In a Quiet Move, Washington Replaces the Head of AHRQ. Is It Too Late to Save the Agency?

Stealthily, AHRQ has acquired a new head, but the ax still hovers over it.

Very quietly, researcher Richard Kronick, PhD was named by the Department of Health and Human Services (HHS) to be the new director of the Agency for Healthcare Research and Quality (AHRQ). He joins an organization that remains squarely on the House GOP’s chopping block and with few friends strong enough to ward off the blow.

Last fall, when a House appropriations subcommittee voted to eliminate all AHRQ funding, I wrote that the agency’s execution went almost unnoticed: it didn’t even rate a separate mention in the committee’s lengthy press release.

Back then, the House GOP’s big target was Big Bird, a/k/a funding for public broadcasting. Since then, the rampaging Republican right-wing has decided it won’t approve subsidies to farmers unless it can also slash food stamps to the poor and that undocumented immigrants are mostly a law-and-order problem, not a human one. That these positions contradict views held by many conservative Republican senators, governors and party leaders has had little to no effect.

Enter Kronick, after a months-long search to replace Dr. Carolyn Clancy, who’d held the top AHRQ post since February, 2003. Oddly, the announcement by HHS Secretary Kathleen Sebelius wasn’t posted on the HHS website or even the AHRQ one. Searching Kronick’s name simply turned up press releases from his current position as deputy assistant secretary for health policy. According to MedPage Today, the naming of Kronick was made “in the department’s daily electronic afternoon newsletter.”

Why? My guess: politics.

Clancy was known for good relations with policymakers of both parties; she was upgraded from “acting director” to permanent status during the George W. Bush administration. Her predecessor, Dr. John Eisenberg, enjoyed a similar bipartisan rapport. Of course, that was before conservatism gave way to crusaders. Kronick, by contrast, has a background almost tailor-made to tick off Tea Partyers.

To begin with, he is a researcher from California with a focus on vulnerable populations. Add to that working on national health reform as a White House aide during the Clinton administration and, later, responsibilities for Medicaid with the Massachusetts Department of Public Welfare. In Kronick’s current post, he’s been examining the consequences of a lack of health insurance and has helped with implementation of the Affordable Care Act. Finally, his new job is heading an agency whose mission is helping guide the practice of medicine. That’s a red flag to many, and the fact that he is a non-physician raises some blood pressures even more.

While all of that’s enough to explain why Kronick was quietly named AHRQ chief in a low-key way while Congress was out on recess, I suspect there’s another factor, as well. Kronick works in the office of the assistant secretary for planning and evaluation (ASPE). That job’s previous occupant, researcher Sherry Glied, had to wait months for Senate confirmation at the beginning of the Obama administration. Now, with Obamacare implementation an inflammable political issue, no new ASPE head has a chance of even getting a Senate vote until at least the 2014 elections. Glied’s deputy is currently “acting.” With no place “up” to go, and Clancy clamoring to get out before the new budget season begins, I suspect Kronick was asked to take the AHRQ job, which does not require Senate confirmation, and agreed to be a good soldier. Given the flak AHRQ is taking from the GOP right, this metaphor is particularly apt.

Some in the health policy community have tried to shrug off the AHRQ elimination vote as likely be reversed by the Senate. While that’s true, the reality is there are just so many chips senators can call in during conference committee negotiations. As the 2014 budget season approaches, AHRQ is again endangered, but this time the list of worthy causes to be saved from capricious funding cuts is much larger than before. AHRQ may not be killed, but it surely is at high risk of being crippled.

Who will champion AHRQ’s cause? The National Institutes of Health can boast of Searching for a Cancer Cure. While they’re looking, the job of making sure hospitals don’t kill cancer patients with a medication error or infection and that care is based on evidence, not economic self-interest, is critically important. However, it has no glamor factor whatsoever.

Besides, what’s the government doing telling hospitals and doctors in the private sector who they can and can’t kill, anyway? Sounds like death panels to me.

Eisenberg jokingly called himself, “John of AHRQ.”  In the George Bernard Shaw play Saint Joan, the Inquisitor presents the persecution of Joan of Arc as an unpleasant necessity to maintain the monopoly of the Catholic Church on revelation. Nothing personal. In a similar vein, even the chair of the subcommittee that zeroed out AHRQ last year told Politico the death sentence wasn’t based on anything AHRQ had done but was just meant to maintain the GOP’s commitment to balancing the budget. Nothing personal.

