Health advocacy groups are scrambling to save a U.S. research agency on the chopping block in Congress. Last month a House of Representatives panel approved a spending bill that would give the National Institutes of Health (NIH) a $1.1 billion raise next year, with some of the new money coming from zeroing out funding for the Agency for Healthcare Research and Quality (AHRQ), which funds studies to improve health care delivery. A proposal from the corresponding Senate committee, approved 25 June, would be only slightly less kind, slashing AHRQ’s $364 million budget by 35%.
Those who want to trim or eliminate AHRQ argue that its work overlaps with NIH research. To make his point, Representative Andy Harris (R–MD) points to the $1.37 billion that NIH spends each year on health services research and $1 billion for studies of patient safety (both listed here). Others say AHRQ overlaps with the Patient-Centered Outcomes Research Institute (PCORI), a nonprofit supported by a trust fund that was created by the 2010 Affordable Care Act. PCORI now spends about $500 million a year on studies looking at which of two treatments works better, an area known as comparative effectiveness research.
But supporters say these three agencies focus on different pieces of the health care puzzle. Whereas NIH focuses on efficacy—does a treatment work in a clinical trial?—AHRQ was created in 1989 to study effectiveness, explains pediatrician Lisa Simpson, a former AHRQ deputy director and president and CEO of AcademyHealth in Washington, D.C., which runs a coalition called Friends of AHRQ. “Not, ‘can it work in a highly selected group of patients,’ but ‘will it work on patients in the community?’” Simpson says.
PCORI differs from AHRQ, Simpson adds, because its mission is specifically to compare treatments, such as two different doses of aspirin to prevent heart attacks. AHRQ had funded comparative effectiveness research before PCORI came along, she says, but it no longer does.
Simpson acknowledges that the titles of some NIH projects sound similar to those supported by AHRQ and PCORI. But the agencies work hard to avoid duplication, she says. In addition, NIH-funded research tends to focus on specific diseases, whereas AHRQ looks at broader questions. “How do you organize primary care practices for more effective care? How about access, or out-of-pocket costs for patients? These are not related to a specific disease but are critically important,” she says.
In addition, AHRQ funds annual reports on the quality of U.S. health care, supports training of health services researchers, and works to disseminate research findings on best treatments. Those activities make it stand out from the pack, says Ann Bonham, chief scientific officer of the Association of American Medical Colleges in Washington, D.C., a member of Friends of AHRQ. “NIH doesn't get up every morning thinking about improving practice and patient safety at the practitioner level. PCORI doesn’t, either,” Bonham says.
AHRQ has attracted critics in the past because its work can threaten the financial interests of some groups. In the 1990s, Republicans tried to shut down the agency after spine surgeons objected to a report that found rest and pain medications worked as well as surgery for back pain, notes one commentator. Simpson says it’s important to have a U.S. agency that keeps a close eye on health care quality, noting a 2011 Institute of Medicine report that found 30% of the $2.5 trillion the United States spends annually on health care is wasted on unnecessary services and other needless costs. “With that amount of waste, it’s shocking that people talk about duplication of AHRQ research,” she says.
The same House committee proposed 3 years ago to abolish AHRQ, but the corresponding Senate panel did not concur. Given the initial support for cuts in the Senate, a bigger hurdle this time around may be the budget process itself. Congress seems headed toward maintaining the status quo into the 2016 fiscal year, which starts in October, while Republicans and the Obama administration argue over whether to lift spending caps for the entire government. So it will probably be several months before AHRQ knows whether it will remain in business.