Under the Affordable Care Act, hospitals with “worse than expected” 30-day readmission rates will be penalized by Medicare. But though a focus on readmissions may have good face validity, the policy attention to 30-day readmissions may be misguided.

The Affordable Care Act's financial penalty for “excessive” readmissions may be too weak to overcome the substantial counterincentives currently at work. But a “warranty” payment would provide a stronger business case for hospitals to get with the program.

HIV infection is now a chronic, treatable disease, and transmission is readily preventable. The Centers for Disease Control and Prevention recommend expanding HIV screening and eliminating unique requirements for informed consent, but not all states have done so.

Policymakers may be overlooking the lessons of Medicare Advantage. Though current policy guarantees greater government spending on private Medicare Advantage plans than on traditional Medicare, the plans are developing low-cost ways of delivering attractive benefits.

What is the proper relation between a scientific understanding of disease and the subjective phenomenon of being sick? Between the subspecialist and the general physician? Between cure and care? “Patient-centered medicine” is the newest salvo in these debates.

An alternative approach to improving the quality of care — especially for patients with multiple conditions, severe disability, or short life expectancy — is to determine whether patients' individual health goals (e.g., for symptoms and functional status) are being met.

The most important attribute of patient-centered care is the active engagement of patients when fateful health care decisions must be made — when they arrive at a crossroads of medical options, where diverging paths have different and important consequences.

Many people believe that improving clinical quality — reducing readmissions, shortening lengths of stay, and building efficiency into clinical processes — will reduce health care costs. So why haven't years of work in quality improvement had a measurable effect on costs?

Health care organizations considered among the nation's highest performers often have unique personalities, structures, resources, and local environments. Yet they often have remarkably similar approaches to care management, common habits that may be transferrable.

Recent studies have called into question whether the U.S. patient-safety movement has made any progress at all. But we have an opportunity to turn the tide by including in the “meaningful use” of electronic health records the systematic assessment of adverse events.

A patient-safety investigation motivated by a lawsuit over pneumococcal sepsis in a patient who had undergone splenectomy but never received pneumococcal vaccination demonstrates the complexity of redesigning systems and care processes to prevent common errors.

Clinica Family Health Services, a Denver-area community health center serving a low-income population, is on the front lines of a primary care revolution, constructing patient-centered medical homes by focusing on continuity, prompt access, and teamwork.

Despite the best of intentions to practice medicine that is based on Level I evidence, a physician comes to appreciate that the influence of a randomized, controlled trial pales in comparison with that of adverse events and outcomes witnessed firsthand.

The first step toward identifying and targeting the causes of racial and ethnic disparities in care is for health care organizations to collect and analyze data that adequately describe their populations. Unfortunately, such data are collected haphazardly.