Meeting Minutes, April 13, 2012
Call to Order and Approval of November 4, 2011, Summary Report
Update on AHRQ's Medical Liability Initiative
Implications of the Affordable Care Act for Communities of Color
The Patient-Centered Outcomes Research Trust Fund
Chairman's Wrap-Up and NAC Input
National Advisory Council (NAC) Members Present
Bruce Siegel, MD, MPH, National Association of Public Hospitals and Health Systems (Chair)
Mitra Behroozi, JD, 1199SEIU Benefit and Pension Funds
Paul N. Casale, MD, The Heart Group, Lancaster General Hospital (by telephone)
Jane Durney Crowley, MHA, Catholic Health Partners
Helen Darling, MA, National Business Group on Health (by telephone)
Louise-Marie Dembry, MD, MS, MBA, Yale-New Haven Hospital
Silvia M. Ferretti, DO, Lake Erie College of Osteopathic Medicine
Helen W. Haskell, Mothers Against Medical Error
Ardis Dee Hoven, MD, University of Kentucky College of Medicine
Michael P. Johnson, PT, PhD, OCS, Bayada Home Health Care
Newell E. McElwee, PharmD, MSPH, Merck Global Affairs
Andrea H. McGuire, MD, MBA, Meridian Health Plan
Welton O'Neal, Jr., PharmD, CryerHealth LLC
David F. Penson, MD, MPH, Vanderbilt University Medical Center
Christopher Queram, MA, Wisconsin Collaborative for Healthcare Quality
Katherine A. Schneider, MD, M.Phil., AtlantiCare Health System
Harry P. Selker, MD, MSPH, Tufts University
Alan R. Spitzer, MD, Pediatrix Medical Group (by telephone)
Jeffery Thompson, MD, MPH, Washington State Medicaid Purchasing Administration
Janet S. Wyatt, PhD, RN, Institute of Pediatric Nursing
Alternate Members Present
Clarice Brown, MS, National Center for Health Statistics, Centers for Disease Control and Prevention
Patrick Conway, MD, Centers for Medicare & Medicaid Services
Pauline Sieverding, MPA, JD, PhD, Veterans Health Administration
AHRQ Staff Members Present
Carolyn M. Clancy, MD, Director
Boyce Ginieczki, PhD, Acting Deputy Director
Jamie Zimmerman, MPH, NAC Coordinator
Karen Brooks, CMP, NAC Coordinator
Call to Order and Approval of November 4, 2011, Summary Report
Bruce Siegel, MD, MPH, Chair of the NAC, Agency for Healthcare Research and Quality (AHRQ), called the group to order at 8:30 a.m., welcoming NAC members, other participants, and visitors. He noted that the NAC featured six new members and asked all members, alternates, and AHRQ staff members to introduce themselves. New NAC member Henry H. Ng, MD, MPH, MetroHealth System, was unable to attend.
Dr. Siegel referred to the draft minutes of the previous NAC meeting (November 4, 2011) and asked for changes and approval. NAC members approved the November 4, 2011, meeting minutes with no changes.
Carolyn M. Clancy, MD, AHRQ Director, welcomed NAC members, speakers, and other guests. She highlighted six new members: Jane Durney Crowley, MHA, Michael P. Johnson, P.T., PhD, OCS, Newell E. McElwee, PharmD, MSPH, Henry H. Ng, MD, MPH, David F. Penson, MD, MPH, and Harry P. Selker, MD, MSPH She announced that Dr. Siegel had been reappointed as NAC Chair.
Dr. Clancy reported that Andrea H. McGuire, MD, MBA, recently became President and Chief Operating Officer of Meridian Health Plan. Welton O'Neal, Jr., PharmD, recently became Vice President, Medical Affairs, at CryerHealth LLC. Helen Darling, MA, received a 2012 National Committee for Quality Assurance Health Quality Award for her leadership in promoting health care quality.
The Big Picture
Dr. Clancy reviewed the AHRQ fiscal year (FY) 2012 budget, which features a core of $369 million, with an additional $12 million from the Prevention and Public Health Fund (PPHF) and an additional $24 million from the Patient-Centered Outcomes Research Trust Fund (PCORTF). The budget comprises large fractions for patient safety (especially health care–associated infections research), crosscutting grants, health information technology (IT), patient-centered health care research, prevention/care management, and value research.
