Budget Estimates for Appropriations Committees, Fiscal Year 2010
The U.S. health care system is considered by many to be the finest in the world. Americans are living longer, healthier lives, thanks to significant advances in biomedical and health services research. The translation of research findings into clinical practice has raised awareness of the importance of appropriate preventive services—such as timely screenings for cancer, heart disease, and other serious conditions—and the crucial role that maintaining a healthy lifestyle plays in maintaining health and enhancing quality of life.
However, our health care system faces many challenges: improving the quality and safety of health care, ensuring access to care, increasing value for health care, reducing disparities, increasing the use of health information technology, and finding new avenues for translating research into practice. We have made progress in meeting these challenges, but we can and must do better. Failure to improve health care delivery substantially is likely to impede realizing the full benefits of current breakthroughs in molecular medicine that can lead to personalized treatments.
As one of 12 agencies within the Department of Health and Human Services, the Agency for Healthcare Research and Quality (AHRQ) supports health services research initiatives that seek to improve the quality of health care in America. AHRQ's mission is to improve the quality, safety, efficiency, and effectiveness of health care for all Americans. The Agency works to fulfill this mission by conducting and supporting health services research, both within AHRQ as well as in leading academic institutions, hospitals, physicians' offices, health care systems, and many other settings across the country. The Agency has a broad research portfolio that touches on nearly every aspect of health care. AHRQ-supported researchers are working to answer questions about:
- Clinical practice.
- Outcomes of care and effectiveness.
- Evidence-based medicine.
- Primary care and care for priority populations.
- Health care quality.
- Patient safety/medical errors.
- Organization and delivery of care and use of health care resources.
- Health care costs and financing.
- Health care system and public health preparedness.
- Health information technology.
The ultimate goal is to disseminate AHRQ's research findings to produce healthier, more productive individuals and an enhanced return on the Nation's substantial investment in health care.
AHRQ's FY 2010 President's Budget Request level of $372,053,000 maintains the support provided by the FY 2009 Omnibus level. At this level AHRQ will support ongoing efforts to improve the quality, safety, outcomes, access to, and cost and utilization of health care services.
AHRQ has three budget activities: Research on Health Care Costs, Quality, and Outcomes (HCQO), the Medical Expenditure Panel Survey (MEPS), and Program Support (PS). The FY 2010 President's Budget Request for the HCQO budget activity totals $314,053,000, maintaining the FY 2009 Omnibus level. MEPS continues to provide the only national source for annual data on how Americans use and pay for medical care. The FY 2010 Request of $55,300,000 maintains the support provided at the FY 2009 level. Finally, Program Support is maintained at the FY 2009 Omnibus level of $2,700,000 to cover required costs related to the overall operation of the Agency.
Within the HCQO budget activity, AHRQ supports research related to five research priorities. These research portfolios include: Comparative Effectiveness, Prevention/Care Management, Value Research, Health Information Technology, and Patient Safety. In addition, AHRQ supports Crosscutting Activities Related to Quality, Effectiveness and Efficiency Research. Crosscutting Activities includes a variety of research projects that support all of our research portfolios. These activities include data collection and measurement, dissemination, rapid cycle research, training, research management and salary costs, and intramural and extramural research sponsored by multiple portfolios. The FY 2010 Performance Budget is displayed using these priorities.
HCQO: Crosscutting Activities Related to Quality, Effectiveness, and Efficiency—Research Management (+$2,478,000): In FY 2010, research management costs for AHRQ total $67,600,000, an increase of $2,478,000 from the prior year. The FY 2010 President's Budget Request level provides $1,872,000 for pay raise costs for AHRQ as a whole. An additional $606,000 is provided in FY 2010 for required research management increases within AHRQ's budget, including rent increases, travel, printing, and data costs.
HCQO: Crosscutting Activities Related to Quality, Effectiveness, and Efficiency—Investigator-initiated Research Grants (-$2,478,000): The FY 2010 Estimate includes $37,124,000 (77 grants) in total research grants funds for HCQO: Crosscutting Activities Related to Quality, Effectiveness and Efficiency. This level provides a decrease of $2,478,000 from the FY 2009 level of $39,602,000—equivalent to a decrease of approximately 52 small, investigator-initiated research grants with an average cost of $50,000. The FY 2010 President's Budget Request will fund $6,421,000 in new investigator-initiated research grants, for a total of $23,551,000 in investigator-initiated research. This is a decrease of $2,478,000 from the FY 2009 funding level of $26,029,000 for investigator-initiated research grants.
