Last week, the House of Representatives Appropriations Committee introduced a bill (pdf) that directly targets efforts at making the United States’ healthcare system patient-centered and evidence-based. The bill’s targets:
- The bill would terminate all funding for the Agency for Healthcare Research and Quality (AHRQ). AHRQ is funded by the government in order to carry out the sort of research that for-profit companies will not. Rather than perform research that will provide a financial benefit, AHRQ assesses what treatments are best-supported by the available evidence, and often compares treatments directly to each other (as opposed to comparing an active treatment to placebo). AHRQ plays an essential role in informing healthcare providers as to the best, evidence-based treatments for our patients and focuses on quality, patient safety, and healthcare efficiency.
- As part of ending all funding for AHRQ, the proposed budget also terminates the U.S. Preventive Services Task Force (USPSTF). The USPSTF provides unbiased reviews of the evidence surrounding preventive care services, such as cholesterol screening, mammograms, and prostate cancer screenings. This information, in turn, is used by clinicians to help determine what tests might help our patients avoid future illness or injury.
- The budget would prohibit any funding for the Patient-Centered Outcomes Research Institute (PCORI). PCORI was established by the Patient Protection and Affordable Care Act (ACA) as a means to promote research that would investigate health outcomes that truly matter to patients. For example, patients might not be all that interested in whether a given treatment reduces their cholesterol by 10 or 15 points. Rather, patients might be most interested in whether this treatment might reduces their risk of stroke or heart attack. PCORI will focus its research funding on projects that directly address outcomes that are important to patients puts great importance on the direct involvement of patient advocates and patients themselves in the research process.
The bill does not only target these lesser-know organizations. The bill holds funding flat for the National Institutes of Health (NIH), and cuts funding for the Centers for Disease Control (CDC) by 10% and for the Substance Abuse and Mental Health Services Administration (SAMHSA) by 9%.
There is broad consensus that healthcare in the United States is too expensive, and that the current rate of increase in this spending is unsustainable. There is increasing understanding that too much of the care Americans receive is sub-par, inefficient, and all too often harmful. There is also an increasing desire from both patients and healthcare providers that we must create a healthcare system that is centered on patients and responsive to patients’ needs. The missions of the NIH, CDC, SAMHSA, PCORI, USPSTF and AHRQ are all aimed at meeting these goals.
Evidence-based, patient-centered, safe, efficient and effective care should the mission of any and all healthcare systems. The Appropriations Committee’s proposed budget stands in stark contrast to this mission. It is irresponsible to terminate or harm the very organizations that aim to address or nation’s healthcare challenges. Funding PCORI, AHRQ, USPSTF, NIH, CDC, and SAMHSA must remain a key priority.