brewer, controller for Community.

&uot;We have not cut any services, but we’re always looking for ways to improve efficiency,&uot; Brewer said.

While no services or personnel have been cut in the next budget, there are also no plans to expand.

&uot;We’re going to pretty much stay the same,&uot; she said.

Community is privately owned by Health Management Associates, Inc. based in Naples, Fla.