The FY 2013 budget request features a core of $334.5 million, to which are added $12 million from the PPHF and $62.4 million from the PCORTF. The FY 2013 request for the core budget reflects decreases in most research areas, although there is a significant increase from the PCORTF.
Dr. Clancy announced that AHRQ will be moving its offices from the John M. Eisenberg Building on Gaither Road to the Parklawn Building (also in Rockville) in a few years. The Parklawn Building will be radically renovated and upgraded prior to the move. AHRQ will be sharing the large Parklawn space with the Indian Health Service, the Health Resources and Services Administration, and the Substance Abuse and Mental Health Services Administration.
Dr. Clancy reviewed the following recent accomplishments:
- The Wall Street Journal featured a story on the longstanding and continuing Chronic Disease Self-Management Program in California, which is funded by AHRQ.
- An article in the Journal of the American Medical Informatics Association featured discussions with physicians and pharmacists about e-prescribing, revealing its importance for patient safety and timeliness and barriers to its use.
- AHRQ and a number of Hispanic group partners promoted the use of new Spanish-language resources in the "Toma las Riendas" ("Take the Reins") campaign, which encourages people to take control of their health and treatments.
- The results of an AHRQ-funded study of consumer use of health data were published in the March 2012 issue of Health Affairs. The research found that consumers tend to choose a more expensive provider when presented with cost information alone. However, when provided with cost and quality data, consumers more often will focus on high-quality care at lower cost.
- The Saint Louis University School of Medicine recently incorporated AHRQ's Health Literacy Universal Precautions Toolkit in its curriculum.
- Alliant/GMCF, the Medicare Quality Improvement Organization for Georgia, recently offered AHRQ's Nursing Home Survey on Patient Safety Culture and TeamSTEPPS training. Improved communication and teamwork skills were observed.
- Primary Health Care Centers in Georgia used AHRQ's booklet "Blood Thinner Pills: Your Guide to Using Them Safely" in a program to help patients manage their anticoagulation therapy and health. The program also used AHRQ's video "Staying Active and Healthy With Blood Thinners." The program led to an increase in the number of people seeking regular blood tests. Alliant/GMCF also used the booklet in a program to help Medicare patients manage anticoagulant therapy and health.
- The St. Barnabas Rehabilitation & Continuing Care Center in New York reported a reduction in new pressure ulcers after using the On-Time Quality Improvement for Long-Term Care Program. Seton Health at Schuyler Ridge Nursing Home, also in New York, produced similar results by using the program.
- StayWell Health Management in Minnesota has been incorporating AHRQ's Effective Health Care Program guides in its consumer programs.
AHRQ Program Updates
- Beth A. Collins Sharp, PhD, RN, was named AHRQ's Senior Advisor for Nursing. AHRQ developed a new Effective Health Care Nursing Working Group, featuring leading nursing organizations, to explore nursing needs, embrace innovation, and sustain dialogue.
- In the March 2012 issue of Health Affairs, AHRQ sponsored five articles focused on issues in public reporting.
- The Arkansas Department of Health adopted AHRQ's MONAHRQ ("My Own Network, powered by AHRQ") Web software system to develop hospital data and reports.
- A new AHRQ toolkit will guide hospitals in using AHRQ Inpatient and Patient Safety Quality Indicators. The toolkit explains quality improvement processes and helps users identify best resources. It is available at http://www.ahrq.gov/professionals/systems/hospital/qitoolkit/index.html.
- An AHRQ-supported study found that, although the use of electronic medical records (EMRs) does not reduce the rate of patient safety events, once an event occurs, EMRs help reduce deaths, readmissions, and costs.
- A new AHRQ ACTION (Accelerating Change and Transformation in Organizations and Networks) project will help reduce readmissions for Medicaid patients by creating and testing strategies and tools to address challenges.
- Research related to implementation of the Affordable Care Act includes the use of AHRQ data to determine the small employer health insurance tax credit, evaluations of the health insurance status of and health care use by young adults, estimates of tax subsidies for employer-sponsored insurance, and more. AHRQ data from the Medical Expenditure Panel Survey have also been used in models that simulate the effects of the Affordable Care Act.
- As part of the Effective Health Care Program, AHRQ released new brochures on analgesics for osteoarthritis, self-measured blood pressure monitoring, nonpharmacological therapies for treatment-resistant depression, and urinary incontinence. Materials on bone fractures, chronic pain, and mechanical thrombectomy are being developed.
