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Funding for the Research on Health Costs, Quality and Outcomes program during the last 5 years has been as follows (select for Text Version).
|2001 Actual—Current Law
|2001 Actual—Proposed Law
|2002 Current Estimate
|2003 Request—Current Law
|2003 Request—Proposed Law
Sources of Research on Health Cost, Quality and Outcomes funding follow (select for Text Version).
||1 Percent Evaluation
|2001 Current Law
|2001 Proposed Law
|2002 Current Estimate
|2003 Current Law
|2003 Proposed Law
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Rationale for AHRQ's FY 2003 Request
The FY 2003 request provides a decrease of $53,560,000 for the Research on Health Costs, Quality and Outcomes budget activity. The major components are:
1. Department of Commerce—Current Population Survey: + $10,000,000
2. Secretarial Initiative to Improve Patient Safety—AHRQ: + $5,000,000
3. Research Management: + $4,400,000
4. Accrued Retirement and Health Benefits Costs: + $86,000
5. Non-Patient Safety Research and Training Grants
Commitments: - $27,113,000
New: - $39,291,000
6. Non-Patient Safety Contracts: - $6,641,000
Priority 1. Department of Commerce's Current Population Survey +$10,000,000
AHRQ's request includes $10,000,000 in FY 2003 to cover the annual cost to support a sample expansion to the Department of Commerce's Current Population Survey. In addition to sample expansion, these funds will support enhanced analytical content in order to improve the accuracy of State estimates of the uninsured and improve the measurement of the SCHIP expansions.
Priority 2. Secretarial Initiative to Improve Patient Safety +$5,000,000
In addition to the $55,000,000 appropriated in FY 2002, AHRQ requests $5,000,000 of new funds for activities that promote the translation of patient safety research into programs and products for health care systems with the goal of having measurable improvement in the safety of healthcare for Americans. The proposed budget activities will allow the Department to act on what we know works in improving patient safety while building for the future.
These activities will be conducted in concert with other parts of the HHS, specifically the CDC, CMS, FDA, HRSA, IHS, and OASPE through the existing Patient Safety Task Force collaboration and the development of new coordinated activities. Through this coordination the Department will be able to develop synergy among the various Agencies investments in improving patient safety to ensure that the coordinated Departmental effort will produce a "whole which is greater than the sum of the parts."
Building on AHRQ's Patient Safety Investment
The new patient safety activities in FY 2003 will build on and enhance the work begun in FY 2001 and continuing in FY 2002. One of the initial results of work begun this year is the release of a report, Making Health Care Safer: A Critical Analysis of Patient Safety Practices, which examines the evidence supporting 79 promising patient safety interventions.
Many of these proven lifesaving interventions, such as the use of medications to reduce the risk of heart attacks and infections in surgical patients, are not consistently implemented. AHRQ will use this evidence in FY 2003 to support cooperative agreements, called "challenge grants," that will help implement local safety improvement practices.
In FY 2001, AHRQ also funded a series of reports by the National Academy for State Health Policy to examine the ability of States to meet the patient safety challenge. These reports, as well as an April 2001 National Summit on Patient Safety Reporting, indicated that State health departments are committed to improving patient safety but need technical assistance. AHRQ initiated a review of various models used at the State level, for example CDC's EIS program, to develop a plan for training patient safety experts who will improve local capacity. Development for this capacity building effort will continue in FY 2002 and implementation will occur in FY 2003.
New Patient Safety Investment
The FY 2003 patient safety initiative request $5,000,000 to Implement Local Safety Improvement Priorities. This will be done in 2 ways: challenge grants and on-site patient safety experts.
Challenge Grants ($3,000,000). In July, 2001 the Agency released a report, entitled Making Health Care Safer: A Critical Analysis of Patient Safety Practices, which examined the evidence supporting 79 promising patient safety interventions. Many of these proven lifesaving interventions, such as the use of medications to reduce the risk of heart attacks and infections in surgical patients, are not consistently implemented.
The $3,000,000 will be used to implement local safety improvement priorities through challenge grants that will provide incentives to put systems-based interventions in place in healthcare organizations. Local communities and institutions would be asked to identify priority interventions they would like to implement from a menu of current fully developed evidence based interventions. A limited, seed challenge grant would be provided to the institution for initial implementation, with the actual cost of the intervention to be borne by the grantee. The grantee would be expected to demonstrate that the intervention works and to have data to back up conclusions and thus receive the remainder of the grant.
These challenge grants will complement the work of the CDC, CMS, and FDA in accelerating the implementation of existing patient safety practices to reduce medication errors, reduce hospital acquired infections, and eliminate preventable procedure and device related complications.
Measure of Success:
Nationally, 12 health facilities or regional initiatives will be funded to implement interventions and service models on patient safety improvements by 2004.
On-site Patient Safety Experts ($2,000,000). In addition, AHRQ requests $2,000,000 for on-site patient safety experts. In FY 2001 the Agency funded a series of reports by the National Academy for State Health Policy which examined the ability of States to meet the patient safety challenge. These reports, as well as an April 2001 National Summit on Patient Safety Reporting, indicated that State health departments are committed to improving patient safety but need technical assistance to do so. In FY 2001 the Agency initiated a review of various models, including those from the CDC's Epidemic Intelligence Service (EIS) program and the Agriculture Extension program, which will inform the development of a program to train patient safety experts. The trainees will be used to improve local capacity in field assignments where they will provide technical assistance on information management, on-site assistance of experts in patient safety, support of regional health initiatives, and assistance in using administrative, regulatory, and payment mechanisms to support a culture of safety. The FY 2003 request will allow us to begin implementation of this training program.
