With the U.S. now spending nearly 18% of its gross domestic product on health care, Congress has targeted for drastic budget cuts the one agency of the government whose sole purpose is to improve the health care system.
Bob GattyWashington-With the U.S. now spending nearly 18% of its gross domestic product on health care, Congress has targeted for drastic budget cuts the one agency of the government whose sole purpose is to improve the health care system.
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In June, the House Appropriations Committee voted to eliminate all funding for the Agency for Healthcare Research and Quality (AHRQ), while the Senate Appropriations Committee subsequently passed a separate fiscal year 2016 Labor-Health and Human Services bill that reduces the agency’s funding by 35%.
There’s no telling whether either bill will come to the House and Senate floors for a vote, but Congress will eventually pass final FY 2016 legislation for the Department of Health and Human Services, and if a compromise is negotiated, the ultimate result could be somewhere between zero funding and that 35% Senate cut.
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On July 28, the AUA sent a letter to top appropriators in the House and Senate expressing opposition to the House proposal to end funding for the AHRQ.
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“Unlike the National Institutes of Health, which focuses much-needed resources on the study of cause, diagnosis, prevention, and management of human disease in a controlled setting, the AHRQ uniquely focuses on the application of medical exploration and, ultimately, the delivery of that care to patients,” the letter said. “To eliminate such an agency would be an injustice to not only the hospitals, private practices, health departments, and communities across the nation that rely on the services of the AHRQ to make important healthcare decisions, but also to the researchers who work tirelessly to further medical research as it relates to the identification and treatment of disease.”
The AUA pointed out that other agencies, such as the Centers for Medicare & Medicaid Services and the Centers for Disease Control and Prevention, have turned their focus to quality improvement strategies aimed at providing better and more affordable care for individuals, as well as greater health education for communities and populations.
To achieve such goals, the AUA said a two-pronged approach must be undertaken that funds both scientific research as well as the use of that research as it translates to patient care.
In its Aug. 18 Policy & Advocacy Brief, the AUA said that the AHRQ was established in 1989 with the mission of producing evidence to make health care safer, higher quality, more accessible, equitable, and affordable. Now, the AUA contended, the AHRQ’s evidence-based work is more important than ever given the federal government’s recent transition to provider quality measures as a way to control health costs and improve the delivery of care.
The AUA noted that the AHRQ created the Evidence-Based Practice Center Program, which produces evidence syntheses by conducting systematic evidence reviews and advances the methods of evidence synthesis to ensure scientific rigor and unbiased reviews.
“These cost-saving reports may be used for informing and developing coverage decisions, quality measures, educational materials and tools, clinical practice guidelines, and research agendas,” the AUA said.
The Alliance for Aging Research said it is “puzzling why Congress has put the AHRQ in jeopardy of losing its funding” considering that its purpose is to fund research that focuses on achieving the best possible care for patients, maximizing efficiency, reducing waste, and identifying incentives to optimize care.
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The Alliance pointed out that the AHRQ’s work is having a direct and significant impact, noting that a 2014 AHRQ report showed that hospital care alone was markedly safer and cheaper than just 3 years prior, in part because of knowledge gained through AHRQ-supported research.
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A major priority of the AHRQ in FY 2016 is to launch a new initiative targeting the poor outcomes and high costs people with multiple chronic conditions experience as a result of often-fragmented, inefficient, and ineffective care, the Alliance noted. The AHRQ would devote funding to provide clinicians with evidence-based tools to develop integrated care plans that comprehensively reflect patients’ health conditions, values, preferences, and relevant life circumstances.
In addition, the AHRQ would use additional resources to collect and analyze nationally representative data to examine the impact of integrated care plans and new Affordable Care Act care delivery models on health care utilization and the quality of care provided to people with multiple chronic conditions.
Also in FY 2016, the AHRQ is to undertake a Health Insurance Evidence Initiative that examines how changes in health insurance benefit packages impact health care utilization, costs, and outcomes. The goal, the Alliance noted, is to understand how health plans can be redesigned to maximize health status and quality and reduce unnecessary costs.
Of course none of this, as well as other projects on tap, will be accomplished if the AHRQ is eliminated.
In its Policy & Advocacy Brief, the AUA said it would continue to make AHRQ funding a priority. Time, however, was running out as Congress returned from its 5-week summer vacation Sept. 8 and needed to act before the current fiscal year expired Sept. 30. Otherwise, a continuing resolution would be needed, keeping funding at current levels until a final appropriations bill is passed.
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