- An AHRQ- and U.S. Food and Drug Administration-supported study of patients with attention deficit hyperactivity disorder (ADHD) found that use of ADHD medications was not associated with an increased risk of serious cardiovascular events.
- An AHRQ-supported study of patients with type 2 diabetes who underwent bariatric surgery found that health care costs were not reduced during a 6-year followup, although there was a decrease in the number of primary care visits.
- An AHRQ-supported database study of the comparative effectiveness of oral antidiabetic drugs on kidney function found that patients taking sulfonylureas had an increased risk for a decline in kidney function, end-stage renal disease, and death compared with patients taking metformin.
- On June 12–13, 2012, AHRQ will host the 4th Symposium on Comparative Effectiveness Research Methods, "From Efficacy to Effectiveness." The proceedings will be published in a journal.
- AHRQ data resources will be featured at a Health Data Initiative (HDI) forum on June 5–6, 2012. HDI is a project to establish collaborations for health data within the U.S. Department of Health and Human Services (HHS), leading to greater public access to data.
- Within the Patient-Centered Medical Home initiative, AHRQ produced white papers and briefs on evaluating the medical home, coordinating care, serving complex needs, and more. Materials are available at http://www.pcmh.ahrq.gov.
- Two new AHRQ reports addressing key issues in measuring care coordination in primary care—accountability and data sources—are available. They are "Care Coordination Accountability Measures for Primary Care Practice" and "Prospects for Care Coordination Measurement Using Electronic Data Sources."
- The U.S. Preventive Services Task Force (USPSTF) began posting draft research plans for public comment. Recent postings include "Screening for Peripheral Arterial Disease" and "BRCA Mutation Testing for Breast and Ovarian Cancer Susceptibility." A final recommendation on screening for cervical cancer was released in March 2012.
- The USPSTF recently welcomed four new members: Linda Ciofu Baumann, PhD, RN, University of Wisconsin, Madison; Mark H. Ebell, MD, MS, The University of Georgia; Jessica Herzstein, MD, MPH, Air Products; and Douglas K. Owens, MD, MS, Stanford University.
- An AHRQ-supported case study of family health information management tasks found that the design of consumer health IT elements should be balanced with individual needs.
- AHRQ is supporting the development of videos promoting the use of health IT, featuring AHRQ grantees. The videos are available at http://healthit.ahrq.gov/HITFeaturedProjects.
- AHRQ and the National Science Foundation are providing funding for research that advances health services through system modeling. This involves health IT design.
- Two AHRQ-supported studies of aspects of health IT were published in the Journal of the American Medical Informatics Association. One is a review of trials of integrated health IT across phases of medication management, and the other deals with transmitting and processing electronic prescriptions.
- As directed by the Affordable Care Act, AHRQ and the Centers for Medicare & Medicaid Services (CMS) have begun planning a program to connect hospitals with high readmission rates to Patient Safety Organizations (PSOs). AHRQ provides resources on its PSO Web site (http://www.pso.ahrq.gov). The upcoming PSO annual meeting will feature software developers. A new version of Hospital Common Formats for reporting safety events was published in April 2012.
- The Institute of Medicine released a report calling for health IT systems that lead to safer and better care and recommending that AHRQ support the effort.
- AHRQ is close to releasing the 2011 "National Healthcare Quality Report" and "National Healthcare Disparities Report." The reports feature new topical sections and address the priorities of the National Quality Strategy.
- Implementation of the Comprehensive Unit-Based Safety Program to reduce rates of central line–associated bloodstream infections (CLABSIs) has expanded to 46 States, the District of Columbia, and Puerto Rico. Interim analyses have found reductions in CLABSI rates. AHRQ is working with CMS, the Centers for Disease Control and Prevention, and the Office of the Assistant Secretary for Health in an HHS effort to reduce all health care–associated infections.
- The 2012 AHRQ Annual Conference will take place September 9–12, 2012, at the Bethesda North Marriott Hotel & Conference Center.
Dr. Siegel encouraged AHRQ to transmit findings of the ACTION project nationally; that is, to other agencies doing similar work addressing readmissions. Dr. Clancy stated that AHRQ has various avenues for such engagement (e.g., it could be aligned with AHRQ's CLABSI work).
Christopher Queram, MA, noted research and an article by his organization focusing on issues of public reporting. He suggested that, as performance measurement becomes a commodity, new forms of competition would arise. We need good equilibrium between State and national ideas.
