Anton, the COO at Mercy, fears there could be indiscriminate, across-the-board cuts, ``which will obviously be a problem in this community. Most of the hospitals are already struggling financially.''

With such high Medicare costs, you might think hospitals are raking in a fortune. They're not. State records indicate Mercy Hospital lost $34 million in 2008 and its sister facility, Holy Cross in Fort Lauderdale, lost $25 million.

Anton said the two hospitals have been merging many back-room operations to create ''high efficiency'' and will be in a good position to survive, but he wondered if some smaller, stand-alone hospitals might be threatened by Medicare cuts.

Quick, head of the hospital association, said she considered hospital closings ''a worst-case scenario,'' but there could be ''some consolidation'' and perhaps reductions in services as hospitals determine their core business.

Keeley at Baptist is ready to embrace change. ''We have a very perceptive president, and I'm convinced change is going to be done in an intelligent way. . . . We're prepared to retool. If they say you need to bundle services'' -- treating an illness rather than charging for every test and pill -- ``then we are going to be the best bundler we can be.''

Bundling services could also mean reducing the amount of lab and diagnostic work, as well as reducing the frequency with which patients bounce between specialists.

Sandra Friedman, a senior in Aventura, is one who is ready for changes. ``There's all this overutilization. They give me rehab with two little electrodes to stimulate my muscles. It's silly. Doctors are taking a lot of money. Or they give me exercises to do but don't even touch me. But then I have a mole under the eye and they don't want to test it, because if it's not cancer, it's not covered.''

Whatever the cost, reform is necessary, said Quick. ``The excessive utilization here is indefensible.''

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