The Little Agency That Could

Leah-BinderIn the children’s book The Little Engine That Could, a little blue engine hauls an improbably large trainload of toys and candy over a mountain while chanting, “I think I can, I think I can, I think I can.” The Labor Department named this classic among the 100 books that shaped work in America.

There’s a federal health agency in Washington that might be called the “Little Agency That Could”: the Agency for Healthcare Research and Quality (acronym “AHRQ”, pronounced “Arc”) – and it’s shaping the work of healthcare in America.

AHRQ’s priority is making the work done in healthcare benefit the patient. They assemble all the treatments, medicines, expertise, technology and medical advances, and figure out the best strategies for delivering them safely and effectively. This is very complex, and lapses and errors in delivery can and do cause unnecessary patient death and suffering on a grand scale. Avoidable errors in hospitals kill upwards of 500 people a day, making it equivalent to the third leading cause of death in the United States.

What works for the patient often defies conventional wisdom, which AHRQ has observed time and again. For instance:

Pre-AHRQ Conventional Wisdom: tens of thousands of hospital inpatients must get a devastating central line infection, because that’s inevitable in hospitals.

 Now: One in five hospitals across the country report zero central line infections. That’s untold suffering averted.

Pre-AHRQ conventional wisdom:  People in rural communities are basically stuck with substandard care, because there’s a shortage of specialists and other problems.

Now: Rural hospitals are showing major gains in quality and safety, and AHRQ tools and research are front and center to that progress.

Now: AHRQ-funded researchers developed a scientific survey to gather patient perceptions, and lo and behold, those perceptions align with rates of complications and outcomes. Now the AHRQ survey is ubiquitous and hospitals are creating a whole new job category, the “chief experience officer”— a person in charge of listening to patients.

AHRQ gets political support in Congress from a group of respected researchers across the country called Friends of AHRQ. They share the outlandishly idealistic view that science should trump special interests when it comes to getting the best care to patients. These professors manage to get Congress to eke out an appropriation for their little agency, about $440 million last year, which sounds like a lot, but it’s less than one thousandth of one percent of overall federal spend on health care (0.00045%).

Unfortunately, there’s now a credible effort in Congress to kill off this little agency. Last June, the House Committee on Appropriations passed a bill that would terminate AHRQ’s funding. Two days later, the Senate Committee on Appropriations voted to cut AHRQ’s budget by 35%, decreasing the AHRQ FY 2015 budget by $128 million. Outcries to restore the little agency are coming from leaders on both sides of the aisle, from Dr.Gail Wilensky, Medicare’s administrator under President George H.W. Bush, to Senator Richard Blumenthal (D-CT), in a pointed letter to colleagues.

Why derail one of the most effective and efficient little agencies in Washington? The answer requires another recollection from our first-grade reading days. Before the little blue engine came along to save the day, four other trains declined to help. Most of them were like the shiny passenger train, with another important job to do, and so not enough time to deliver toys to the good little boys and girls on the other side of the mountain.

Health interest groups in Washington are frequently like that passenger train: large, strong, glamorous and well-funded, with an important job delivering their product or service. The hospital lobby must deliver for hospitals, the medical lobby must deliver for doctors, the pharmaceutical lobby must deliver for medicines, and so on.

They are indeed important to our healthcare infrastructure and deserve Congressional attention. But AHRQ and its bespectacled supporters focus on a more humble mission: delivering for the patients. That deserves Congressional attention too. Fortunately, those powerful interest groups care deeply about patients, and they have been leading major efforts to improve care delivery and patient safety. So we will look to them to help pull this agency over the mountain.

Some in Congress want to fold AHRQ’s kind of research into the National Institutes of Health  (NIH). But that’s pounding a square peg into a round hole—and it’s the patient who would get flattened. NIH researches diseases, with multi-billion dollar investments in cancer, heart disease, lung disease, and other leading causes of death. AHRQ researches patients, whatever their affliction. It’s hard to imagine where at NIH you would house AHRQ’s campaign to eliminate hospital infections, or improve rural healthcare, or use technology wisely, or save lives lost to preventable errors and accidents. None of these critical campaigns should be subsumed into an agency with a very different mission.

We all have a stake in preserving funding for this little agency. My nonprofit, the Leapfrog Group, does not get funding from AHRQ, but we benefit enormously from their research.

AHRQ is a very American bipartisan success story. They save lives, cut waste, go to bat for the most vulnerable of all economic classes, put the interests of the American people above the interests of the lobbyists, and don’t spend a lot of taxpayer dollars accomplishing all this. Many of our most pressing problems in healthcare—waste, errors—derive from exactly the problems AHRQ aims to solve. AHRQ is about protecting and healing the patient, first and always. With this little agency, pressure from the people who care about it and leadership from Congress, we think we can.

Leah Binder is the CEO of The Leapfrog Group, a voluntary program aimed at mobilizing employer purchasing power to alert America’s health industry that big leaps in health care safety, quality and customer value will be recognized and rewarded.

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  1. AHRQ also administers The Healthcare Cost and Utilization Project. Without HCUP, it would not be possible to have proven that wellness is a complete scam, and has almost iiterally not avoided a single event. This insight by itself will pay for all of AHRQ 15 times over, once benefits consultants learn to read.