Hi Brian,
Awesome stuff.
1. I know you had wanted to aim this project at medical and not at surgical patients but many readmissions post-surgery are medical related. Even though surgical readmissions are usually medical conditions related, hospitals are still penalized for these within 30d readmissions. Let me know what your thoughts are about including surgical patients.
2. Good thoughts about the quality performance piece and it may be that patients will increase utilization of ER and be readmitted because there is greater amount of health care (being the telephone f/u call) whereas they might have just died at home (which wouldn't count against your current stated outcome) or dragged out long enough to not meet criteria for within 30d readmission
That's all I've got. :)