Preparing for impact. Many hospitals will struggle to escape or absorb penalty for readmissions.

October brings the beginning of a program hospitals around the country have been anxiously awaiting--a program that will penalize them for too-high readmission rates. Many fear the economics of the program will drive independent, community hospitals to join systems. "We are the hospitals that are least able to effect change, and we're being asked to do the most," says Stephen Estes, of Rockcastle Regional Hospital and Respiratory Care Center.