Baby or bathwater?: Early follow-up after hospital discharge.

S ince 2008, the Centers for Medicare and Medicaid Services have publicly reported risk standardized 30-day readmis-sion rates for patients hospitalized with heart failure, acute myocardial infarction (AMI), and pneumonia. Over the next few years, the portfolio of readmission measures will expand to include patients with a broad range of medical and surgical conditions. 1 Furthermore, under the Hospital Readmissions Reduction Program of the Affordable Care Act, hospitals with higher-than-average readmission rates will be subject to a payment penalty. 2 The stakes are high for hospitals, with millions of dollars of Centers for Medicare and Medicaid Services payments at risk, and hospitals are trying to identify and implement effective strategies for reducing readmissions. One promising approach to reducing 30-day readmissions has been to increase rates of follow-up occurring within 7 days of hospital discharge. In 2010, Hernandez et al 3 examined a population of heart failure patients and demonstrated that hospitals with a higher proportion of patients seen within 7 days of discharge had statistically and clinically significantly lower 30-day readmission rates compared with hospitals that had the lowest proportions of patients seen soon after discharge. 3 Intuitively, this finding makes a lot of sense. Early follow-up appointments provide an opportunity for clinicians to reassess the patient's condition and address any outstanding issues regarding medications, patient education, and need for additional testing. Furthermore, ensuring that patients have appropriate follow-up (although not necessarily within 7 days) has been a central component of care transition programs shown previously to reduce readmission rates. 4 For clinicians and hospitals struggling to reduce readmission rates, this article was a welcome relief. Finally, we had a strategy that was effective, easy to implement, required relatively few additional resources, and, perhaps most importantly, was scalable to a variety of patient populations. In large part because of this study, many hospitals have embarked on efforts to prioritize early follow-up, in some cases setting up clinics specifically designed to meet this new expectation. In this context, the findings of Hess et al 5 published in the current issue of Circulation are an unwelcome but important wake up call. In this study, the authors asked the very reasonable question of whether these results were generalizable to different patient populations, in this case patients hospitalized with non-ST-segment elevation myocardial infarction. To minimize confounding, the investigators took advantage of the natural variation in hospital rates of early follow-up and analyzed outcomes at …