The recent tug-of-war between the White House and Congress over the Federal Budget included a recurring attack on a small agency committed to delivering better healthcare to every American, with special focus on older adults. As it has for the last three budget cycles, the Agency for Healthcare Research and Quality, or AHRQ, saw its budget reduced, and its very existence threatened. Once again, the Agency appears to have survived, at least until September 30 when the current interim funding legislation expires. In the face of a looming shutdown, Congress simply did not have the time to go over the fine points of the budget. But Congressional inefficiency cannot be counted on every time to save the work of this very valuable agency, nor should that be the long-term strategy for AHRQ’s survival.
Some background here: if you are not familiar with AHRQ, you are probably not alone. This small, low-profile agency has, for more than two decades, produced groundbreaking research, aimed at making healthcare safer, more affordable, and more effective. Simply put, it has helped translate medical discoveries and research-supported best practices into front-line, effective clinical care. Older adults have been a “priority population” for AHRQ, and the agency has conducted a broad variety of research to improve the care of our aging population. For example, AHRQ has conducted research to validate the use of a newly-introduced screening tool to provide more efficient diagnosis of delirium. The Agency has conducted an evidence review on oral anti-coagulants for stroke prevention in atrial fibrillation that informs clinicians about the latest research on treatment options, and identifies where there are still significant evidence gaps that the National Institutes of Health (NIH), Patient-Centered Outcomes Research Institute (PCORI), and other research centers can work to fill. And it has established the Assisted Living Disclosure Cooperative to provide consumers with the essential facts they need to differentiate among individual assisted living residences, and make the best choice for themselves and their loved ones.
Why has such a small agency, with a relatively small budget, been targeted for demolition by members of Congress on both sides of the aisle? The reasons are as varied as the questions that AHRQ answers. In some instances, the Agency’s recommendations for new approaches have met with the resistance of medical specialties that simply do not welcome change. Additionally, the Agency has issued guidance clearly pointing out that the sometimes lucrative standard of care is ineffective. For example, when the Agency suggested that spine surgery was often unnecessary, it ran afoul of powerful and well-funded spine surgeons. These surgeons contacted their equally powerful and well-funded representatives in Congress, and AHRQ barely escaped the legislative scalpel. Perhaps most important, funding for research that supports slow and steady improvement of medical practices is most likely less attractive – and more difficult to explain to voters – than funding of potential research breakthroughs that could lead to blockbuster drugs.
This year, in addition to proposing a cut in funding for AHRQ’s efforts, the Trump administration proposed completely dissolving AHRQ as an independent agency and folding its current functions into a new institute within the National Institutes of Health. Some of AHRQ’s supporters see this as a positive step, hoping that AHRQ would gain protection as part of the NIH fold. Others fear that AHRQ with its comparatively tiny budget may be lost in the competition for resources with other, highly visible institutes.
Almost twenty years ago, the Institute of Medicine published its ground-breaking report on hospital safety which estimated that up to 98,000 patients died each year due to medical errors and other related hazards. Since then, significant resources have been dedicated to improving the safety of our hospitals. While there has been enormous progress, a recent survey of healthcare experts by Modern Healthcare reported that about one in four U.S. hospital patients still suffer at least one healthcare-related injury. Clearly more work is needed. At a time when consumers are asking for safer, more effective, and less expensive healthcare, curtailing or ending the work of AHRQ to save Federal dollars would be a step backwards, delivering short-term savings at a long term cost. Without AHRQ’s work, hospital patients could pay a very high price measured in lost safety improvements, and vulnerable older adults could pay a disproportionately large part of that bill.
Jim Scott serves as the chair of the Alliance for Aging Research’s Board of Directors. He is also the president and CEO at Applied Policy in Washington, D.C.