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Should AHRQ’s Survival in 2016 Be Seen as an Existential Triumph?

December 22, 2015
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The twists and turns of the funding fate of AHRQ speak to a congressional culture that imperils data-driven health system optimization

On any proverbial journey of a thousand miles, there are bound to be a few potholes in the road. That certainly has been the case with regard to the broad push towards transparency and accountability in U.S. healthcare.

Indeed, the journey towards transparency and accountability in our broad healthcare system has had more than its share of bumps in the road. And one of the “Perils of Pauline” stories that healthcare policy wonks have been following for some time has been the saga around the attempted defunding of the Agency for Healthcare Quality and Research (AHRQ) that has been threatened for some time now, and seemed to reach its zenith of possibility in the past couple of months or so, as some members of Congress have pushed for the complete zeroing out of the agency’s budget.

Indeed, in the always-rambunctious House of Representatives, a majority of the House Appropriations Committee in June voted to support a bill that would eliminate AHRQ altogether. Still, in the end, the FY 2016 final omnibus budget resolution ended up funding AHRQ with a $334 million budget, down from its $364 million FY 2015 budget by about 8 percent, but far from the summary execution that some in Congress had planned for it.

As the Wikipedia article on AHRQ notes, the agency, which began in 1989 as the Agency for Health Care Policy and Research (AHCPR—always an awkward acronym, by the way), and was reauthorized in 1999 as AHRQ, has had its share of controversies, including some pushback on the part of ophthalmologists over a cataract guideline and on the part of orthopedists over a low back pain guideline, as a July 1995 report from the United States General Accounting Office (GAO) noted. More broadly, however, the federal research funded by the Department of Health and Human Services (HHS), including AHRQ, has become confused in the minds of the public, but also among certain federal legislators, with elements of the Affordable Care Act (ACA), which came into the headlines in 2009 and 2010, as that healthcare reform legislation was being developed.

In particular, a vice-presidential candidate made the charge, later completely debunked, that the ACA included a provision for “death panels,” in which patients would allegedly be “sentenced to death” by panels of individuals given the power to cut off all their healthcare coverage. In fact, the later-debunked charge related to a previously little-known clause in H.R. 3962, “America’s Affordable health Choices Act of 2009,” an earlier form of healthcare legislation later superseded by the ACA, that would have reimbursed physicians for providing end-of-life counseling to patients. Outside certain political and social circles, the “death panels” charge has largely been forgotten by the general public. And yet, and yet—the “death panels” claim ended up having a rather broadly negative impact on federal funding for research, including funding for research around or support for the development of, appropriateness criteria and other evidence-based guidelines and tools, as everything related to data, guidelines, appropriateness criteria, and healthcare services utilization ended up becoming confused into one big brain cloud among some members of Congress, it seems; and that problem has been at the root of the resistance to the refunding of AHRQ.

All that is particularly unfortunate given the broad support that AHRQ has given and continues to give to very worthy research around healthcare quality. Just check out the current list of notices on AHRQ’s website regarding its funding support for a variety of research projects: the list includes support for research around patient safety in ambulatory care settings and long-term care facilities; for child health quality measurement implementation and development; for clinical decision support for increased patient safety; and for IT-facilitated patient safety research.

The plain reality here is that healthcare providers need every bit of help they can get in order to help sort through a vast range of questions and issues around patient safety, clinical efficacy, and operational efficiency in today’s (and tomorrow’s) healthcare. And the federal government is the only entity in the United States that can legitimately and successfully support certain types of research on behalf of the entire healthcare system, and therefore, on behalf of all the patients, healthcare consumers, and communities in this country.

Indeed, we all keep saying that future healthcare in this country will be data- and evidence-driven. If so, don’t we need a lot more (intelligent) data and evidence?

And it has been terribly unfortunate that political developments have led to the questioning of health services research in this country. And that is why AHRQ’s survival in this 2015 year-end budgeting process can only be seen as the agency’s triumph, in the current climate.