In the world of healthcare delivery system reform, Dr. Peter Pronovost of Johns Hopkins University is a rock star. His pioneering work in reengineering hospital processes that lead to unnecessary infections has been credited with preventing 50,000 deaths and saving the healthcare system over $12 billion.
Much of that work was financed by the federal Agency for Healthcare Research and Quality.
Pronovost still relies on AHRQ for funding. His Learning Lab at Johns Hopkins is in the middle of a four-year, $1 million effort to translate the interdisciplinary team approach used by the U.S. Navy on its submarines into better processes inside the nation's intensive-care units. The goal, according to the grant proposal on the AHRQ website, is “to eliminate preventable harm, optimize patient outcomes and experience, and reduce waste in healthcare.”
For decades, the nation has poured hundreds of billions of dollars into basic and applied science to devise cures for diseases. With support from the drug and device industries, which mine that research, legislation to boost the National Institutes of Health's $30 billion budget has become a bipartisan cause célèbre on Capitol Hill.
But investing in research and development for new and better ways of delivering care in the nation's hospitals and physician offices remains a stepchild in Washington. And now it is threatened with becoming an orphan.
NIH doesn't fund such research. And while the CMS, which pays for Medicare and half of Medicaid, has created incentives to improve quality, reduce harm and lower costs in the seniors' program, it does not fund delivery system R&D. Its demonstration projects—accountable care organizations, medical homes and the like—are the equivalent of trial-and-error experiments whose early stumbles could have been reduced if there had been adequate research before setting up the programs. Yet instead of beefing up funding for such research through AHRQ, Republicans on Capitol Hill are trying to kill the agency. Its paltry $465 million annual budget is a rounding error compared with the more than $600 billion the CMS spends on services.