A study in the April 2 New England Journal of Medicine estimates that Medicare payments for unplanned re-hospitalizations totaled $17.4 billion in 2004. Based on Medicare billing data for fiscal year 2003-2004, the authors estimate that one in five Medicare patients were re-hospitalized within 30 days of discharge, with only about 10% of these re-hospitalizations planned. The most frequent reasons for re-hospitalization were heart failure (8.6%), pneumonia (7.3%), psychoses (4.3%) and chronic obstructive pulmonary disease (3.9%). Half of patients re-hospitalized within 30 days did not visit a physician after discharge to the community. Nancy Foster, AHA vice president for quality and patient safety, said, "There are many reasons for readmissions, including the natural course of disease, treatment regimens that involve repeated hospitalizations, lack of access to appropriate health support after discharge, difficulty in patients' understanding and adhering to care directions following discharge as well as missteps in the care that was delivered during the patient's stay. This set of complex issues can only be understood by looking at a much richer set of clinical information than is available from the billing data, and its resolution will certainly require coordinated action from hospitals, doctors, public health officials, patients and their families, public policy makers, payers and others. We look forward to collaborating with others to drive down the number of readmissions that can be prevented through better, more coordinated care."