Performance Budget Submission for Congressional Justification, Fiscal
Letter from the Director
Introduction and Mission
FY 2009 Overview
Discretionary All Purpose Table
AHRQ Exhibits and Narrative
Amounts Available for Obligation
Summary of Changes
Budget Authority by Activity
Appropriations History Table
Health Costs, Quality, and Outcomes (HCQO): Summary (Details)
Medical Expenditure Panel Survey: Summary (Details)
Program Support: Summary (Details)
Budget Authority by Object Class
Salaries and Expenses
Detail of Full-Time Equivalent Employment
Detail of Positions
House Appropriation Committee Report
Senate Appropriation Committee Report
Committee Appropriation Committee Report
Enterprise Information Technology Funds
Exhibit 300: Capital Asset Plan and Business Care Summaries
Unified Financial Management System—Operations and Maintenance
HHS Consolidated Acquisition System (HCAS)
A. Introduction and Mission
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—resulting in healthier, more productive individuals and an enhanced return on the Nation's substantial investment in health care.
To Improve the Quality, Safety, Efficiency and Effectiveness of Healthcare for all Americans
B. Overview of AHRQ Budget
AHRQ's FY 2009 Estimate level of $325,664,000 is a decrease of $8,900,000 or 2.7 percent from the FY 2008 Enacted 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).
- Program Support (PS).
The FY 2009 Estimate for the HCQO budget activity totals $267,664,000 a decrease of $8,900,000 from the FY 2008 Enacted level. MEPS continues to provide the only national source for annual data on how Americans use and pay for medical care. The FY 2009 Request of $55,300,000 maintains the support provided at the FY 2008 level. Finally, Program Support is maintained at the FY 2008 Enacted level to cover required costs related to the overall operation of the Agency.
Earlier this year AHRQ realigned our research portfolios within the HCQO budget activity. AHRQ went from 10 research portfolios to 6 research portfolios. The new research portfolios include: Comparative Effectiveness, Prevention/Care Management, Value Research, Health Information Technology, Patient Safety, and Other Quality, Effectiveness and Efficiency Research. The FY 2009 Performance Budget is displayed by these new portfolios.
HCQO: Value (+$6,000,000): The FY 2009 Request includes $9,730,000 for Value Research, an increase of $6,000,000 from the FY 2008 President's Budget. AHRQ's Value Research priority includes research related to the Value-driven Healthcare Initiative and a new Initiative—the Health Insurance Decision Tool. The entirety of the increase is directed to a new initiative—Health Insurance Decision Tool. This initiative will facilitate the development of State-based affordable health plans for low income individuals and to provide State decisionmakers with the tools and information they need to design effective programs for reducing the numbers of uninsured Americans. This initiative will advance the President's goal to provide access to basic health insurance at an affordable price. In addition, this initiative will provide Federal decisionmakers with the information they need for evaluating States' proposals, and could assist in understanding the impacts of other Federal initiatives, for example, consumer driven health plans, on the overall U.S. healthcare system.
HCQO: Other Quality, Effectiveness and Efficiency—Research Management (+$2,322,000): The FY 2009 Estimate provides $1,280,000 for required increases within AHRQ's budget, including rent increases, funds for the Unified Financial Management System (UFMS), and data costs, as well as funds for one additional FTE for the Affordable Choice Decision Tool initiative. In addition, the AHRQ request includes funding to support the President's Management Agenda e-GOV initiatives and Departmental enterprise information technology initiatives identified through the HHS strategic planning process. An additional $1,042,000 is provided for pay raise costs in FY 2009.
HCQO: Patient Safety (-$2,059,000): The FY 2009 Estimate provides $32,055,000 for the patient safety program, a decrease of $2,059,000 from the prior year. The Patient Safety Program is comprised of two research components: Patient Safety Threats and Medical Errors and Patient Safety Organizations (PSOs). The FY 2009 decreases occur within the patient safety threats and medical errors program. Of the total, $1,881,000 is from reductions in inter-agency agreements (IAAs) related to data standards and the remaining $178,000 will come from patient safety IAAs.
HCQO: Other Quality, Effectiveness and Efficiency (-$15,163,000): The FY 2009 Estimate for the Other Quality, Effectiveness and Efficiency portfolio includes a reduction of $15,163,000 from the FY 2008 Enacted level of $156,800,000. The reductions are as follows:
- MRSA (-$5,000,000): The FY 2008 Enacted level provided $5,000,000 for contract activities to reduce infections from methicillin-resistant Staphylococcus aureus and related infections (MRSA). With the additional $5,000,000 provided in FY 2008, AHRQ will work closely with CDC to identify gaps in the prevention, diagnosis, and treatment of MRSA and related infections across the healthcare system. In conjunction with CDC and other health care agencies within HHS and within the Federal government, AHRQ will use available mechanisms to fund research, implementation, measurement, and evaluation regarding practices that identify and mitigate these infections. This research will be done through one year contracts in FY 2008 and does not continue into FY 2009.
- Research and Training Grants (-$7,277,000): The FY 2009 Estimate provides for $25,415,000 (61 grants) in non-competing research grants funds for HCQO: Other Quality, Effectiveness and Efficiency—a decrease of $7,277,000 (70 grants) from the FY 2008 level of $32,692,000. A total of $7,277,000 in non-patient safety research and training grants funded in prior years ended in FY 2009. AHRQ will not re-invest these funds in new investigator-initiated research grants in FY 2009. The 61 grants funded in FY 2009 support a variety of research activities including research related to clinical practice, health care quality, organization and delivery of care and use of health care resources, and health care costs and financing. An example of grants that will be funded in FY 2009 includes CAHPS® grants. The Consumer Assessment of Healthcare Providers and Systems (CAHPS®) program is a public-private initiative to develop standardized surveys of patients' experiences with ambulatory and facility-level care. Health care organizations, public and private purchasers, consumers, and researchers use CAHPS® results to: assess the patient-centeredness of care; compare and report on performance; and improve quality of care. Also included in FY 2009 are career development awards. Examples of grant titles funded in FY 2009 include: Chronic Care Quality Improvement Learning Laboratory, Evaluating Treatment Options and Patterns of Care in Early Pregnancy Failure, and Spaced Education to Optimize Prostate Cancer Screening.
- Research Contracts and IAAs (-$2,886,000): The FY 2009 Estimate reduces contract and IAA support by $2,886,000. The reductions in FY 2009 will impact the level of outgoing IAA support AHRQ can provide in partnership with other agencies, as well as a small reduction to planning and evaluation contracts. The FY 2009 Estimate will allow AHRQ to continue to fund research contracts and IAAs that support research on health care quality, organization and delivery of care and use of health care resources, and health care costs and financing. Examples of contracts that will be funded in FY 2009 include: National Quality Measures Clearinghouse (NQMC), National Guideline Clearinghouse (NGC), Healthcare Cost and Utilization Project (HCUP), and contracts and IAAs support the development and release of the annual National Healthcare Quality Report and its companion document, the National Healthcare Disparities Report.
Discretionary All-Purpose Table
(Dollars in Thousands)
|Program||FY 2007 Enacted||FY 2008 Enacted||FY 2009
FY 2008 Enacted Level
|Research on Health Costs, Quality and Outcomes (HCQO)||Budget Authority||$0||$0||$0||$0|
|Public Health Service (PHS) Evaluation||260,983||276,564||267,664||-8,900|
|Full Time Equivalents (FTEs)||273||277||278||1|
|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||2,700||0|
|Total Operational Level||318,983||334,564||325,664||-8,900|