BACKGROUND Efforts to curb healthcare spending have included interventions that target frequently hospitalized individuals. It is unclear the extent to which the most frequently hospitalized individuals also represent the costliest individuals. OBJECTIVE To examine the relationship between 2 types of “high users” commonly targeted in cost‐containment interventions—those incurring the highest hospital costs (“high cost”) and those incurring the highest number of hospitalizations (“high admit”). DESIGN, SETTING, AND PATIENTS Cross‐sectional study of 2566 individuals with a primary care physician and at least 1 hospitalization within an academic health system from 2010 to 2011. MEASUREMENTS Overlap between the population constituting the top decile of hospital costs and the population constituting the top decile of hospitalizations; characteristics of the 3 resulting high user subgroups. RESULTS Only 48% of individuals who were high cost (>$65,000) were also high admit (≥3 hospitalizations). Compared to hospitalizations incurred by high cost–high admit individuals (n = 605), hospitalizations incurred by high cost–low admit individuals (n = 206) were more likely to be for surgical procedures (58 vs 22%, P < 0.001), had a higher cost ($68,000 vs $28,000, P < 0.001), longer length of stay (10 vs 5 days, P < 0.001), and were less likely to be a 30‐day readmission (17 vs 47%, P < 0.001). CONCLUSIONS Stratifying high admit individuals by costs and high cost individuals by hospitalizations yields 3 distinct high user subgroups with important differences in clinical characteristics and utilization patterns. Consideration of these distinct subgroups may lead to better‐tailored interventions and achieve greater cost savings. Journal of Hospital Medicine 2013;8:665–671. © 2013 Society of Hospital Medicine.

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Photography shares little with the logic of simulation and simulacrum, instead it facilitates a dimension within which people and objects we photograph emerge from an impossible frame. Its intrigue resides in the palpable sense of impossibility that photographs render visible to us. This sleight of hand obfuscates the question of how appearance appears. In Finders Keepers, Dutch photographer Laura Chen works with imagery sourced from undeveloped films purchased from eBay and car-boot sales. When Chen develops the films, the real of someone else’s reality is transformed into art. Left undeveloped, these images occupy nowhere in particular, but Chen makes appearances fill in a void and poses a question which is not one of “why” but of “where” are images? Furthermore, in seeking out meanings, the magic of photography is understood through the misdirection of illusion and appearance. What is more useful is to ask how photography appears to appear? Keywords: photography and illusion, magic of photography, reality and simulation, appearance of photography, Laura Chen