Emergency care leading to hospital readmission rates within 30 days of a prior discharge will be penalized by Medicare and Medicaid in the form of reduced payments. The costs associated such readmission penalties will likely run into the millions of dollars. Two thirds of U.S. hospitals (2,211hospitals) will be penalized starting in 2013. Two hundred seventy eight (278) facilities have already been told that they will receive the maximum penalty of a 1% reduction in payments, which means millions less in payment to penalized hospitals. For example in Tennessee, Vanderbilt University Medical Center expects to be penalized between $500,000 and $1,000,000 a year, and Saint Thomas Health Hospital expects to lose about $1.2 million dollars a year in payments. Because every dollar lost hurts hospital operations, there will be increased pressure on Emergency Room physicians to not readmit recently discharged patients who need care.