North Mississippi Health Services in Tupelo has laid off 109 employees. A statement from a NMHS says Monday's cuts are across the board. The hospital has declined to give specific numbers or positions being eliminated. Chief medical officer Dr. Mark Williams says the reductions were prompted by the ongoing shift from inpatient to outpatient care, declining government reimbursements and other factors. The cuts represent almost 2 percent of the company's total workforce, most of who work at North Mississippi Medical Center in Tupelo. NMHS currently has 6,190 employees system-wide.