In what now must seem like a previous lifetime, nearly all of the region's major healthcare organizations ended fiscal year 2008 in June with increased revenue over the previous year. Will they be able to say the same after fiscal 2009?

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Revenue, of course, tells only part of the story.

Highmark Inc., the local revenue king, has not had layoffs in the first half of the current fiscal year, but it is the exception.

The next two biggest revenue generators, UPMC and West Penn Allegheny Health System, both saw increased revenue in fiscal 2008 -- UPMC most notably following its acquisition of Mercy Hospital Pittsburgh -- but both also have eliminated positions.

UPMC's investment portfolio -- and just about everyone else's -- has taken a big hit since the fall, and West Penn Allegheny is still working through an unexpected $73 million shortfall. Both systems could be greatly impacted by any changes in federal Medicare reimbursements.

As for the other major players in Western Pennsylvania, the immediate future could be a mixed bag.

Typical may be Excela Health, headquartered in Greensburg, which recently announced it is closing skilled-care units in three of its hospitals, displacing about 100 employees. But the organization is going ahead with plans to open a new neuroscience center this month in Latrobe Hospital.

Despite the setbacks, almost everyone has at least some good news.

The Heritage Valley Health System is in the midst of a $35 million renovation and expansion project at its Beaver and Sewickley campuses that will include expanded emergency departments at both places. Heritage Valley also has opened three new diagnostic centers in Ellwood City, Cranberry and Hopewell as well as the new Heritage Valley Convenient Care Center in Beaver.

Jefferson Regional Medical Center in Jefferson Hills saw a slight decrease in revenue last year but is moving ahead with plans for information technology upgrades and now has a fourth cardiac catheterization lab. Jefferson also has added an inpatient dialysis unit on the hospital's fourth floor and an outpatient testing site in Baldwin. A 9,000-square-foot physical rehabilitation complex opened at the hospital in 2008 and, in July, Jefferson purchased the former Mercy-HealthTrax Building on Higbee Road in Bethel Park.

St. Clair Hospital in Mt. Lebanon also underwent a major renovation and expansion of its emergency department, which can now handle 80,000 patients per year.

Uniontown Hospital, the flagship for Fayette Regional Health System, is undergoing a $50 million expansion and renovation project that will include an expanded emergency department and a 56-private room patient tower. The work, expected to create 127 new jobs, is scheduled to be completed in early 2010.

At Monongahela Valley Hospital, meanwhile, Moody's Investors Service recently reaffirmed an A3 stable rating on its $12.4 million Series 2000 bonds. Moody's cited the hospital's strong market share position, strong balance sheet -- it saw a $6 million increase in revenue in 2008 -- and favorable contract negotiations as well as revenue growth.