When the Trump administration revealed its budget priorities on March 16, it proposed dissolving the Agency for Healthcare Research and Quality as a freestanding agency within the Department of Health and Human Services and moving it under the purview of the National Institutes of Health. This has raised concern among some in the medical research field, but Andrew Bindman, AHRQ's former director, cautiously sees this as an opportunity to avoid partisan conflict.
Health services research, which was once consolidated under AHRQ, has been dispersed to the detriment of the field, Bindman wrote in a recent Health Affairs blog post. The Affordable Care Act, he said, re-assigned AHRQ's responsibility for conducting comparative effectiveness research to the Patient-Centered Outcomes Research Institute; it also created the Center for Medicare and Medicaid Innovation, which uses its $1 billion annual budget to examine delivery system innovation.
With AHRQ once representing what Bindman called "a shared narrative for collective action," he wrote that spreading out its responsibilities across myriad agencies has "muddled the message" of what the research is trying to accomplish, despite overall better funding for the research.
Bindman called AHRQ a "unifying home" and said that, by reorganizing it into the NIH, it could be again.
If it happens, the administration is calling for a simultaneous budget cut to the NIH, which would effectively undermine what the reorganization is trying to achieve. But Bindman said that if Congress can be convinced to move forward with adequate funding for AHRQ, as a corresponding entity within the NIH, the move could come with benefits.
First, health services and primary care researchers may gain a safe haven from political action and bickering. Another benefit is that it would combine the NIH's role in discovery with the AHRQ's penchant for converting research into tangible improvements in healthcare safety and value.
Trump's budget calls for a $5.8 billion cut to the NIH. The organization currently spends about $1.5 billion per year on research.
"The proposal to relocate AHRQ within the NIH is a threatening change," wrote Bindman, "but under the right conditions a reorganization could represent a new beginning with an opportunity to refocus within a larger new home."