Under President Trump’s Fiscal Year 2019 budget, the Agency for Healthcare Research and Quality would see its budget slashed and the organization absorbed by the National Institutes of Health. However, AHRQ officials are trying to stay positive in the face of these proposed funding cuts and consolidation.
“I want to remind you that the President’s budget is the administration’s proposal to Congress, and it’s the starting point of a very long process,” Lucie Levine, AHRQ’s chief financial officer, told Friday’s meeting of the National Advisory Council for AHRQ.
However, until and unless Congress acts, some AHRQ programs are at risk, particularly those related to information technology and data-related programs.
Levine noted that the FY19 budget “transitions the highest priority activities into a new institute at NIH,” including almost $70 million in patient safety research and more than $72 million for the Medical Expenditure Panel Survey (MEPS), a set of large-scale surveys of families and individuals, their medical providers and employers across the country.
In an effort to eliminate duplication and redundancies, the FY19 budget includes $256 million to consolidate AHRQ activities into NIH’s new National Institute for Research on Safety and Quality (NIRSQ).
“Within NIH, the FY 2019 budget includes $256 million in budget authority for NIRSQ to continue selected unique, systemically important activities formerly funded by AHRQ that have demonstrated effectiveness in improving healthcare quality,” according to a Department of Health and Human Services budget document.
While some of AHRQ’s formerly funded activities will continue at NIRSQ under the FY19 budget, health information technology is not one of them, according to Levine.
She told those attending the meeting that the proposed budget cuts include a $16.4 million reduction to the health IT research portfolio. “It essentially discontinues specific research for this portfolio, bringing the total to zero,” Levine said.
Another funding area that would be eliminated in FY19 is $38 million for the health services research, data and dissemination portfolio.
“This a steep reduction that requires the elimination of the quality indicators program, grants and contracts related to the Consumer Assessment of Healthcare Providers and Systems or CAHPS program—it cuts all data analytics contract support and it eliminates all dissemination and implementation contracts,” observed Levine.
According to AHRQ, health services research is a “multidisciplinary field of scientific investigation that studies how social factors, financing systems, organizational structures and processes, health technologies, and personal behaviors affect access to healthcare, the quality and cost of health care, and ultimately, our health and well-being.” Applied health services research provides data, evidence, and tools to “make healthcare affordable, safe, effective, equitable, accessible, and patient-centered.”
In addition, the FY19 budget calls for a $13.9 million reduction in research management and support.
“As AHRQ transitions to NIH, some programmatic activities clearly end, and this reduction in scope requires a decrease of 32 staff members at AHRQ in 2019,” Levine reported to the council.
Despite the deep proposed cuts to the agency, Levine ended her presentation with a positive tone, insisted that “it is not a fait accompli.” She pointed to the fact that both the House and Senate in their mark-ups requested that AHRQ conduct a study on health services research.
“I don’t believe Congress wants to act until they see the results of that study,” Levine added. “We expect that the House will give us their mark for their budget for 2019—probably in June—and the Senate does it later, most likely in September.”
AHRQ has been on the congressional chopping block in recent years, only to survive thanks to a reprieve from lawmakers. In a combined appropriations bill for fiscal year 2018, the agency received $300 million in FY18 funding—a $34 million cut compared with 2017, but a far cry from consolidating AHRQ into NIRSQ as called for in the Trump administration’s “skinny” budget.
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