Cautious Optimism Surrounds Budget Proposal to Roll AHRQ Into NIH

A provision in President Donald J. Trump’s budget proposal would incorporate the Agency for Healthcare Research and Quality (AHRQ) within the National Institutes of Health (NIH). Supporters of the small agency are concerned about its long-term future, but say the move could present some new opportunities.

In the health policy world, headlines from the March 16 release of Trump’s budget blueprint mainly centered on the $12.6 billion in cuts to HHS funding for 2018, or the provision of $500 million in additional funds for opioid prevention and treatment programs. Nestled in the paragraph about reducing NIH spending by $5.8 billion is a sentence indicating that the budget represents “a major reorganization of NIH’s Institutes and Centers to help focus resources on the highest priority research and training activities,” accomplished in part by incorporating the AHRQ within NIH.

It did not specify any reductions in funding to AHRQ itself, aside from the overall NIH budget cuts, but some supporters of the agency, including former director Andrew Bindman, see the reorganization as a possible threat to its future. In a Health Affairs blog post, Bindman wrote that advocates must dissuade Congress from treating AHRQ as “the basis for making up for a shortfall in other NIH funding priorities.”

Bindman wrote that this is not the first threat to the independence of the agency, which is responsible for conducting healthcare research, developing evidence-based guidelines for practice, and generating data and measures intended to make healthcare safer and higher quality, according to its website.

He pointed to the agency’s slow financial growth, along with the development of other organizations like the Patient-Centered Outcomes Research Institute and the Center for Medicare and Medicaid Innovation that have taken over some of the AHRQ’s original tasks, as examples of recent impediments to the agency’s operation. He also hypothesized that some of the attacks on the AHRQ come from those who fear that the agency’s guidelines “threaten professional autonomy and practice reimbursement.”

Bindman was not the only one to sound the alarm about the potential risks of the AHRQ’s absorption. Contributor Bruce Y. Lee penned an article for Forbes explaining that while “AHRQ may sound like something you would say when you step on a tack,” it actually serves a vital, if underappreciated, purpose. The agency works to identify drivers of medical errors and healthcare-associated infections, which allows it to disseminate best practice guidelines that aim to prevent these occurrences. Medical errors cost an estimated $1 trillion yearly and are the third leading cause of death in the United States, Lee wrote, which makes AHRQ funding “an investment, not a cost.”

Still, some are trying to view the proposed incorporation within NIH as an opportunity, not a death knell. Bindman wrote that the reorganization could potentially serve as a kind of shield for the embattled agency. NIH enjoys widespread bipartisan and public support, which could give the AHRQ’s researchers “some shelter against the attempts to have their work undermined through political action.” If allowed to function as a separate entity within the NIH while given sufficient funding, it could even expand its research functions.

Advocates like Bindman hope to paint a compelling picture of the AHRQ’s value and the conditions needed for it to flourish as Congress drafts a budget based on Trump’s proposal.