Performance Budget Overview

Budget Estimates for Appropriations Committees, Fiscal Year 2011

This statement summarizes budget information submitted to Congress for fiscal year 2011 by the Agency for Healthcare Research and Quality (AHRQ).

 

A. Introduction and Mission

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.

To Improve the Quality, Safety, Efficiency and Effectiveness of Health Care for All Americans

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B. Overview of AHRQ Budget Request

AHRQ's FY 2011 Request level totals $610,912,000, an increase of $213,859,000 over the FY 2010 Appropriation. The Request is all in PHS Act evaluation funds.

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 2011 Request level for the HCQO budget activity totals $478,899,000, an increase of $208,246,000 from the FY 2010 Appropriation. MEPS continues to provide the only national source for annual data on how Americans use and pay for medical care. The FY 2011 Request level of $59,300,000 provides an increase of $500,000 over the FY 2010 Appropriation. Finally, Program Support is funded at $72,713,000, an increase of $5,113,000 from the FY 2010 level of $67,600,000, to support the overall operation of the Agency.

Within the HCQO budget activity, AHRQ supports research related to five research priorities. These research portfolios include: Patient-Centered Health Research, 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, measurement, dissemination and translation, program evaluation, grant review support, and other crosscutting contracts. The FY 2011 Performance Budget is displayed using these priorities.

Program increases:

HCQO: Patient-Centered Health Research (+$251,750,000): The FY 2011 Request level provides $286,274,000 for Patient-Centered Health Research ($272,750,000 in HCQO and $13,524,000 in Program Support), an increase of $261,218,000 overall (+$251,750,000 over the FY 2010 Appropriation level for HCQO and an increase of +$9,468,000 within Program Support). Patient-centered health research improves health care quality by providing patients and physicians with state-of-the-science information on which medical treatments work best for a given condition. At the FY 2011 Request level, AHRQ will provide increases in seven key activities: identification of new and emerging issues for patient-centered health research (+$9.5M), evidence synthesis (+$25.0M), evidence gap identification (+$25.0M), evidence generation (+$117.8M), translation and dissemination (+$54.0M), training and career development (+$8.5M), and a citizen forum (+$12.0M). An additional $2,250,000 is included in Program Support to provide salaries and benefits for an additional 15 FTEs needed to help implement this program.

HCQO: Health Information Technology (+$3,877,000): The FY 2011 Request level provides $31,522,000 for Health IT research, an increase of $3,877,000 over the FY 2010 Appropriation. Established in 2004, the purpose of the Health IT portfolio at AHRQ is to develop and disseminate evidence and evidence-based information tools to inform policy and practice on how health IT can improve the quality of American health care. Through grants and contracts, AHRQ and its partners work to improve the quality of health care by identifying challenges to health IT adoption and use, solutions, and best practices for making health IT work, and developing tools that will help hospitals and clinicians successfully incorporate new IT. A total of $221,000 of the increase will be directed to grants, providing $7,191,000 in new grant support for Health IT. The remaining $3,656,000 of the increase will be directed to research contracts, including increased support to the National Resource Center for Health IT.

Medical Expenditure Panel Survey (MEPS) (+$500,000): The FY 2011 Request provides $59,300,000 for the MEPS, an increase of $500,000 over the FY 2010 Appropriation. This increase will restore the MEPS to full analytic capacity and precision levels. The MEPS Household Component sample size is restored in 2011 to 14,500 households with full calendar year information. These sample size specifications for the MEPS permit detailed analyses of the health care expenditures, health insurance coverage, and the quality of care received by special populations meeting precision specifications for survey estimates.

Program Support (+$5,113,000): The FY 2011 Request for Program Support is $72,563,000, an increase of $5,113,000 from the prior year. Of this increase, $2,225,000 is provided for an additional 15 FTEs to support the Patient-Centered Health Research portfolio. In addition, the FY 2011 Request level provides $1,600,000 for pay raise costs for AHRQ as a whole. An additional $500,000 is provided in FY 2011 for required increases within AHRQ's budget, including rent increases, printing, and data costs. Finally, an additional $763,000 is provided for increases to the Service and Supply Fund (SSF) and other joint funding arrangements.

Program decreases:

HCQO: Patient Safety (-$25,963,000): The FY 2011 Request level provides $64,622,000 for Patient Safety research, a decrease of $25,963,000 from the FY 2010 Appropriation. AHRQ's patient safety research priority is aimed at identifying risks and hazards that lead to medical errors and finding ways to prevent patient injury associated with delivery of health care. In FY 2010, $25,000,000 was allocated to a Medical Malpractice research program. The research grant program was funded using multi-year authority and no outyear costs are required in FY 2011. An additional reduction of $963,000 is directed to patient safety contracts.

