A Word From The President:

Now's the Time to Billionize AHRQ

Photo of Jordan J. Cohen, M.D. As with its previous publication on patient safety, the Institute of Medicine's sweeping new report titled Crossing the Quality Chasm calls on the Agency for Healthcare Research and Quality (AHRQ) to play a pivotal role in helping us achieve our potential for providing high-quality health care to all of our people. There's no question that AHRQ, the leading federal agency tasked with health care quality, is in a strategic position to address many of the deficiencies outlined in the IOM's reports. But there's also no question that its fiscal position severely hampers its ability to do so.

AHRQ currently has some $270 million at its disposal to help improve the quality of a $1.2 trillion health care industry. (That's about $1 for quality improvement for every $4,500 in service delivery.) Now, I don't think anyone knows what the right budget number for AHRQ should be. Indeed, I don't believe there is a "right" number. But I do know a wrong number when I see it, and $270 million is most certainly the wrong number if we hope to get our country moving on the huge agenda for quality improvement that is now on the table.

That's why the AAMC is calling on Congress to "billionize" AHRQ - to crank up its appropriation over the next two or three years to a level that will begin to approximate the magnitude of the tasks we are asking the agency to undertake. Here is a short list of those tasks:

Be an agent for change within the health care system - Charged with creating and disseminating quality improvement information, AHRQ is uniquely positioned within the federal government to catalyze the enormous changes needed to optimize the efficiency and efficacy of our nation's health care system. Absent such changes, our desire to improve health care quality, our need to decrease health care costs, and our obligation to expand access to essential health care services are all destined to languish.
Spur the development of evidence-based medicine - One of AHRQ's principal missions is to advance the science base for everyday clinical practice. Yet, it is able to support only 12 Evidence-Based Practice Centers, which are designed to review relevant literature about the management of specific ailments and interventions and publish guidance based on their findings. Moreover, at the agency's current funding levels, it cannot sustain its highly successful Patient Outcomes Research Teams (PORTs), which are ideally positioned to generate the new knowledge needed to reduce the wide variations in practice patterns commonly encountered in clinical settings.
Sponsor health services research - AHRQ is currently able to fund only 8 percent of investigator-initiated proposals it receives; this paltry "success rate" not only leaves hundreds of promising applications unfunded; it also discourages many health services researchers from even trying to get their ideas funded.
Help to build the nation's capacity to perform health services research - AHRQ can currently support research and training efforts in fewer than a dozen medical schools; supporting investigators from a broader spectrum of schools would help sustain health services research at institutions nationwide and enlarge the educational pipeline for health services researchers from all backgrounds and regions of the country.
Lead the federal response to the urgent call for improved patient safety - AHRQ received a one-time congressional appropriation of $50 million last year to respond to the IOM's recommendations for reducing errors in the health care system. The IOM itself advocated $100 million annually for this purpose as the minimum necessary to make requisite progress. An adequate patient safety agenda for the agency would include ample support for research on why errors occur, the development of tools to prevent errors, the implementation of novel safeguards, and the establishment of reporting mechanisms to capture information on errors and "near misses" and to promote learning from adverse events.
Monitor progress in improving the quality of health care - Congress has charged AHRQ with producing a national health care quality report. Such a report could serve to focus much-needed public attention on the enormous quality gaps that remain to be closed, but, alas, the agency lacks sufficient funds to complete the task.

We Americans have chosen to expend some 14 percent of our GDP on health care services. And yet we know that this massive level of expenditure is failing to buy us a commensurate level of quality. We have a federal agency, AHRQ, that is poised to help us close the quality gap. It can't do the job with mirrors. But with a little more money, say about a billion dollars, it could do wonders.

Jordan J. Cohen, M.D.
AAMC President

18 April 2001