There is conflicting evidence about whether the Hospital Readmission Reduction Program (HRRP) is associated with an increase in mortality. Methods: In 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

more »

... mulated data that was designed with an inflection in mortality. Results: We 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. Conclusion: A national policy incentivizing efforts to reduce readmission did not increase the risk of mortality.