HCQO: Crosscutting Activities Related to Quality, Effectiveness, and Efficiency (-$21,418,000): The FY 2011 Request level provides $90,371,000 for Crosscutting Activities, a decrease of $21,418,000 from the FY 2010 Appropriation of $117,789,000. At the FY 2011 Request level, AHRQ will provide $40,211,000 for grants, a decrease of $14,533,000 from the FY 2010 Appropriation. The FY 2011 provides $50,160,000 for contracts, a decrease of $6,885,000 from the FY 2010 level. Within the overall decrease for contracts, AHRQ will provide an additional $1.7 million for the Healthcare Cost and Utilization Project (HCUP). HCUP includes the largest collection of longitudinal hospital care data in the United States, with all-payer, encounter-level information beginning in 1988.

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Discretionary All-Purpose Table

Agency for Healthcare Research and Quality
(Dollars in thousands)

ProgramFY 2009 AppropriationsFY 2009
Recovery Act1
FY 2010
Appropriations
FY 2011 President's Budget Request
Research on Health Costs, Quality and OutcomesBudget Authority$0$700,000$0$0
PHS Evaluation251,6310270,653478,899
Subtotal, HCQO251,631700,000270,653478,899
Medical Expenditures Panel SurveyBudget Authority$00$0$0
PHS Evaluation55,300058,80059,300
Subtotal, MEPS55,300058,80059,300
Program SupportBudget Authority$00$0$0
PHS Evaluation65,122067,60072,713
Subtotal, Program Support65,122067,60072,713
SubtotalBudget Authority$0700,000$0$0
PHS Evaluation372,0530397,053610,912
Total Operational Level372,053700,000397,053610,912
FTEs28938300315

1 In FY 2009, the American Recovery and Reinvestment Act (ARRA) provided $1,100,000,000 for research that compares the effectiveness of medical options. Of this total, $400,000,000 was transferred to the National Institute of Health and a total of $400,000,000 will be allocated at the discretion of the Secretary of the Department of Health and Human Services. A new Federal Coordinating Council helped set the agenda for these funds. The remaining $300,000,000 was available for the AHRQ. These funds are available for obligation in FY 2009 and FY 2010. Of the 38 FTEs allocated for the ARRA funds, AHRQ is allocated 15 FTEs and the Office of the Secretary supports 22 FTEs with their ARRA funds.

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AHRQ Mechanism Table

Agency for Healthcare Research and Quality
Grand Total Mechanism Table
(Dollars in Thousands)

MechanismFY 2009 ActualFY 2010 AppropriationFY 2011 Request
NumberDollarsNumberDollarsNumberDollars
Research GrantsNon-Competing18553,17021664,43920775,431
New & Competing19438,37421763,638155123,084
Supplemental 0 0 0
Total, Research Grants37991,544433128,077362198,515
Total Contracts/IAAs 215,387 201,376 339,684
Research Management 65,122 67,600 72,713
Total 372,053 397,053 610,912

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Recovery Act Obligations and Performance

The American Recovery and Reinvestment Act (Recovery Act) appropriated $1.1 billion for research that compares the effectiveness of different medical options of which $300 million is for the Agency for Healthcare Research and Quality (AHRQ), $400 million is for the National Institutes of Health (NIH), and $400 million is for allocation at the discretion of the Secretary of the Department of Health and Human Services (HHS). This summary will focus on the $300 million for AHRQ and the $400 million for the Office of the Secretary.

AHRQ's Research Activities ($300 million)

AHRQ will use Recovery Act funds to expand and broaden existing activities through its Effective Health Care (EHC) program. These activities were initiated at the Agency in response to the Medicare Prescription Drug, Improvement and Modernization Act of 2003. AHRQ will use a process to generate and bolster this research that includes: horizon scanning, evidence gap identification, evidence synthesis, evidence generation, dissemination and translation, and research training and career development. AHRQ will also use Recovery Act funding to expand and standardize public involvement in its EHC program by establishing a Citizens Forum. The comprehensive spending plan transmitted to specified Congressional committees on July 30, 2009 represents an investment in creating the integrated components of a national effort in the United States, including the first coordinated prospective pragmatic clinical studies program for research that compares the effectiveness of different medical options. Additional ARRA investments will support the infrastructure, methods, and capacity necessary to sustain a vigorous national research enterprise in the United States. Proposals for funds will focus initially on the14 priority conditions established by the Secretary of HHS under Section 1013 of the 2003 Medicare Modernization Act (go to http://www.ahrq.gov/about/mmarsrch.htm). Priority will also be given to research focused on under-represented populations. To achieve the goals of producing patient-centered health research, AHRQ will use a variety of funding mechanisms including grants, contracts and inter-agency agreements. Award recipients will include researchers, academic institutions, States, community-based organizations, national organizations, and federal agencies.

