The Wizard of Orszag on Readmissions

On the 71st anniversary of “The Wizard of Oz,” Peter Orszag, the wizard of health care reform, returned to the pages of the NEJM, this time to tell the wonderfulness of his Affordable Care Act. One of its great features is that it will penalize hospitals with excessive readmission rates, easily avoidable by simply assuring that patients have a physician visit quickly upon discharge since, according to a paper that he quotes from a recent JAMA, early follow-up reduces readmissions. So I read the paper and summarized it in the bar graph below. What it shows is that there is no difference in readmissions among hospitals in the three highest quartiles of follow-up visits, despite a substantial decline in follow-up among them. Only the lowest quartile of hospitals has more readmissions. Also, there’s no difference in the percent of blacks at the hospitals in the three highest quartiles for follow-up. Only the lowest quartile has more blacks – by double. So there’s no gradient that links follow-up to readmissions, but there is a distinctive quality about the hospitals with more readmisions – more blacks, which really means more poverty. Follow the yellow brick road. It leads to poverty. Penalizing hospitals that take care of the poor and therefore have more readmissions certainly will not help.