Ms. Crowley raised the issue of underlying factors that lead to readmissions. Are readmissions driven mainly by socioeconomics, and will we identify the drivers? Dr. Clancy noted that AHRQ supported the Re-Engineered Hospital Discharge Project (Project RED) 3 years ago. Some structural issues, such as changes in staffing, made it difficult to study the causes of readmissions. A partial answer in the future might be the use of a "computerized nurse" to advise patients. Another might be some sort of case management system.
Ms. Darling raised the issue of overuse of health care elements and encouraged AHRQ to consider demonstrating strategies for translating or using new evidence. Professional organizations might play significant roles in such a process.
Update on AHRQ's Medical Liability Initiative
Timothy McDonald, MD, JD, University of Illinois at Chicago
Dr. Clancy introduced Dr. Timothy McDonald, Interim Assistant Vice President for Quality and Safety, University of Illinois (UI) Hospital and Health Sciences System. She also provided background on AHRQ's liability initiative, which features demonstration grants to help States develop and test models addressing preventable injury and patient compensation. Seven major projects are ongoing.
Dr. McDonald, who heads one of the seven demonstration grants, described his background at Loyola University, including his work in child advocacy leading to efforts to prevent harm. The current project at UI involves 10 private hospitals that feature open medical staffing—a scenario that offers challenges with respect to medical liability. Dr. McDonald referred to recent studies and data revealing how a lack of openness and poor medical staff performance influence the area of medical liability. A study reported in Health Affairs in 2011 demonstrated that the immediate sharing of information about potential malpractice can lead to the dropping of claims.
Dr. McDonald described his program at the UI Medical Center, which is comprehensive; integrates safety, risk, quality, and credentials; and features medical student education. This "seven pillars" program addresses reporting, investigation, communication, apologies with remediation, process/performance improvement, data tracking/analysis, and education. It seeks to reduce harm, reduce lawsuits, resolve inappropriate cases early, support patient and family engagement, and support health care professionals following harm events.
One key to the program is a "Patient Communication Consult Service," a process that establishes all-time access, empowers patients, highlights the value of emotional intelligence, involves the physician and the family, and mitigates the effects of health care workers with low emotional intelligence. It also establishes policies and procedures, creates trust and learning, obtains data, and helps physicians overcome their fears about harm events. The UI program features a patient safety compensation card, which ensures no cost to a patient in the event of inappropriate care and leads to better legal results. The program has seen increased reporting of events and a reduction in claims.
Dr. McDonald related the case of the Malizzo family, whose daughter died as a result of medical error. The UI program helped mitigate resulting difficulties, and the family became involved in a hospital safety review committee, serving as a strong conscience in deliberations.
Dr. Siegel wondered whether the results might differ in nonteaching hospital environments. Dr. McDonald noted that some of the participating hospitals lack physician-residents and are nonteaching. Dr. Johnson wondered about the effects on the hospital culture (e.g., satisfaction), especially in light of how the program addresses less talented staff members. Dr. McDonald stated that the program has a group performing interventions with physicians who have problems. Nevertheless, some physicians do not improve.
Mitra Behroozi, JD, noted a need to ensure a sufficient supply of staff members with strong emotional intelligence. One answer is to use an emotional intelligence tool when hiring. Dr. Selker wondered whether cultural transformation occurred—especially among the leadership of the hospitals. Dr. McDonald stated that the hospitals differ in rates of acceptance, although all feature champions. Malpractice insurance companies are increasingly becoming involved. Ardis Dee Hoven, MD, emphasized that such programs can create fear in physicians. Dr. McDonald noted that his program makes it easy to report events anonymously and creates safe harbors. One site created a doctor-to-doctor program to reduce fears. Of course, problems arise because of nonphysicians as well—a safety culture survey helps identify such aspects.
Jeffery Thompson, MD, MPH, wondered whether the program might be applied in obstetrics. Dr. McDonald noted that the program (especially communication) can begin with the informed consent process, which is key in obstetrics. Ms. Crowley stressed the importance of the time lapse between the occurrence of a harm and the determination that an inappropriate action had taken place. To address that issue requires leadership and support for communication with patients. Dr. McDonald noted that his program focuses on reporting harm immediately. Malpractice insurance companies are now helping fund the project.
Janet S. Wyatt, PhD, RN, cited a need for training for process improvement, and Dr. McDonald responded that the program features team training and targets multiple disciplines. There is a group to handle unsolicited patient complaints. The program has focused on certain areas, yet it has found benefits generally.
