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New Balance 373 Light Brown

"I truly don't mean to be rude or abrupt, but anyone who is not now, or can't rapidly get on board with this work, is frankly standing in the way of everyone else, and most importantly, they are standing in the way of progress we simply must make," he said in the video.

"I don't want hide from that because it's the truth," he told them. "We don't take it lightly."

The job shedding at hospitals continued this year.

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The low volume, in part, comes from hospitals getting better at reducing re admissions by cutting down on factors like infections.

Paulus was blunt in a July 17 talk with a group of managers at an auditorium at St. Joseph's Hospital, a meeting the Citizen Times was allowed to attend. He told them some people would lose their jobs as the system retools.

Slim margin

The company is looking at everything from services and procedures to staffing levels to billing and payment collections across all its locations, including its five rural hospitals.

Included in that amount is $228 million the company says it will lose under the Affordable Care Act, also know as Obamacare.

Managers started learning about the financial picture on July 17 in a recorded video message from Mission Health Chief Operating Officer Jill Hoggard Green and Dr. Ron Paulus, CEO of the company. The hospital provided the Citizen Times with a copy of the video at the newspaper's request.

firm Challenger, Gray Christmas.

Wake Forest Baptist Medical Center in May announced it would eliminate 350 jobs, according to Triad Business Journal.

Mission Health System is not alone in facing cuts.

Labor accounts for more than half of the system's cost.

Short term fixes like freezing raises and vacation allocation New Balance 574 Fresh Foam Breathe

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trend analysis at the American Hospital Association.

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are not good solutions, he said. The system used them, and deep salary cuts for hospital executives, to save $26 million last year.

´╗┐Jobs at risk as Mission eyes deep budget cuts

He said Mission workers are placed in a new job inside the system about 70 percent of the time when an old job is eliminated. There are 700 open jobs now representing 500 full time workers.

Many are hospitals walking the line between having enough staff to handle higher volume expected under the ACA as more people get health insurance and right sizing their staff to meet today's lower New Balance 373 Light Brown demand, she said.

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Low utilization of hospitals is the reason many are struggling, said Caroline Steinberg, vice president of New Balance 990 Red

Mission Health predicts a $500 million decrease in payments over the next decade as more people get medical care outside of hospitals and reimbursements from Medicare and Medicaid decline. Seventy five percent of Mission's patients are covered by Medicare and Medicaid.

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Paulus said the entire system needs to make fundamental and permanent changes.

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People are also getting care more often at outpatient facilities, she said.

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Some workers will not have the skills to fill the open jobs.

Hospitals in Indiana, Kentucky and New Jersey this month announced layoffs ranging from 70 150 jobs.

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The drop in margin is not expected to hurt the company's bond rating, which it needs to maintain to borrow money at a favorable rate.

Vidant Health closed its hospital in Belhaven, a rural town in the eastern part of the state, on July 1.

Mission Health will have an operating margin hovering around 2.5 percent through 2017 a number about half of what it has been in years past but an improvement over the 1.7 percent set for this year. Margin is generally the amount of money left over after expenses.

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Hospital leaders held briefings with managers in Asheville, Franklin and Marion.

The healthcare sector cut 52,638 jobs nationally last year, making it second only to the financial industry in layoffs, according to outplacement New Balance 3000v3

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