FY 2009 American Recovery and Reinvestment Act (ARRA) Funding Comparative Effectiveness Research
In FY 2009, the American Recovery and Reinvestment Act (ARRA) provided $1,100,000,000 for Comparative Effectiveness Research. Of this total, $400,000,000 was transferred to the National Institutes of Health. A total of $400,000,000 is available for Comparative Effectiveness Research to be allocated at the discretion of the Secretary of the Department of Health and Human Services (HHS). A new Federal Coordinating Council for Comparative Effectiveness Research will help set the agenda for these funds.
The remaining $300,000,000 is available for the Agency for Healthcare Research and Quality (AHRQ) to conduct and support comparative effectiveness research. Comparative effectiveness research provides information on the relative strengths and weakness of various medical interventions. Such research will give clinicians and patients valid information to make decisions that will improve the performance of the U.S. health care system. AHRQ's comparative effectiveness research is related to the Department's Strategic Goal 1: Health Care: Improve the safety, quality, affordability, and accessibility of health care, including behavioral health care and long-term care.
Once the AHRQ Comparative Effectiveness Spend Plan has been approved by HHS, OMB and Congress, AHRQ will provide additional details of how the funding will be distributed.
(Dollars in thousands)
|Program||FY 2008 Appropriations||FY 2009 Omnibus||FY 2009|
|Research on Health Costs, Quality and Outcomes (HCQO)||Budget Authority||$0||$0||$700,000||$0|
|Public Health Service (PHS) Evaluation||276,564||314,053||0||314,053|
|Full Time Equivalents (FTEs)||278||278||316|
|Medical Expenditure Panel Survey (MEPS)||Budget Authority||0||0||0||0|
|Program Support||Budget Authority||0||0||0||0|
|Subtotal, Program Support||2,700||2,700||0||2,700|
|Total Operational Level||334,564||372,053||700,000||372,053|
1 In FY 2009, the American Recovery and Reinvestment Act (ARRA) provided $1,100,000,000 for Comparative Effectiveness Research. Of this total, $400,000,000 was transferred to the National Institute of Health. A total of $400,000,000 is available for Comparative Effectiveness Research to be allocated at the discretion of the Secretary of the Department of Health and Human Services. A new Federal Coordinating Council for Comparative Effectiveness Research will help set the agenda for these funds. The remaining $300,000,000 is available for the AHRQ to conduct and support comparative effectiveness research. These funds are available for obligation in FY 2009 and FY 2010. The number of FTE in FY 2010 includes an estimated 38 non-permanent FTEs to be compensated using Recovery Act funds.
Mechanism Table Summary
(Dollars in Thousands)
|New & Competing||112||19,064||112||38,053||57||22,596|
|Total, Research Grants||277||72,531||275||91,710||0||TBD||210||89,232|
|Contracts and Inter-Agency Agreements (IAAs)||144,117||159,921||159,921|
*Reflects actual obligations not appropriated dollars.
**The American Recovery and Reinvestment Act (P.L. 111-5) included additional funding for AHRQ for comparative effectiveness research available in FYs 2009 and 2010. FY 2009 Recovery Act amounts will be provided once the spending plans are finalized.
Select HCQO and Other Portfolios1
(Dollars in Thousands)
|New & Competing||73||6,912||59||16,080||0||0||21||8,421|
|Total, Research Grants||178||36,155||147||43,702||0||0||95||41,224|
|Contracts and Inter-Agency Agreements (IAAs)||71,559||64,220||0||64,220|
Patient Safety Mechanism Table
(Dollars in Thousands)
|New & Competing||34||9,655||26||9,920||0||0||36||14,175|
|Total, Research Grants||94||33,879||98||35,508||0||0||88||35,508|
|Contracts and IAAs||45,055||58,201||0||58,201|
Comparative Effectiveness Mechanism Table
(Dollars in Thousands)
|New & Competing||5||2,497||27||12,053||0||0|
|Total, Research Grants||5||2,497||30||12,500||0||TBD||27||12,500|
|Contracts and Inter-Agency Agreements (IAAs)||27,503||37,500||37,500|
1Reflects actual obligations not appropriated dollars.
2The American Recovery and Reinvestment Act (P.L. 111-5) included additional funding for AHRQ for comparative effectiveness research available in FYs 2009 and 2010. FY 2009 Recovery Act amounts will be provided once the spending plans are finalized.