Pressed by declining patient volumes, St. Anthony's Medical Center has laid off dozens of employees.

In recent weeks, about 85 hospital workers have been let go as part of a  "reduction in force," said Tess Niehaus, the hospital's vice president of marketing and communications.

But, she added, the south St. Louis County hospital has rehired 10 of those workers in different positions and hopes to rehire 11 others. "At this point, the net effect will probably be about 65 people," she said. "That's 1.5 percent of our workforce."

St. Anthony's currently has about 4,000 full-time equivalent workers. Some of the laid-off employees received their pink slips over the holidays.

For the 2010 fiscal year, which ended on June 30 of that year, the hospital reported about $418 million in revenues, according to a company filing with the Internal Revenue Service. 

But the hospital's "inpatient admissions are down by approximately 4 percent over the prior year," Niehaus said, and expenses have exceeded revenues in five of the past six months. 

"Fewer people have insurance. Fewer people go ahead with elective treatments," Niehaus said. "People are foregoing care both in the doctor's office and in the hospital."

St. Anthony's decline in patient volumes mirrors the situation for a growing number of hospitals in the St. Louis area and nationwide.

Niehaus said that layoffs are just one aspect of the hospital's efforts to ratchet down its expenses.

"We're not changing the nurse-patient ratio," she said. "Every area of the hospital has been asked, 'Where can we trim our expenses to be comensurate with our patient volume?'"  

Salaries, compensation and employee benefits account for about $198 million -- or nearly half -- of the hospital's annual expenses, including about $3 million in compensation for its top-level employees, according to the hospital's IRS filing.

"We always live on a narrow margin. We're a nonprofit organization," Niehaus said. "We're looking at all the usual suspects. We look at consulting arrangements, at unnecessary travel."

In fiscal year 2010, the hospital spent about $1.9 million on advertising and promotion including radio and print ads on the hospital's lines of service, such as cardiology, cancer, and urgent care, as well as to trumpet its physicians.  The funds also paid for doctors' free lectures and screenings.

Also during the 2010 fiscal year, the hospital paid $937,505 to Spellman Brady & Co. for design consulting services for various remodeling and expansion projects.

The hospital, which is governed by a volunteer board, also pays yearly bonuses to its executive staff when the hospital's budget, quality, and patient satisfaction targets are met.

For instance, Thomas Rockers, the hospital's president and chief executive, received a $62,051 bonus as part of his total compensation package of $631,021 in fiscal year 2010. 

"A certain percent of your compensation is set aside, and you have to earn it," Niehaus said. "You don't get it for breathing or showing up."

For now, Niehaus said, the hospital's layoffs have stopped.

"As we told our employees today (Tuesday), We had a plan and we have executed that plan," she said, "and we our hopeful that we are done."