As the urgency of healthcare cost containment in the United States increases, this study concerns the impact of this process at the community level in the metropolitan area of Syracuse, New York. It suggests that the responses of the Syracuse hospitals to cost containment have resulted in greater numbers of adult medicine patients. This development has been paralleled by a reduced integration of services with long-term care and ambulatory care providers. As a result, the hospitals have encountered longer stays as well as greater risk of in-patient complications and readmissions for these patients. The study identifies initiatives related to improving integration of care that the Syracuse hospitals are beginning to use to address these issues.