An article in the Wall Street Journal (May 5, 2013) discusses the impact of the Affordable Care Act’s penalties for hospitals with excessive re-admits within 30 days, set at 1% in 2013 and going up to 3% in 2015. But the article claims that a) studies show that only 25% of the re-admits are preventable, b) the penalties will incent hospitals not to admit critical patients, c) hospitals servicing low-income patients have a 30% higher likelihood of re-admits within 30 days. Given these issues, is a focus on this metric of performance detrimental to patient health ? Should the focus be on providing “best practice” solutions that can decrease re-admits rather than penalties ? How should strategies to improve health care results while decreasing costs be justified or analyzed for their odds of being successful before they are implemented ?