We wrote about the high rate of hospital readmissions recently on the blog and for The Washington Post/Kaiser Health News. Today, both the Wall Street Journal and NPR examine the problem, both focusing (as we did) largely on older people with heart disease.

NPR's Joseph Shapiro told the story of Jessica MacLeod, a nurse with advanced training at the University of Pennsylvania Health System in Philadelphia. (We've written about Penn's Mary Naylor and their Transitional Care Model, too, here and here). MacLeod gets to know her patients in the hospital, and then follows them at home for  two or three months, with particular attention to those first 48 hours when lots of things can go wrong.

One of her patients is Ken Rogers, 80, a retired superviser at a printing company. He recently spent a week in the hospital after experiencing chest pains.When he was hospitalized in the past, he recalled, "when I came out of the hospital, you go, 'Yeah? What do I do now?' It was, 'See ya,' " This time MacLeod was at his home within a day, and she returned often.

She reviews the instructions Rogers got from his cardiologist and takes the couple's questions about the medication he has just started to treat his atrial fibrillation and what foods he needs to avoid as a result.

"Mr. and Mrs. Rogers, I would consider very smart and savvy people -- and assertive," MacLeod says. "And even having those skills, health care is complex, and we have a health care system that is increasingly complicated. And, you know, if you've ever been to the doctor's office yourself, you are hearing words for the first time and they're maybe said once and it's hard to get a word in edgewise sometimes and say, 'Wait, what is atrial fibrillation, Doc?' You know, what does that mean? So part of my job is a translator, really, and I translate the language of health care to a layperson's language."

The care is expensive, although Naylor cites research showing it saves about $5,000 per Medicare patient each year.

The Wall Street Journal looked at the efforts to keep congestive heart failure patients out of the hospital -- and away from hot dog stands. Even on the Fourth of July, CHF patients can't afford all that salt, particularly if they already have a plate full of sodium-rich foods. The article focused on a program at Berkshire Medical Center in Pittsfield, Mass. They are using a combination of techniques -- telephone monitoring, clinics, medication counseling -- to keep people stable and out of the hospital. But the hospital makes money when people are admitted. Keeping them out of the hospital is not good for Berkshire's bottom line (although experts and hospital executives I interviewed when working on my story said that's true at some hospitals but not at all.)

Hospitals naturally worry about being punished for doing the right thing. And in the current system, some have reason to worry. But a goal of health reform -- at least the "cost-bending" and quality improving part of health reform -- is to change the incentives and get them right. That means turning our system from one that rewards quantity of care and crisis care to one that rewards quality of care and managing diseases before they turn into crises. There are a lot of approaches to try -- medical homes, accountable care organizations, bundled payments, transition benefits. Some of the hospitals and health care systems that are bringing down readmission are thriving. Now we have to help the rest of them find a way of improving care, in a reshaped system where the incentives help them do the right thing.