Joyce M. Hunter, MBA, Vulcan Enterprises, encouraged AHRQ to help widely replicate the Georgia Medicaid Quality Improvement Project. She stressed that we need better recognition of aspects of medication dispensing in nursing homes—for example, better multiprovider collaboration. Ms. Hunter encouraged AHRQ to ensure that results from the challenge grants in the CMS Innovation Center are used to inform quality initiatives.
Implications of the Affordable Care Act for Communities of Color
Brian D. Smedley, PhD, Joint Center for Political and Economic Studies
Dr. Brian D. Smedley is Vice President and Director of the Health Policy Institute, Joint Center for Political and Economic Studies. He described a large program at his organization devoted to analyzing and addressing issues of health and health equity for communities of color. Dr. Smedley applauded AHRQ for its continuing development and publication of the "National Healthcare Disparities Report." He noted that the Affordable Care Act features about 75 provisions that address health equity in systems. Between 2003 and 2006, about 30 percent of direct medical care expenditures for African Americans, Asians, and Hispanics were excess costs due to health inequalities. The Joint Center recently published "Patient Protection and Affordable Care Act of 2010: Addressing Health Equity for Racially and Ethnically Diverse Populations," a book of analysis devoted to implications of the Act.
Many factors contribute to health disparities, including socioeconomics, segregation, occupational risks, health risks, health-seeking behaviors, health care access, and health care quality. Dr. Smedley provided data revealing significant segregation and links to poverty for African Americans. He described many of the negative effects of segregation, such as isolation from mainstream resources (including good grocery stores); fewer parks and safe areas for walking, jogging, and playing; and the presence of environmental hazards. Solutions to these dire phenomena include a focus on prevention, use of multiple strategies, sustained investment and policies, investments in communities, and housing mobility options.
The Joint Center has developed the program "Place Matters" to focus on communities, or other geographical places, that define inequities. The program focuses on local factors and seeks to do the following:
- Build capacity of local leaders to address conditions that shape health.
- Encourage communities to increase capacity to identify and advocate for strategies to address health disparities.
- Support and inform efforts to establish data-driven strategies and data-based outcomes to measure progress.
- Establish a national learning community to support applications of successful strategies.
So far, the Place Matters program has identified key social determinants and health outcomes that must be addressed at the community level, has built multisector alliances, has engaged policymakers and stakeholders, and has evaluated practices.
Dr. Wyatt raised the issue of school health staff, their diminishment (i.e., in their capacity or presence; for example, school nurses who are only part time or fully absent), and a resulting reduction in access to care. Ms. Darling noted the "Million Hearts" campaign, the national HHS initiative to prevent heart disease and stroke. The initiative includes a community focus and possibly overlaps with efforts in the Joint Center's Place Matters program. Dr. Smedley agreed that the two efforts share a number of important objectives.
The Patient-Centered Outcomes Research Trust Fund
Carolyn M. Clancy, MD, AHRQ; Sharon Levine, MD, The Permanente Medical Group of Northern California; and Anne C. Beal, MD, MPH, Patient-Centered Outcomes Research Institute
Dr. Clancy introduced the speakers for this session on patient-centered research. Dr. Sharon Levine, a pediatrician, is Associate Executive Director of The Permanente Medical Group of Northern California and serves on the board of governors of the Patient-Centered Outcomes Research Institute (PCORI), helping especially in the areas of communications and outreach. Dr. Anne C. Beal is Chief Operating Officer of PCORI. She served previously as President of the Aetna Foundation. Dr. Clancy stressed the collaborative relationship between AHRQ and PCORI and reviewed the history of AHRQ's work in comparative effectiveness, including focus on patient-centered outcomes research and implementation. She noted that the PCORTF supports an initial focus on outcomes of PCORI endeavors and seeks to discover complementary initiatives.
Dr. Levine serves with Dr. Clancy on the AHRQ/PCORI Dissemination Workgroup. She stated that PCORI would build on the Effective Health Care Program as it disseminates research findings on relative health outcomes, clinical effectiveness, and appropriateness of treatments. The program will have the following assumptions about dissemination:
- Success will be defined as an impact on practice and patient outcomes.
- In disseminating research results and funding research on dissemination, PCORI will not duplicate efforts by AHRQ and the National Institutes of Health.
- The opportunities and requirements for PCORI are unique.
