Evaluation of the Hospital Readmissions Reduction Program

BackgroundThere is conflicting evidence about whether the Hospital Readmission Reduction Program (HRRP) is associated with an increase in mortality. MethodsIn a cohort of Medicare beneficiaries hospitalized with heart failure (HF), we compared two published approaches to evaluating the association of HRRP and risk-adjusted 30-day mortality, including changes in average mortality across periods and changes in slope of monthly mortality rates across discrete periods. We also tested various methods with simulated data that was designed with an inflection in mortality. ResultsWe identified 4,313,523 hospitalizations for HF, 1,788,219 for AMI, and 3,758,111 for pneumonia. Monthly slope-change models identified an increase in mortality for HF and pneumonia in the pre-HRRP period (P<.001 for slope-change). The changes in average mortality across the four time periods model found an increase in mortality for HF and pneumonia in the HRRP anticipation period (post-announcement, pre-implementation) as well as following HRRP implementation. However, under those conditions, our simulations reveal that method errs in identifying the timing of a change. Varying the data sources and risk-adjustment strategies had no significant effect on the results. ConclusionA national policy incentivizing efforts to reduce readmission did not increase the risk of mortality.