President Obama Stretches Readmission Gains

The medical literature is apparently not immune to promotions and marketing. Graphics can be powerful at a time when few read between the lines - or read the lines at all. The following graphic was prepared for the President by CMS.

• Note the use of only 2 points of change from 17.5 to 19.5 to enhance the apparent effect.
• The change from 19% readmissions to 18% across this 2 percentage point difference generations a much steeper slope. 

Truncated graph - from wiki  A truncated graph (also known as a torn graph) has a y axis that does not start at 0. These graphs can create the impression of important change where there is relatively little change.

The other graphics presented by the President are more reasonable. For example the % uninsured has the full 0% to 25% represented graphically.

The big question arising from the claim of improvement with readmissions penalties is whether the previous payment system resulted in worsening of readmissions and perhaps other quality measures. Perhaps the DRG design was the problem as seen in patients sent home at times too soon, as seen in in marginalization of nurses, and as seen in overstressed home and primary care situations. 

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