Greenview Regional Hospital, owned by Nashville-based HCA Inc., is realigning its resources and has cut some positions as part of its strategic plan.

Chief Executive Officer Mark Marsh points to challenges in the health care industry to deal with uncompensated care for the uninsured and underinsured as a main reason for cutting fewer than a dozen positions.

Marsh said the decision was made at the end of the company’s third quarter, which begins around July.

Those affected were notified at the beginning of November, he said.

Greenview eliminated its industrial-business development position because of what Marsh said was redundancies in staff output.

The person in this position worked closely with health insurance representatives, human resources representatives and insurance brokers in town.

The hospital has also reallocated some of its PRNs, or &#8220as needed,” employees who help balance staffing with the fluctuating volume of patients throughout a work day.

Marsh said the employees affected were offered other jobs within the hospital.

&#8220Those affected were offered a job to come back and work in the hospital,” Marsh said. &#8220Some of those PRNs are in the process of coming back into (other areas of) the hospital and working as PRNs.”

Absorbing the cost of uncompensated care as the number of uninsured and underinsured patients rises, has forced hospitals to focus on efficiency.

&#8220This is not a challenge just in Bowling Green, this is across the country,” Marsh said.

The hospital’s bad debt reflects the increasing number of uninsured and poor people the hospital is treating. Greenview Regional Hospital had a bad debt 100 percent greater than what was originally budgeted for last year, according to Marsh.

HCA incurred bad debt of $1.3 billion through the first half of 2006 – an increase of 14 percent over last year, according to Marsh.

Another challenge for hospitals is the growing number of people using emergency rooms for primary care outpatient services. As a result, there are fewer beds for patients with serious health problems, Marsh said.

&#8220We need intervention on a national level to help this,” Marsh said.

&#8220A lot of this realignment is when we can look at various things that are occurring,” Marsh said. &#8220People are leaving the community because they can’t get in a timely manner either to a physician or outpatient facility. What we have heard from patients and consumers is that they don’t want to have to drive to Nashville or Louisville. So if we can better use the space, the resources and the people we have, so they don’t have to do, that is helpful.”

Dr. Charles Wainright is the health care administration director for undergraduate and graduate programs at Western Kentucky University.

Wainright called the changes &#8220strategic positioning,” where a hospital trims down in some areas to expand in others.

Wainright said hospitals must reposition themselves so they can still afford to give the care they want to give.

&#8220Hospitals throughout the United States are all experiencing indigent care or uncompensated care,” Wainright said.

Wainright also points to changes in the economy as another factor.

&#8220A lot of folks are being forced to not have insurance because they’re changing jobs or losing their jobs,” he said. &#8220A lot of employers are switching from defined benefits to defined contributions, where employees have to find their own health care. That creates a lot of problems for a lot of people. Indirectly, hospitals get all of those individuals and serve them.”

But Wainright said since hospitals in Bowling Green act as regional health care hubs for people in neighboring counties, bad debt is most likely higher in rural areas.

&#8220Our hospitals here give a fair amount of uncompensated care but it could be worse if you look at rural areas in Kentucky and Tennessee where you see a lot more,” Wainright said.

Bowling Green supplies health care for neighboring counties, he said.

Marsh said Greenview’s $7.6 million expansion is still on track.

The hospital is recruiting new physicians and adding 40,000 square feet to its Physicians Specialty Center, Marsh said.

Marsh said the company is also renovating the hospital’s floors to look more aesthetically pleasing and will host an open house sometime around late January or early February to show off the changes.