Could AHRQ Really Be Eliminated? And Why Would It Be?

June 26, 2015
Some members of Congress have the liquidation of the Agency for Healthcare Research and Quality in their sights. The question is why.

As HCI reported on June 25, “The [U.S.] House Appropriations Committee voted in favor of a bill that would eliminate the Department of Health and Human Services’ (HHS) Agency for Health Research and Quality, a research agency that has long been disliked by some members of Congress.”

As Associate Editor Rajiv Leventhal wrote in his report, “The appropriations bill, which the House committee approved on Wednesday by a vote of 30-21, must be approved by the full House of Representatives as well as the Senate. In total, the draft bill includes $153 billion in discretionary funding, which is a reduction of $3.7 billion below the fiscal year 2015enacted level and $14.6 billion below the President’s budget request.” Meanwhile, the U.S. Senate’s budget proposal reportedly includes a cut of at least $100 million in AHRQ’s budget, but does not eliminate the agency altogether.

AHRQ’s 2015 budget was $440 million, the report noted; and its 2016 budget request called for a total of $20 million in research grant support. Further as the report noted, “Just last week, AHRQ announced plans to fund three Centers of Excellence to study how high-performing healthcare systems promote evidence-based practices in delivering care. The three grants, which are set to begin in September, will provide approximately $52 million over five years to study how complex delivery systems disseminate evidence-based findings and provide lessons learned to inform the dissemination of findings in other settings. However, effective Oct. 1, 2015, the agency would be eliminated outright if this bill were to pass.”

In a statement accompanying the announcement of the vote, House Appropriations Committee Chairman Hal Rogers (R-KY) said in a statement, “The funding in this bill is targeted to programs that are proven to produce results. In addition, great efforts were made to ensure none of the funding in the bill is spent wastefully or inappropriately. This includes terminating unnecessary programs, trimming back lower-priority areas, and preventing tax dollars from going toward extreme, intrusive regulations that have a net negative effect on this nation.”

This is not the first time that AHRQ has been in danger. As the Wikipedia article on AHRQ notes, “The agency began as the Agency for Health Care Policy and Research and was tasked with producing guidelines. However, it became controversial when it produced several guidelines which would reduce medical drugs and procedures. This included concern from ophthalmologists on a cataract guideline and concern by the pharmaceutical industry over a reduction in the use of new drugs. When the agency produced a guideline which concluded that back pain surgery was unnecessary and potentially harmful, a lobbying campaign aided by Congressmen whose backs had been operated on changed the name of the agency and ‘wound down’ the guidelines program.”

What’s distressing here is the extent to which a federal healthcare agency dedicated to funding research into best practices in healthcare should be in any political or policy danger to begin with. AHRQ has focused strongly on providing funding for research that helps providers to develop more clinically effective and cost-effective care delivery at a time when new strategies are desperately needed.

Jeff Smith, vice president of public policy for AMIA, the Bethesda, Md.-based American Medical Informatics Association, told me this week that “AHRQ has a foundational role to play towards improving care and lowering cost. They are the research and development arm of HHS, and essentially go to work every day to figure out more efficient ways of delivering healthcare. I think it’s a vital agency inside the department,” he added. “So cutting the research budget for AHRQ is really cutting off the nose to spite the face, at a time when the message seems to be resonating.”

Putting all of this in context, Smith (who joined AMIA in his present role on June 1, after serving as vice president of public policy at the Ann Arbor, Mich.-based College of Healthcare Information Management Executives, CHIME) noted that, “For a long time, the National Institutes of health has been underfunded. And recently, there’s been a lot of acknowledgement that we as a country have suffered through underfunding basic research. Yet there is this misunderstanding related to AHRQ, because in a lot of ways, AHRQ is the basic R&D agency working to help figure out how to fund healthcare in new and more efficient ways. And the conversation needs to be about delivering tools to providers to deliver care more efficiently.”

I must say, I’m totally with Jeff Smith on this. AHRQ has been a source of real support and facilitation for innovation in healthcare. And honestly, while in the abstract, a $440 million budget (or possibly, a $300 million budget) may sound big in the abstract, but in context, it is miniscule. Total U.S. healthcare spending in 2014 was over $3 trillion, while total Medicare and Medicaid spending in 2015 is expected to be about $1.4 trillion. So the amount spent on programs at AHRQ is a tiny percentage of one percent of total U.S. healthcare spending, and with a $100 million funding cut, far less even than that.

Think of it his way: if you were about to spend $3,000.00 on a restaurant meal and someone offered to help you figure out a way to save a meaningful portion of that restaurant bill by choosing your meal in a smarter way for less than a penny, would you refuse to spend a copper penny to do that?

Let’s hope that members of Congress, and their staffs, will rethink this move to defund AHRQ totally or even partially, and get back to serious discussions about how to optimize care delivery processes and make good choices as a nationwide healthcare system, at a time when research into best practices needs more than ever to be intelligently funded.  And let’s hope that those members of Congress who are in positions of power over what aspects of healthcare to fund in the next few years open their eyes and see the wisdom of intelligently guided research into how to optimize our healthcare system’s delivery and payment processes.

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