It's old news now that complex rehab companies are under the gun. For example, while they received an exemption from national competitive bidding, they also got hit with a 9.5% Medicare reduction effective Jan. 1, 2009. Unfortunately, there is neither a silver bullet nor a great business secret that can be used to solve the challenges stemming from reimbursement reductions. Companies have been forced to look at a variety of changes to ensure survival.