The Office of the Secretary (OS) Research Activities ($400 million)

The HHS's overall goal for this investment is to promote high quality care through broad availability of information that helps clinicians and patients match the best science to individual needs and preferences. Moreover, the investment can build a sustainable foundation for future research so that it will enable—now and in the future—the United States healthcare system to deliver the highest quality care to all Americans. The Recovery Act established the Federal Coordinating Council (FCC) to foster optimum coordination of this research by relevant Federal departments and agencies, with the goal of reducing duplicative efforts and encouraging coordinated and complementary use of resources.

The Recovery Act funds represent a significant investment in research that compares the effectiveness of different medical options, allowing many high-priority issues to be addressed in the short-term, but also strengthening and sustaining this research in the long-term. As such, if we are to realize the full potential of this research to improve health and health care, we must be equally strategic about the direction moving forward. Evidence needs for this research will be identified through syntheses of existing evidence as well as horizon scanning (which will include public outreach and consultation). These identified needs will inform development of priorities for evidence generation across HHS operational and staff divisions. As appropriate, these priorities will incorporate cross-cutting needs relating to priority interventions, conditions and populations.

AHRQ Summary of Recovery Act Obligations and Performance
(dollars in millions)

ARRA Implementation PlanAppropriated AmountFY 2009FY 2010FY 2009 - FY 2010
AHRQ$300.0$4.9$295.1$300.0
Office of the Secretary$400.0$1.6$398.4$400.0
Total Obligations$700.0$6.5$693.5$700.0

Selected Performance Measures

AHRQ1

 Performance MeasureFY 2009 ActualsFY 2010 Target 2
AHRQ ARRA 1Increase the number of Effective Health Care (EHC) Program products available for use by clinicians, consumers, and policymakersN/A (data to be reported beginning Q1 FY2010)5-15 Research Reviews or Research Gap Reports and 5-7 translation and education products
AHRQ ARRA 2Increase the dissemination of Effective Health Care (EHC) Program products to clinicians, consumers, and policymakers to promote the communication of evidence about the effectiveness of different medical interventionsN/A (data to be reported beginning Q1 FY2010)Establish baseline and set targets for 2011 and beyond
AHRQ ARRA 3Increase the percentage of stakeholders who report they use Effective Health Care (EHC) Program products as a resourceN/A (data to be reported beginning Q1 FY2010)Establish baseline and set targets for 2011 and beyond
AHRQ ARRA 4Number of competitive contracts and grants awarded to support AHRQ's Recovery Act research activities1 grant;

3 contracts

8 contracts to date;

FY 2010 Total Estimate:

19 contracts

75 grants

Note: Targets reflect activities funding with the ARRA Appropriation and are in addition to the performance targets for AHRQ's annual appropriation provided in the Patient-Centered Health Research portfolio section.

1 Additional information about this implementation plan is contained at http://www.hhs.gov/recovery/reports/plans/ahrq_cer_plan.pdf (PDF File, Plugin Software Help)
2These are preliminary targets for ARRA. They are under review and are subject to change.

Data Sources for AHRQ:

AHRQSources
AHRQ ARRA 1AHRQ's Recovery Act-funded products will be posted on the AHRQ Effective Health Care Program Web site, http://effectivehealthcare.ahrq.gov/.
AHRQ ARRA 2Requests for copies of AHRQ's Recovery Act-funded products (ordered by title and publication number) will be made to the AHRQ Publications Clearinghouse. Data will be provided bi-annually from the Publications Clearinghouse on the number of organizations requesting more than 50 copies of AHRQ's Recovery Act-funded products.
AHRQ ARRA 3Data for this output is available from AHRQ's Medicaid Medical Director's Learning Network (MMDLN). At an annual meeting, members of MMDLN will report on how they use AHRQ's Recovery Act-funded products.
AHRQ ARRA 4UFMS Accounting Data, AHRQ Budget Database, and HHS Financial and Activity Report.

Office of the Secretary3

 Performance MeasureFY 2009 ActualsFY 2010 Target
OS ARRA 1Number of Federal Coordinating Council Meetings132
OS ARRA 2Number or people and organizations who provided written or verbal comments for Council's consideration41210

Note: The current OS ARRA measures focus on the FCC, whose work was designed to be heaviest in FY 2009. Therefore, the FY 2010 targets are lower than the FY 2009 Actuals.

Data Source: Office of the Secretary Staff.

3 Additional information about this implementation plan is contained at http://www.hhs.gov/recovery/reports/plans/os_cer_plan.pdf (PDF file, Plugin Software Help).

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Current as of February 2010
Internet Citation: Performance Budget Overview: Budget Estimates for Appropriations Committees, Fiscal Year 2011. February 2010. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/about/mission/budget/2011/web11over.html