Cutbacks at SSM Health Care were announced late last week affecting all of their facilities in 4 states, but there will be layoffs in Centralia at Saint Mary’s Hospital and in Mount Vernon at Good Samaritan Hospital.  This could be up to 55 affected positions.  It is unknown at this time how many at each location or specific jobs, but some of this is through attrition and just won’t be refilled.  There may be some relocation involved for some workers, but more will be known in the weeks to come.  Overall, 586 jobs, including 206 in the Saint Louis region are affected.  A statement from SSM says health care organizations are facing “unprecedented changes and challenges,” including a shift to more outpatient settings, reduced reimbursement from federal payers, increased bad debt and charity care and the financial impacts from sequestration.  The SSM system includes 18 hospitals, two nursing homes, more than 150 outpatient sites and other units.