- Dissemination requires investment.
- A related role is creating demand for and receptivity to PCORI.
- Translating results and influencing behavior are context dependent.
- Early partnerships will lead to the effectiveness of the program.
- Patient and stakeholder engagement will be the first steps in research.
Dr. Levine noted lessons from past endeavors in dissemination, which PCORI will take to heart. For example, programs are most successful when they employ formats, channels, and sources preferred by the audience. The Dissemination Workgroup is developing a checklist of components for a process of accelerating dissemination, including the following:
- Identifying stakeholders for whom results will be meaningful.
- Identifying points during research where stakeholders will be engaged.
- Defining methods for engaging stakeholders.
- Creating a governance plan and strategy for conveying results.
- Determining how to identify facilitators of and barriers to dissemination.
- Describing ways to allocate and share resources with stakeholders.
Dr. Beal noted that PCORI has two main mandates—generating research and disseminating results. She described current efforts, such as developing agendas to drive research. The mandate for PCORI is broad and the resources limited; therefore, the program will seek synergies through partnerships (as with AHRQ). The program seeks to engage providers and patients and to obtain and disseminate research results. Separate focus groups with patients and providers have already been conducted and have revealed the need for communication with and among them. The program has featured public comment periods, Web postings, and dialogue with national organizations.
PCORI program staff are establishing criteria for judging research projects, identifying activities for dissemination, and establishing ways to involve researchers. All research projects will require a dissemination component. Stakeholders will be included in study sections. A methodology committee will produce a report in May 2012.
Dr. Hoven stressed the importance of engaging physicians at various levels and encouraged PCORI to support research involving registries.
Dr. Penson expressed concern that many researchers are not versed in the skills of dissemination. Perhaps PCORI could help establish a basic infrastructure for dissemination. Dr. Levine noted that PCORI seeks to have researchers address dissemination in modest ways; for example, by incorporating patients into research. Dr. Clancy added that dissemination would require various solutions in addition to the activities of the researchers.
Patrick Conway, MD, encouraged the program to stress the use of directed questions rather than independent investigator research. Which questions and investments can be built on? Which multiple gaps can be addressed?
Pauline Sieverding, MPA, JD, PhD, noted efforts supported by the Veterans Health Administration, which has supported implementation research for many years. She stressed the difficulty of tracking the uptake of research results. One new program features a coordinated set of projects with links between investigators and operations personnel. Dr. Clancy encouraged efforts that build capacity, noting that PCORI is a private sector entity with the involvement of the Federal Government.
Dr. McElwee encouraged PCORI to consult with individuals in schools of communication. Silvia M. Ferretti, DO, applauded the attention to partners and encouraged work with undergraduate and residency programs (e.g., osteopaths). Dr. Thompson proposed a focus on the development of rates (who should be paid more?) and attention to the equation involving eligibility and access to benefits.
Helen W. Haskell emphasized the idea that we cannot simply ask patients to change. Universal concerns, including the health care system, must be addressed. Researchers who have suffered from bad experiences in the health care system can provide insight. Dr. Selker stated that a patient does not want to be considered as a diagnosis. We must respect an integration of the person.
Chairman's Wrap-Up and NAC Input
Dr. Siegel asked NAC members for final comments and suggestions for the next agenda.
- Dr. Siegel proposed as a future agenda item a consideration of primary care and how it can be advanced and improved.
- Dr. McGuire stressed the importance of addressing one patient at a time. How might AHRQ address that scenario? People need tools to make changes in their lifestyles.
- Dr. Hoven proposed that the issue of ambulatory care safety gaps be a future agenda item.
- Dr. Johnson raised the issue of getting people (i.e., patients, physicians) to converse and listen more. The NAC might consider areas such as relationship management, workforce development, and patient development.
- Dr. Katherine A. Schneider, MD, M.Phil., wondered about potential results in the event that the U.S. Supreme Court blocks the Affordable Care Act. Dr. Clancy stated that such a scenario will affect how AHRQ integrates its priorities.
- Dr. Selker applauded the work of the CMS Innovation Center and encouraged AHRQ to coordinate with its activities.
- Ms. Crowley suggested that the NAC take up the issue of the small fraction of the population responsible for a large fraction of health care use and costs.
Dr. Siegel stated that the next NAC meeting will take place on July 13, 2012. He thanked NAC members, invited speakers, and guests and adjourned the meeting at 3:05 p.m.