It’s a good thing Kronick has a background in vulnerable populations. Right now, that would be AHRQ’s employees, the researchers it funds and, of course, Kronick himself.

Michael L. Millenson is president of Health Quality Advisors LLC in Highland Park, IL; the Mervin Shalowitz, MD Visiting Scholar at the Kellogg School of Management; and a board member of the Society for Participatory Medicine.

15 replies »

  1. Since the commenter above clearly delights in heated remarks rather than illuminating ones — and is anonymous because of that — how can I respond other than, “You don’t know Jack.”

    The New Republic article is well done, but it is in no way directly relevant to AHRQ. It is complementary, but not in any way a substitute — not that I’d read it beforehand. More to the point, this is a site for informed discussion, even heated disagreement. Smug charges of plagiarism based on superficial reading don’t have a place here.

  2. Nothing about this is interesting or new. The first commenter alluded to the fact that it was regurgitated from New Republic piece.
    Aurhor’s conclusion: politics
    Wow, that incite cuts to the heart of the matter.

  3. Clancy was a failure in that she was chummy with the HIT industry and served its kool aaid, neglecting to push for truth that these devices have no business being sold until they were proven to be safe, efficacious, and usable.

    Her premise is that HIT is safe and does not need to be under the purview of the F D and C Act.

    Glad to see her go. Maybe someone there will wake up to the deaths, injuries, and near misses associated with the unvetted HIT devices.

  4. Nice piece, Michael. Thanks. Agree: AHRQ plays a unique and critical role in pushing the health system towards evidence-based and sustained improvement. Carolyn did an great job and deserves a standing ovation. Rick’s a health services researcher first and foremost so will likely seek, with HHS leadership support, to strengthen AHRQ’s main mission and navigate the treacherous political waters to preserve the agency and its funding — and steer clear of being too closely tied to Obamacare implementation. Much as some of us might welcome a more activist AHRQ on many fronts, that’s the wise course of action.

  5. He talks out of his mouth both ways so much it was easy to mock & slam him during the GOP primaries in ’12.

    Since his political career ended, he still whatever is convenient to pick a decent paycheck. Doesn’t make him any different than a lot of other ex-politicians but I was pretty astounded how many different pies he had his fingers in.

  6. Especially maddening (to me) was listening to Newt Gingrich talk about how the US needed research on which treatments were most effective in order to save money on health care, knowing he had tried to kill AHCPR. What a hypocritical blowhard.

  7. Remember that AHRQ is a relatively small agency…about two orders of magintude smaller than NIH…and about 350 people.

    What is the return on health services research? I seem to recall Atul Guwande placing it at ~10X that of biomedical research (in one of his books).

    If anything we need to spend MORE on health service research, not less.

    The political wrangling around (again) de-funding AHRQ speaks volumes about how difficult it will be to change the status-quo in our health system.

    A historical reference (from the brilliant Shannon Brownlee) about Newt Gingrich’s effort to end what is now AHRQ: http://www.washingtonmonthly.com/features/2007/0710.brownlee.html


  8. Thanks, Michael. I know they do some good stuff (they do a LOT of stuff). Just wondering how they net out. A prevalent question these days.

  9. Thanks, Jeff. Rick and I have crossed paths as Investigator Award winners but I don’t really know him. Meanwhile, to clarify a point made in the original post: AHRQ head does NOT require Senate confirmation. Why do some agency heads require confirmation (CMS) and some do not (AHRQ), while other posts lower down in HHS and other agencies also do (assistant secretaries)? It’s just the way it is.

    I hope that there is an influential GOP senator or representative somewhere on the Hill that shares your view of AHRQ and Rick.

  10. Rick is a really good guy, thoughtful and well respected in the health services research community, both inside and outside academia. This was an excellent appointment. He’ll do a good job running the agency, whether he’s confirmed or not.

  11. AHRQ funds many projects which would not be funded by the private sector because of the spillover effect/law of the commons; i.e., patient safety advances. A health plan that improved care at a hospital would do so for all patients treated there, for example, and while CMS might wield the stick of “no pay for ‘never events,'” AHRQ comes along with the carrot telling hospitals what improvement strategies are successful.

    If NIH is the surgeon, AHRQ is the nurse on the night shift. Essential, but no recognition.

  12. “Conservatives imagine a land of plucky inventor-entrepreneurs who work out of garages and depend solely on their wits.”

    While at the same time being the tools of corporate billionaires.