AHRQ's potential move to the NIH could strengthen its work
Tucked within the Trump administration's 2018 HHS budget is a proposal that could be easy to miss. A short sentence repeated a few times throughout the budget calls for the Agency for Healthcare Research and Quality to be consolidated into the National Institutes of Health.
Health policy experts say that may be a step in the right direction for AHRQ—if done right. Turning the agency into a separate institute under the NIH's umbrella could elevate AHRQ's importance and strengthen its mission.
But that positive outcome can only happen if AHRQ and NIH receive the appropriate resources and support, experts say.
"Its critical AHRQ would have the same recognition as other key entities at the NIH," said Dr. Andrew Bindman, the former director of the agency from May 2016 to January 2017.
As an independent agency housed at the HHS, AHRQ has faced frequent budget cuts and harsh criticism from congressional leaders who question its importance. Moving to the NIH might change that, Bindman said. AHRQ could benefit from NIH's bipartisan support and a robust budget roughly seven times larger than its own.
NIH "might in fact create more of a safe and stable home for AHRQ," he added.
But NIH is facing its own budgetary hurdles. Trump's budget also proposed cutting $5.8 billion—or 18%—from the institutes' budget for 2018. Those cuts have garnered significant backlash and Congress quickly boosted NIH's funding by $2 billion for the last five months of this fiscal year.
Bindman said he anticipates AHRQ's budget would grow at a "rate that parallels the work that goes on at the NIH as a whole."
NIH Director Dr. Francis Collins didn't say Thursday at a hearing with lawmakers on the Hill whether or not AHRQ would fit well at the institute, but he did say if it were to merge with the NIH, "We would figure out how to make the best of that circumstance."
Collins also noted that AHRQ's research is "complementary" to some of NIH's quality and safety research.
AHRQ often follows up on NIH findings to test their implications on safety and quality. Bindman said that relationship would only improve if AHRQ was part of NIH.
AHRQ could also re-emphasize its important and unique patient safety research work at its proposed new home, Bindman said, and advocates should push for more funding since errors related to patient safety are one of the leading causes of mortality in the U.S., he added.
AHRQ can be forgotten in its current state under the HHS' vast umbrella, according to Francois de Brantes, vice president and director of the Center for Payment Innovation at the Altarum Institute. "They might not get lost at the NIH," he said.
But there are still differences that could hurt AHRQ, according to Dr. Richard Kronick, former director of AHRQ from 2013 to 2016. AHRQ focuses on health services research, whereas NIH largely focuses on biomedical research.
"Maintaining AHRQ's razorlike focus on improving quality and safety could get more difficult over time" at the NIH, Kronick said.
In order to ensure AHRQ doesn't get "lost" in the vast work that goes on at the NIH, Bindman said it's crucial AHRQ is a distinct entity at the institute. The Trump administration proposed to keep AHRQ's identity by creating the National Institute for Research on Safety and Quality to replace AHRQ.
If AHRQ is within the NIH, it could become the unified voice on priorities for health services research, Bindman said. He suggested the agency make a yearly address to Congress that lays out the priorities for health services research for that year. "AHRQ needs to be the home for health services research activity," he said.
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