AHRQ facing new budget worries in fiscal year 2017
Once again on the congressional chopping block, the fate of the Agency for Healthcare Research and Quality’s fiscal year 2017 funding remains up in the air, according to AHRQ Director Andy Bindman, MD.
Last year, AHRQ was able to dodge an appropriations bullet. The agency had been threatened with having its entire fiscal 2016 budget zeroed out by the House of Representatives, yet in the end was granted a reprieve thanks to an omnibus bill that gave AHRQ $334 million in FY16—an 8 percent reduction. However, in FY17 AHRQ might not be so lucky.
Speaking on Wednesday at a meeting of AHRQ’s National Advisory Council, Bindman told the 21-member body that the agency “continues to have challenges receiving the budget that the President has requested.”
According to Bindman, AHRQ’s FY17 discretionary budget request is for $363.7 million. “If that were to be enacted, that would be a $29.7 million increase from the fiscal year 2016 amount that we received. But, the total amount would actually be $469.7 million because of also anticipated increases in the Patient-Centered Outcomes Research Trust Fund,” he said.
The budget request is an attempt to “reverse the significant reductions to research activities in FY16 and makes investments in AHRQ’s core mission areas of improving the quality and safety of healthcare; creating tools and resources to be used by healthcare providers; and developing measures and data that can track and improve performance of the healthcare system,” states the agency’s FY17 congressional justification document.
Nonetheless, Bindman said that working against these plans is a House Appropriations Committee recommendation made in July for an AHRQ FY17 budgetary authority of $280.2 million—about $54 million less than what the agency received in FY16 and “considerably lower” than the President’s FY17 budget request of $363.7 million.
Though disappointed with the recommendation by the House Appropriations Committee, Bindman quipped that the “silver lining” for the agency is that “it was the first time I believe in four years we didn’t get a zero from this committee.” He also noted that the Senate Subcommittee on Labor, Health and Human Services in June recommended $324 million for AHRQ in FY17—$10 million less than what it received in FY16.
For now, AHRQ and other federal agencies are being funded through Dec. 9 thanks to a continuing resolution signed by President Obama in late September which averted a government shutdown.
“The continuing resolution through Dec. 9 basically prorates forward our fiscal year 2016 budget,” added Bindman. “Because we are uncertain, of course, what will happen beyond Dec. 9, we’ve really been trying to be cautious in how we use our funds and we’re really only providing necessary and limited funding in order to provide continuation of projects and activities.”
When Congress returns in a lame-duck session after the presidential elections, it will try to pass legislation to keep the government open throughout FY17, which began on Oct. 1, 2016 and ends on Sept. 30, 2017. However, what ultimately happens is anyone’s guess.
Bindman commented to AHRQ’s National Advisory Council that members of Congress and their staff have raised “questions” about the redundancy of the mission/activities of AHRQ relative to the Patient-Centered Outcomes Research Institute (PCORI), an independent nonprofit, nongovernmental organization authorized by Congress in 2010.
“That gets more nuanced to be able to help explain how AHRQ’s work is aligned and not redundant,” acknowledged Bindman. “When does what could appear to be overlap actually reflect a positive thing?—as opposed to an inefficiency, which I think is sometimes the perception that some might have.”
From his perspective, PCORI Executive Director Joe Selby, MD, sees the two organizations serving unique but complementary roles.
“PCORI funds comparative clinical effectiveness research (CER), which seeks to determine which healthcare options work best, for whom, under which circumstances—we are the only funding organization in the U.S. exclusively focused on funding CER,” says Selby. “AHRQ no longer funds CER and instead focuses on supporting important health services research, including addressing patient safety and healthcare quality, the application of health information technology, and research dissemination and implementation efforts, among other priorities.”
At the same time, Selby relates that AHRQ is charged with disseminating findings from patient-centered outcomes research funded by PCORI and government agencies.
“We’re collaborating with AHRQ to develop strategies for disseminating selected PCORI findings and for promoting their uptake into healthcare practice as part of our larger dissemination and implementation efforts,” he concludes. “And we’re submitting promising findings from PCORI-funded research to AHRQ via their public nomination process.”