A decade ago, some hospitals and other health care providers were enjoying profits from reimbursements for Medicare patients — reimbursements, in some cases, that took advantage of the government’s helping hand for elderly patient care.

Flash forward 10 years, and just about all anyone in the healthcare community can talk about are the Medicare cuts that have gouged deep into hospitals’ pockets, leaving little room, they say, for adequate patient care.

Still reeling from the three-year-old Balanced Budget Act that capped and cut Medicare reimbursements, Natchez Regional Medical Center is looking to a new service to help increase revenue: a rehabilitation unit.

&uot;This is brand-new revenue to the hospital,&uot; Natchez Regional CEO Jack Houghton said. &uot;We think this is going to be very positive for the hospital.&uot;

NRMC, which hopes to have the unit up and running by Oct. 1, the start of its fiscal year, still faces an uphill battle.

A new rule by the state Board of Health would prevent the hospital from receiving Medicare reimbursements for the rehab services because Natchez falls within a 65-mile radius of established rehabilitation units.

Natchez Regional is making another bid to the state board to be excepted from the rule.

Houghton said he hopes the revenue from the rehab unit — which would also serve patients who pay privately or through private insurance companies — will help offset the losses caused by the Medicare cuts, losses that, in part, forced two small-scale layoffs over the past two years and killed the hospital’s skilled nursing facility.

But officials at independent rehabilitation centers in the Miss-Lou say they’ve been hit by Medicare cuts as well.

&uot;Medicare cuts have hurt all providers,&uot; said Chris Fox, administrator of Professional Rehabilitation Services in Ferriday, La.

&uot;Our rehabilitation services are cost-based. We can’t make a profit (on Medicare patients.)&uot;

Ironically, Houghton said one of the frustrating aspects of the Mississippi board’s keeping Natchez from receiving Medicare reimbursements is that NRMC loses many patients to Pro Rehab.

&uot;We’ve all had to sit back and ask the question, ‘Why would the State of Mississippi deny the distribution of federal monies for rehabilitation services when the same money is going to Louisiana?’&uot; Houghton said last week.

Fox said Natchez Regional and Pro Rehab might be able to complement each other.

&uot;We would be able to enhance each other’s services,&uot; he said.

While some of the services of Pro Rehab and Natchez Regional would overlap, Fox said, Pro Rehab offers a wider range of services.

&uot;Those services include not only physical, occupational and speech therapy but also intensive nursing, dietary services and social services for a full complement of patients … and ventilator rehabilitation for those who need it,&uot; Fox said.

Pro Rehab also offers extended stays for patients who need to remain in a hospital setting for a longer period of time.

The unit at Natchez Regional, meanwhile, would offer in-patient services for treatment for strokes, hip fractures, total joint replacements and polyarthritis.

Pro Rehab and Natchez Regional may see some competition when the latter facility opens its rehabilitation center, said Fox, whose facility serves an average of 38 patients a day, not including about 50 who receive outpatient services.

&uot;But there may be some things we could work together on,&uot; Fox added. &uot;Some patients may not fit into their model.&uot;

In addition to Pro Rehab, which until NRMC opens its unit is the only rehabilitation center with inpatient services, other area facilities offer outpatient services.

Southwest Mississippi Rehab offers physical, occupational, speech and respiratory therapy, as well as social services, skilled nursing and infusion — or IV — therapy, said Administrator Shannon Netterville.

Medicare cuts have forced many centers like Southwest Mississippi Rehab to expand services to try to recoup their losses, Netterville said.

&uot;That’s exactly why all of us are going into other things,&uot; she said. &uot;It’s hard to survive with the way the cuts have gone.&uot;

But Netterville said outpatient clinics like Southwest Mississippi can step in when patients run out of Medicare benefits through hospitals.

&uot;That’s where the clinic comes into play,&uot; she said. &uot;(Patients) can still resume their therapy.&uot;

Key Rehab is one of the newest rehab centers in Natchez. It opened in April 1999 — two years after the Balanced Budget Act went into effect.

&uot;We opened our business at the time when Medicare was making all the cuts,&uot; said Cathy Roboski, an occupational therapist and co-owner of Natchez’s Key Rehab. &uot;We knew if we could make it now we could definitely make it.&uot;

One way Roboski said Key Rehab tried to cut costs is by cutting out upper levels of management. The rehab center is owned by three of its therapists.

Roboski agreed with Fox that there isn’t money to be made off Medicare patients.

&uot;(Medicare payments) pretty comparable with what other services are reimbursed at,&uot; she said.

Still, Natchez Regional is banking on the income from patients who aren’t on Medicare or Medicaid. Houghton said he hopes that can offset the cuts in other areas of the hospital.

&uot;There is a lot of potential new revenue in this service,&uot; he said.