Measure of Success:
On-site patient safety experts in 10 States and technical assistance to improve patient safety by 2004.
Priority 3. Research Management +$4,400,000
In FY 2003, AHRQ requests $4,400,000 for research management costs. These funds will provide for current services, including annualization of the FY 2002 pay raise, the FY 2003 pay raise, and inflation. This request also includes $2,000,000 related to build-out costs for the consolidation of AHRQ 's space, as well as $1,200,000 for relocation expenses to AHRQ's new building.
AHRQ is currently located at three different sites in Rockville, MD. AHRQ's eight offices and centers work closely together, and the separation we now experience reduces maximum work efficiency.
The leases in these three locations expire in the summer of 2003. The lease at AHRQ's headquarters cannot be renewed as the building owner needs the space. The Agency initiated discussions with the General Service Administration (GSA) regarding the acquisition of consolidated space for the Agency in late 1997.
The acquisition for this new space was initiated and a lease was signed in September of 2001 with construction of the space completed by August/ September 2003. Leases of this nature include a minimal internal space build-out allowance that is amortized over the life of the lease. This typically amounts to 40 percent to 60 percent of total build-out costs. A construction contract is needed to fund the balance of these costs.
Funds in the amount of $2,000,000 for this interagency agreement (IAA) are included in the FY 2003 request for completion of the internal space build-out that will be initiated in October 2002. These funds will be used to cover a full range of construction costs, including such things as office space, mechanical units, floor and wall coverings, electrical work, conference facilities, a research resource center, and an information technology server room to support the Agency's network infrastructure.
Included in this request is $1,200,000 for costs associated with our relocation scheduled for August or September of 2003. Costs associated with the move include the physical transfer of property, e.g., furniture, boxes, and equipment; computer and telephone wiring; set-up of a security system; signs; and equipment and furniture needed for additional conference rooms.
Priority 4. Accrued Retirement and Health Benefits Costs +$86,000
The $1,700,000 in FY 2003 for accrued retirement and health benefits is an increase of $86,000 over the prior year. These funds are associated with the proposed Managerial Flexibility Act of 2001. This legislation requires agencies, beginning in FY 2003, to pay the full Government share of the accruing cost of retirement for current CSRS, CIA and Foreign Service employees, and the Coast Guard, Public Health Service and NOAA Commissioned Corps.
The legislation also requires agencies to the pay full accruing cost of post-retirement health benefits for current civilian employees. The intention of the legislation is to budget and present the full costs of Federal employees in the accounts and programs where they are employed. This legislation is part of an initiative to link budget and management decisions to performance by showing the full cost of each year's program operations together with the output produced that year. These accrual costs are shown comparably in FY 2001 and FY 2002.
Priority 5. Non-Patient Safety Research and Training Grants (-$66,404,000)
The FY 2003 request provides no funding for new non-patient safety research and training grants. AHRQ will fully fund grant commitments for our Translating Research Into Practice grants (TRIP) and our Consumer Assessment of Health Plans Survey (CAHPS®) grants.
Translating Research Into Practice (TRIP) is the final step of the research pipeline. This step focuses on closing the gap between what we know and what we do. The Agency is committed to informing practitioners, patients, consumers and other decisionmakers about needed health care changes as revealed by research. As we obtain the knowledge of what can be improved, the Agency must be able to promote the adoption and use of these research findings. By doing so, we will be better able to demonstrate that the benefits observed in research are achievable in daily practice and yield measurable and sustainable improvements in health care. TRIP grants will be funded at $7,000,000 in FY 2003.
CAHPS® is an easy-to-use kit of survey and report tools that provides reliable information to help consumers and purchasers assess and choose among health plans. Information from CAHPS® surveys was available to help more than 90 million Americans with their 2000 health care benefits decisions. There are CAHPS® data available to nearly 40 million Medicare beneficiaries on 280 plans. These beneficiaries received the assessment of beneficiaries enrolled in managed care plans. Data were provided in the handbook sent to each beneficiary and were placed on the Medicare.gov website. CAHPS® grants will be funded at $2,500,000 in FY 2003.
Other than patient safety, TRIP and CAHPS® grant commitments, some combination of reductions will be made to ongoing grant commitments reflecting a decrease of $27,113,000 or 46 percent of the unprotected commitment base of noncompeting grants. New non-patient safety research grants, including supplements, decrease a total of $39,291,000 from the FY 2002 level.
Priority 6. Non-Patient Safety Research Contracts (-$6,641,000)
The FY 2003 request provides no funding for new non-patient safety research contracts. AHRQ will fully fund contract commitments for the Healthcare Cost and Utilization Project (HCUP) and for the contract component of CAHPS®.
HCUP is a Federal-State-industry partnership to build a standardized, multi-State health data system. This long-standing partnership has built and continues to develop and expand a family of administrative databases and powerful, user-friendly software to enhance the use of administrative data. Included in HCUP is hospital discharge information from State-specific hospital and ambulatory surgery databases, as well as a national sample of discharges from community hospitals.
HCUP data are used at all levels to inform decisionmaking. HCUP continues to be a very valuable resource in light of recent findings that about 40 percent of personal health care expenditures in the United States go towards hospital care--making it the most expensive component of the health care sector. HCUP is funded at $4,100,000 in FY 2003.
With the exception of the patient safety contracts, the contract component of CAHPS®, and the Healthcare Cost and Utilization Project (HCUP), some combination of reductions to non-patient safety contracts will be required reflecting a decrease of $6,641,000 for non-patient safety research contracts, a reduction of 31 percent of the unprotected contract commitment base.
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Current as of February 2002