Nineteen months ago, an energetic Republican Congress bent on revolutionizing Washington had in its cross-hairs the Agency for Health Care Policy and Research, a quality-research branch of HHS.
As they drew up budget documents for fiscal 1996, which began Oct. 1, 1995, both houses of Congress set out to gut the AHCPR. The reason: GOP leaders believed-apparently in error-that the Clinton administration had designated it as the agency that would have carried out the president's healthcare reform plan if it had been enacted.
With the plan's demise, there was no point in keeping the agency alive, Republican lawmakers argued.
All this came despite the fact the AHCPR had been in existence since 1990, two years before Clinton was elected to the White House.
The House Budget Committee proposed complete elimination of the agency, saving $139 million a year. The Senate Budget Committee, which originally made the off-the-mark assertion about the AHCPR's role, called for a 75% reduction in its budget.
"That characterization, one of many of the agency, was caught up in the fervor of the first few months of Congress to downsize government," said AHCPR Administrator Clifton Gaus. "We're a small part of the healthcare system. We were an easy target."
Today, as Gaus prepares to leave government, the agency has bounced back from that image and has managed to survive the budget battle, partly through a quiet lobbying campaign and partly by remaking itself to better fit private-sector needs.
The AHCPR enlisted "champions" such as Sen. Bill Frist (R-Tenn.), a transplant surgeon, and Rep. William Thomas (R-Calif.), chairman of the House Ways and Means health subcommittee, to make the agency's case to colleagues who didn't always understand its role in quality improvement.
The result: The AHCPR held on to a reduced budget of $125 million in federal fiscal 1996, which ended Sept. 30, and received an increase of about $20 million for fiscal 1997.
"It's clear we are over all that doubt and criticism," Gaus said in a recent interview. "That's one of the reasons I feel comfortable about leaving."
But prodded by some of those same members of Congress, as well as representatives of the private sector, the agency has remade itself to perform functions that private providers can't do and end those the private sector already does.
Gone is the expensive, time-consuming and often controversial effort to develop clinical practice guidelines for the private sector. Instead, the agency will assist private-sector organizations and providers in developing their own guidelines, including cost-effectiveness and appropriateness policies. AHCPR centers will collect and synthesize data for private-sector organizations drafting guidelines.
The agency recently sent out bid solicitations. Gaus said the AHCPR probably will award the contracts this spring.