Washington Health Policy Week in Review: Agency for Healthcare Research and Quality (ARHQ)

— House GOP appropriators’ bid to shut down a little-known federal medical agency in fiscal 2016 likely will fail, but their consistent criticism of the Agency for Healthcare Research and Quality (ARHQ) may take a financial toll.

Appropriators last year curbed a budget practice that had transferred funds from the National Institutes of Health (NIH) and other agencies to the AHRQ, a move that compels the agency to compete more directly with other federal programs in the annual spending scrum.

The initial signs are that the agency isn’t doing well. House Republican appropriators want to eliminate it. Senate GOP appropriators want to reduce its budget by about a third and even the White House asked for flat funding for the AHRQ’s general operations in a request that proposed a 6 percent increase in total federal spending.

The AHRQ describes itself as the “nation’s engine for improving the safety and quality” of health care. The staff pores over vast amounts of data for clues on how best to practice medicine, helping other agencies implement the lessons on such things as reducing falls or potentially deadly infections in hospitals. Health policy wonks see it as an unsung catalyst to improve medical practice.

But that advice can also earn powerful enemies as the agency questions the value of procedures or recommends changes that anger some in the $3 trillion industry. The AHRQ had a previous near death experience in the early 1990s. Unlike the NIH or Centers for Disease Control (CDC), the low-profile AHRQ doesn’t become the centerpiece of Hollywood movies about researchers battling killer contagions.

“Our job is to try to make the other 99.99 percent of spending more effective,” AHRQ Director Richard Kronick said in an interview with CQ Roll Call.

But critics say much of its work is duplicative.

House appropriators, led by Rep. Tom Cole, R-Okla., the chairman of the Labor-HHS-Education Appropriations panel, question whether the agency is needed at all, saying other federal medical programs are doing the same work. Cole has written provisions into the spending bill that would allow some AHRQ programs to move elsewhere in the Department of Health and Human Services if they aren’t already replicated. He said he may be willing to preserve the agency if a budget deal lifts the spending caps for fiscal 2016.

“We think there is ample opportunity here to salvage what’s appropriate, to get rid of some duplications here and to actually capture some savings that can be redirected,” Cole said.

Cole is the third consecutive Labor-HHS-Education Appropriations chairman since Republicans regained control of the House in 2011 to back eliminating the AHRQ. He’s the first, however, to get a bill as far as markup in the full committee. His predecessors, Denny Rehberg, R-Mont., in 2012 and Jack Kingston, R-Ga., in subsequent years, didn’t even get that far.

“Anything that CDC or NIH or somebody else is doing, we are going to eliminate it,” Kingston said in an interview this week. “Anything that no one else is doing, we are going to preserve it.” He supported Cole’s approach. “It’s a pretty small step.”

Powerful Supporters

The agency has fervent and powerful supporters among Democrats and Republicans. One of them is Sen. Barbara A. Mikulski, D-Md., ranking member of the Senate Appropriations Committee. But that hasn’t prevented Senate appropriators from approving a bill (S 1695) that would cut the AHRQ discretionary budget to $236 million in fiscal 2016, a reduction of $128 million from fiscal 2015.

The Senate cuts would hit health services research programs particularly hard. The programs fund efforts to understand how people get access to medical care and how much it costs, and how well treatments provided work to preserve or restore patients’ health.

Former Senate Majority Leader Bill Frist, R-Tenn., who is also a surgeon, contributed a column to Forbes magazine last month saying the agency’s work makes American medicine safer and citing its contribution to preventing hospital-acquired infections as an example.

Gail Wilensky, who led the agency now called the Centers for Medicare and Medicaid Services in the President George H.W. Bush administration, argued in a September article in the Journal of the American Medical Association that the AHRQ is vital for efforts to gain control of rising health expenses.

“Given the cost and the shortcomings of US health care, it shouldn’t be difficult to recognize the need for an agency that focuses on strategies designed to advance evidenced-based treatments, to improve patient safety, to foster the use of health information technology in facilitating these goals, and to aid the dissemination of improved clinical care strategies,” Wilensky wrote. “But apparently it is, as I’ve observed during the 40 years I have been in the field.”

“AHRQ’s work is, let’s face it, boring—but no less important,” said Joe Antos a researcher at the conservative American Enterprise Institute in a June blog post. “We may not be enthralled by a study of how to prevent hospital-based infections, but such studies can change the way health care is delivered on the ground—which can improve patient experience and reduce cost.”