Since it began sending pharmacists into the rooms of patients with heart problems when they are being discharged, the Cleveland Clinic has seen a big drop in the number of patients who need to be readmitted. But it has proved hard for other Cleveland hospitals that serve many of the area's poor patients to achieve the same results. This month, the National Quality Forum began a two-year trial that adjusts Medicare's metrics to account for poorer patient populations. NQF is a not-for-profit advisory group that works with federal regulators on the penalty metrics.