This study focused on hospital populations which account for large amounts of health care utilization at the community level in the metropolitan area of Syracuse, New York. It demonstrated that, between the two largest hospital inpatient services, adult medicine patients accounted for a larger number of excess hospital patient days than adult surgery over a two-year period. Adult medicine stays increased while adult surgery stays declined. Adult medicine also accounted for a larger number of excess inpatient days, an average daily census of 52.7 patients in 2013, although adult medicine outliers comprised only 2.4 - 2.5 percent of discharges while adult surgery patients comprised 4.4 - 4.5 percent of discharges for these services. Adult medicine readmissions accounted for 79 - 81 percent of these adverse events for the combined hospital during the two-year period. Adult medicine complications accounted for 60 - 62 percent of complications in the two hospitals for which data were available. These data clearly demonstrate the challenges that adult medicine patients carry for providers as they attempt to improve the efficiency and outcomes of care in local communities. In the United States, payer reimbursement for the care of these patients frequently does not match the resources required as funding emphasizes surgical specialties and healthier patients. In metropolitan areas such as Syracuse, where local populations are aging or declining, the expenses of caring for these patients can become a major challenge for community providers.