Reducing readmissions has become a central target for hospitals, mostly spurred by Medicare policies that penalize excessive readmission rates. Although some intensive programs have successfully avoided readmissions, many other efforts have failed. This study at an urban academic medical center involved targeting only high-risk patients and providing them with a personalized transitional care plan that included detailed medication reconciliation and follow-up phone calls, as well as linking them with community resources. Over a 2-year period, the readmission rate dropped from 21.5% to 19.5% in the intervention group and from 21.1% to 21.0% in the control population. This 9% relative reduction in readmissions is significant, though it translates to a number-needed-to-treat of 50 (to avoid 1 readmission), which is quite high for a resource-intensive intervention. A prior PSNet perspective discussed strategies for reducing hospital readmissions.