WASHINGTON -- A House committee moved a step closer Tuesday to getting rid of the Agency for Healthcare Research and Quality (AHRQ) -- an agency long disliked by some members of Congress.
The House Appropriations Committee has inserted a provision in a bill providing funding for the departments of Labor, Health and Human Services (HHS), and Education that would zero out funding for the AHRQ, whose 2015 budget was $440 million. A move by to restore the funding failed on a voice vote.
The appropriations bill, which the committee approved Tuesday by a vote of 30-21, must be approved by the full House as well as the Senate; the AHRQ's fate in the latter chamber is unclear.
The 25-year-old agency's mission -- -- is to "produce evidence to make health care safer, higher quality, more accessible, equitable, and affordable, and to work within the U.S. Department of Health and Human Services and with other partners to make sure that the evidence is understood and used." But some members have argued that the agency's work is duplicative of work being done within other divisions of HHS, such as the CDC and the NIH.
, a staunch supporter of AHRQ, argued against that idea. "AHRQ plays a unique role that needs to be continued," she said at the hearing. "It does not do public research into the prevalence of infections as does the CDC ... AHRQ looks at the delivery of healthcare, which makes its mission unique."
DeLauro noted that some members had suggested moving AHRQ's functions to the Office of the National Coordinator for Health Information Technology (IT), "but the bill doesn't provide additional resources to [that] office to pick up the mission. It would be a mistake to shut down this agency."
This is not the first time AHRQ has been on the chopping block, noted , a director at Avalere, a healthcare consulting firm here. "The idea of defunding AHRQ surfaced in 2010 as well," and again in 2012, she said, noting that the 2012 defunding proposal was suggested as a way of offsetting an increase in funding for the NIH.
However, the agency does still have a lot of support from researchers and academic research centers, Choe said. Opponents, on the other hand, "are still holding onto this notion that AHRQ only does clinical outcomes research -- also known as clinical effectiveness research (CER) -- that's now primarily being done by the Patient-Centered Outcomes Research Institute. That's the message I've been hearing in the past couple of days, [so supporters] are really trying to get the message out that AHRQ does a lot more beyond that."
In actuality, only about a quarter of AHRQ's budget goes to health research, and even much of that is beyond studying clinical effectiveness, she continued. The agency looks at patient safety, especially in the hospital setting, "and a lot of things in quality broadly; it funds health IT-related research and provides research and administrative support for the U.S. Preventive Services Task Force ... and also administers the Medical Expenditure Panel Survey. So its purview is actually quite broad."
And the budget for the entire agency, relatively speaking, is quite small -- about 0.1% of the overall HHS budget, Choe said.
Some of the hostility toward AHRQ's work comes from the idea that CER could be used to ration care. Back in 2009, "CER was a very divisive issue, and AHRQ was in the middle of all that," she said.