SAN ANTONIO (July 9, 2009)--Shriners meeting in San Antonio said Thursday they will keep a presence in all 22 cities where they now provide care for children, but some of the facilities may be downgraded to outpatient surgical centers.

Shriners Hospitals for Children will also begin accepting insurance for patients who have it.

Traditionally, the Shriners have provided care free of charge and without billing insurance companies, but the new hospital CEO Douglas Maxwell said Thursday that the nonprofit needs to change the way it does business.

The rising cost of medicine and its shrinking endowment forced the Shriners this week to look at revamping its 22-hospital system to remain solvent.