Variola virus in a 300-year-old Siberian mummy.

n engl j med 367;21 nejm.org november 22, 2012 2057 different standards for patients on the basis of their socioeconomic status. Although this is a laudable long-term goal, it means that hospitals with a high proportion of Medicaid patients are much more likely to suffer a penalty for excessive readmissions than a hospital with a lower proportion of Medicaid patients. This is incredibly bad social policy, discouraging hospitals from admitting Medicaid patients. Objections to it are not merely theoretical — the published penalties show the results of this decision. The method used also makes it more likely that a large hospital will be hit with a penalty than a small hospital with the same readmission rate after adjustment for case mix. The data shown in Figure 1 support these arguments. This issue will grow in importance in the next 2 years as the maximum allowable penalty increases from 1% of payments to 2% then 3%. An additional problem with the method is that patients cannot use the results to assess the probability of having a readmission at hospitals of different sizes or with different disproportionate share percentages.