AHRQ Funding Cuts Threaten Evidenced-Based Testing Advances

In what has been called a "devastating attack on health research funding," this summer a U.S. House of Representatives panel approved a spending bill that would eliminate the Agency for Healthcare Research and Quality (AHRQ), while the corresponding Senate Appropriations Committee cut the agency's budget by approximately 35 percent. The agency's elimination would be felt across the health care system, including in the diagnostics industry, where the agency has been active in conducting technology assessments of emerging genetic tests, evidence-based research on effective screening strategies and testing modalities, as well as through its work to improving patient safety by reducing diagnostic errors, through information technology applications to enhance the testing process.

"Americans deserve reliable information on how to deliver the best possible care, at the greatest value, with the best outcomes. AHRQ-funded health services research provides those answers," wrote Friends of AHRQ, a coalition of advocates from 250 organizations, in a letter to Congress, on behalf of the agency. The $465 million from defunding AHRQ would be reallocated to the National Institutes of Health (NIH) for disease-specific projects, such as Alzheimer's research ($300 million in new funds), $100 million for NIH's contribution to a federal antibiotic resistance initiative, and $200 million for President Barack Obama's Precision Medicine Initiative. (The budget for the Patient-Centered Outcomes Research Institute (PCORI), which was created by Congress under the Affordable Care Act for comparative effectiveness research, was also slashed by $100 million by the House.)

While creating significant alarm throughout the field of health services, the FY 2016 cuts to AHRQ are not final and will be reconciled by the House and Senate during fall conference negotiations. Evidenced-based medicine has become a partisan issue, as its funding is in part tied to 2009 stimulus legislation and the Affordable Care Act. Furthermore, evidenced-based findings are often seen as a threat to the revenue stream of some health industry stakeholders. But AHRQ critics also argue that the agency's work duplicates efforts of other groups, including the NIH and PCORI.

"PCORI is focused on funding comparative effectiveness research, trying to figure out whether in practice treatment A works better than treatment B," says AHRQ Director Richard Kronick, Ph.D., in an August interview with JAMA. "We complement PCORI's focus ... [as] we continue to fund research into how physicians and hospitals can quickly put PCORI's discoveries into practice."

Supporters say, however, that unlike other agencies working on new medical discoveries, AHRQ research centers on cost, quality, and safety of care delivery. While defunding AHRQ would wreak havoc in medical research, experts say the agency is needed to ensure investments in new technologies are effectively used throughout the health care system. The challenge, even AHRQ supporters admit, is that while the agency's work is for the public good, the nature of its work makes it difficult to generate public enthusiasm or dominate headlines, as it lacks the pizazz of Ebola vaccines and emerging cancer treatments.

"Our nation spends more than $3 trillion annually on health care ... [but research] tells us too many patients receive sub-optimal, unsafe, and even harmful care. We can do better, and health services research tells us how," says Lisa Simpson, CEO of AcademyHealth, a national organization representing the field of health services research. "Investments in discovery and development will fall short if we don't have research on how best to deliver them to the right patients, at the right time, and in the right setting."

AHRQ had asked for $479 million with stated priorities for FY 2016 to include: improve health care quality and safety, increase accessibility and affordability, and improve health care efficiency and cost transparency.

"The appropriated budget of the agency is about 1/100th of 1 percent of national health spending," said Kronick in the JAMA interview. "The return on investment from this 1/100th of 1 percent is very large, as evidenced by recent reports on quality of care and patient safety."

Takeaway: AHRQ research efforts face threat of elimination despite its role in assessing effectiveness and value of health care delivery.