Cuts to key healthcare agencies are bad medicine

With Congress racing to complete legislative work, lawmakers should ring the alarm bell and reverse severe budget cuts for two organizations essential to the U.S. healthcare system.  

The Agency for Healthcare Research and Quality (AHRQ) and the Patient Centered Outcomes Research Institute (PCORI) may not be well known to the average American, but the proposed draconian cuts to their budgets will be felt in examination rooms and wallets all around the country.  

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AHRQ provides independent analysis to make healthcare more affordable and accessible, while PCORI provides invaluable research on the comparative benefits of medical treatments to empower patients and their doctors to make better choices. Yet in June the House Appropriations Committee voted to eliminate all funding for AHRQ, redirecting the funds to the National Institutes of Health (NIH). The panel also proposed to cut PCORI’s funding by $100 million. A Senate proposal would cut AHRQ’s $364 million budget by 35 percent. 

Supporters of the proposed cuts argue that the missions of the two organizations overlap with one another and with those of NIH. But this is an inaccurate view and one that ignores the mandate and value of the three organizations, all of which are needed to deliver the best healthcare possible. 

One of the primary roles of NIH is to sponsor discoveries that are focused on addressing specific diseases. In addition, the agency conducts important basic science that is applicable to a wide spectrum of scientific endeavor. In short, it is the nation’s indispensable engine for biomedical study and breakthroughs. 

PCORI’s mission is very different and largely patient focused. The remit of this federally funded non-profit organization is the funding of comparative effectiveness research, which focuses on the effectiveness of any given treatment or preventative recommendation. It provides the essential information physicians and patients need when making treatment decisions. 

One important example of this is PCORI’s funding of a $14 million clinical trial designed to determine the best dose of aspirin for preventing heart attacks and strokes. The study compares the benefits and harms of a low- and regular-strength daily dose of aspirin in patients diagnosed with heart disease. It is the first project to be conducted through PCORnet, the National Patient-Centered Clinical Research Network -- an innovative and exciting new effort which PCORI is developing to enhance the nation's capacity to conduct much-need health outcomes studies. 

Weill Cornell Medicine is the lead organization for PCORnet’s effort among New York City health centers. As of today, we have shared data on 40 million clinical encounters across the city, creating a rich and diverse source of data for evidence-based health advancement. 

AHRQ’s primary mission is complimentary, and not duplicative, of either NIH or PCORI. A division of the Department of Health and Human Services, AHRQ provides health services research. This includes detailed analysis of current and emerging models of healthcare, the cost and financing of healthcare, access to healthcare services, and the quality and safety of our healthcare system. The information generated by AHRQ is used by the medical community, insurance companies and other payers to aid them in choosing models of healthcare that reduce wasteful spending.  

The U.S. medical establishment depends on AHRQ, which is why a coalition of some 250 medical and public health associations and universities has rallied to its defense. The coalition includes such key organizations as the American Medical Association, the American Nurses Association, the National Association of Local Boards of Health, the National Rural Health Association, and the American Cancer Society. 

Advances in medical care are arriving at an extraordinary rate. If physicians and patients are to navigate the growing panoply of treatments and if Americans are to have access to affordable healthcare, we need AHRQ and PCORI in place, fully funded.  

These entities ensure that patients, the medical community and payers have the information necessary to make effective decisions. 

“A good decision is based on knowledge and not on numbers,” Plato wrote. 

Knowledge is what AHRQ and PCORI provide.

Kaushal, of Weill Cornell Medicine, is chair of the Department of Healthcare Policy and Research and the Frances and John L. Loeb Professor of Medical Informatics.