This week, while the public was focused on how the Supreme Court would rule on health care insurance exchanges, Congress was at work eliminating funding for an agency that's part of the Public Health Service. Why should you care? You should if you want to know which drugs, medical devices and clinical procedures work best, or which patient safety practices actually work to prevent the third leading cause of death in hospitals –hospital care itself. Would you like your physician to practice medicine based on evidence developed by the leading clinical specialty societies like the American Heart Association or the American Society of Clinical Oncology, and would you like your doctor and the hospitals you use to be able to measure the quality of your care? Would you like to be able to report on your experience as a patient and learn what other patients experience? These are just some of the functions of the US Agency for Healthcare Research and Quality, the part of the Public Health Service that has been the standard bearer for objective evidence since the 1990s.
This is not the first time that Congress has tried to eliminate this agency. They attempted to do it in 1994, led by Newt Gingrich. They failed because people spoke up. And here's the irony – Newt Gingrich, the Republican leader in the House later became the greatest champion of the Agency when he learned more about what the Agency does to protect your health. He even wrote an editorial with Democrat John Kerry and Billy Bean, the famed manager of the Oakland A's, and on the importance of evidence, "How to Take American Health Care From Worst to First".
It's time to learn that lesson again and to do so before it's too late.
The Agency has a budget appropriation of about $350 million, an amount the House wants to eliminate completely and the Senate wants to cut by a third. In the last five years, about $85 million has come to Pennsylvania institutions including mine as well as the American Board of Internal Medicine; Children's Hospital of Philadelphia; Drexel University; Fox Chase Cancer Center; Geisinger Clinic; the Institute for Cancer Research; the Institute for Safe Medication Practices; Lehigh Valley Hospital; Hershey Medical Center; the Oncology Nursing Society; Pennsylvania State University; the Pittsburgh Regional Health Initiative; the Public Health Management Corporation; the Society of Hospital Medicine; Temple University; Thomas Jefferson University; University of Pennsylvania; and the University of Pittsburgh.
The Agency commissions the studies that Medicare uses to improve your healthcare. It keeps you from being sold a bill of goods by people who just want to push their products and services, telling you that evidence on whether these really work better doesn't matter. Would you buy a car or any other consumer product or service this way? If not, then don't buy healthcare without knowing what works, what works best, and what doesn't work.
The cost of healthcare continues to rise. That's a problem. But at a minimum, you should get your money's worth. Your doctor should be able to learn what's working, and so should your hospital. If you think patient safety isn't a problem, keep in mind that 1 in 7 Medicare patients suffers a serious medical error and an estimated 100,000 people die from medical errors every year. If a jetliner with 275 people aboard crashed every day -- that is about 100,000 fatalities a year -- you'd be outraged. But that's what's happening in hospitals and it needs to change. Your hospitals and doctors are on board for making positive change. But they need the evidence on what does and doesn't work.
You might wonder whether, if this agency goes away, won't some other one take up the safety and quality issues? Isn't this just a duplicative agency? The answer is "No".
Is this agency "just a part of Obamacare"? No. The Agency experienced its greatest growth under the administration of Republican George Bush. When Republicans take the time to learn what the Agency does, they support it. But that evidence-based approach to making decisions is not taking place in Congress. So while everyone was riveted on the Supreme Court decision, under cover of darkness, provisions to eliminate the Agency were buried in a bigger bill. Let's not let this happen. An agency that has this track record, that is this important to the health of all Americans regardless of party and regardless of economic status, shouldn't disappear with no public debate. It's your government, your life, and your healthcare system.
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