Also, they will have to deal with an even larger nightmare with regard to coordination of benefits between Medicaid/Medicare and private insurance and pressures to increase the quality of care while dealing with larger case loads and lower reimbursement levels. In addition, increased pressures on the hospital infrastructure can not be a good factor (Grogan, 2011, 1201)
5% reduction in Medicare reimbursement. That penalty will increase to 2% in 2016 and beyond (Mathe, Hettrich & Nunley, 2011)