• A few things in the Labor/HHS spending bill

    I’m obviously sympathetic to publicly funded health research. My career depends on it. So, I can’t in any unbiased way write about the Labor/HHS appropriation bill that’s headed for a vote in the House. I wouldn’t tell you how you should feel about a pending piece of legislation anyway.

    But, I can tell you a bit about what’s in it and let you make your own decision. Here’s a quick summary from AcademyHealth:

    [I]t completely eliminates the Agency for Healthcare Research and Quality (Sec. 227), and prohibits any patient-centered outcomes research (Sec. 217) and all economic research within the National Institutes of Health (Page 57, line 19).

    The bold is mine. Some other things of relevance:

    • Health care spending is over one-sixth of our economy. Some might think that makes it worthy of a little research.
    • Health (and some other types of) research is a public good, the funding of which is the role of government.
    • The text of the appropriations bill is here.
    • My prior post on this subject is here.


    • I’d be in favor of keeping the funding, but only at 6% above what the funding was in the year 2000, becuase that is what Medicare payments have been to me.
      In fact, why not do all government spending that way so that the rest of the country can experience what I have these last 12 years?

    • Publicly funded health policy research is important and I in no way agree with the House bill.

      That being said a couple of points. This is a subcmte mark at this point for an apporpriations year that portends far more than a mere conference committee. Furthermore, this won’t happen in September after the House finishes up their FY’13 bill and meets with the Senate’s bill (out of committee). We’re very likely headed to a full year CR, negotiated after the election, and with substantial details to be worked out (sequestration). Today we saw the first story of a CR being used to push these negotations to the new congress.

      Also, it’s curious that the Mark terminates the program. Usually appropriators and authorizers are very cautious to stay in their respective lanes. Defunding a program is one thing (IPAB or PCORI), straight out terminating authorization in an appropriation bil is another. One reason the House appropriators may be doing this is that AHRQ is not appropriated it’s full operating budget. It rather receives the majority of its funds from an internal transfer from most HHS agencies to fund Public Health Service evaluations (PHS Eval funds is the budget parlance). For FY’13, the President’s Budget proposed $334M in funding from this transfer out of a total budget of $408M. As you can see from this link ) the other two funding streams are PCORI and the Public Health Prevention Fund, both of which have funding rescinded in the House Mark.

      So yes please call your representative and your senator and let them know you oppose this bill.

    • The committee chair said: “We also fully fund the President’s requested level of $30.6 billion for biomedical research conducted through the National Institutes of Health. And, by focusing a greater percentage of these resources on basic NIH research activities rather than allowing them to be diverted by the Secretary for other, less-pressing purposes, the bill actually provides an increase of $675 million for NIH to use compared with last year.”

      Surely basic science is more important than a lot of AHRQ’s stuff? I work with them a lot and a lot of their products are just not very good.

      • “a lot of their products are just not very good.”

        This is vague. Can you list which products you have experience with and tell us why you find some “not very good”? What proportion is that of the whole?

        • Well first of all AHRQ publications look like they came out of Word 6.0. I realize this is a minor point compared to actual research outcomes but I find it indicative of the level of innovation at the agency.

          I personally work on an AHRQ community collaborative similar (in fact, almost identical) to RWJ’s Aligning Forces for Quality. It gets a decent slug of money and exists to provide resources for the community resources to access (it doesn’t actually give them money), but the resources are honestly pretty bad. A poorly designed and buggy website and poorly attended webinars are about all they’re able to provide. It’s actually a running joke in the agency that no one is able to define exactly what these community organizations are supposed to do. Fundamentally, I don’t understand the justification for a government foray into this if the private sector (RWJF) does exactly the same thing. It could very well be the case that this effort could be improved with a lot more money, but that’s just not going to happen.

          I realize that this is not at all an objective way to rate the overall agency, but I do see other products as collateral damage from this work. The state health quality indicators are a good example of something that sounds good in theory but looks like it was made in 1999:

          I will happily accept that AHRQ funds good research, but the agency itself hasn’t been a force in producing journal-quality work in-house for quite some time.

          Since the draft budget identifies key AHRQ research to be transferred to other agencies, I think it begs the question: if other agencies with much clearer missions and goals can do the same work, why does AHRQ exist? I believe that AHRQ has been fighting for its own existence for years now.

    • I have worked for AHRQ, as well, and I have found the item I worked on a small piece of to be of extremely high quality. I have also found them to be very careful in following up on grants and contracts to ensure good output. I agree that it may vary from project to project, but sweeping statement s seem dangerous.

      I do wonder if restricting the NIH to biomedical research might not be a net positive (focus) conditional upon adequate funding to AHRQ to continue to look at cost effectiveness. This would make the decision about how to split funds transparent (at the overall budget level) and allow both agencies to focus on meeting distinct (but important) goals.

      I would not be wedded to such a plan, but I could see it making a lot of sense.

      But to kick economic research out of the NIH AND to end AHRQ seems like a really difficult decision to justify.

    • Nothing new here. It is pure right wing corporate politics: conservative fee for service anti-evidence pro-“do any procedure i want and bill for it” physicians tried to kill AHRQ’s predecessor (and half succeeded) over critique of back surgery. Drug and device companies don’t want comparative effectiveness or any independent evidenced based medicine.