- President Donald Trump’s proposed 2018 budget calls for major sweeping reforms at HHS in order to balance the federal budget, most notably repealing and replacing the Affordable Care Act and reforming Medicaid. Less eye-catching but equally important to health IT infrastructure and innovation are proposed changes at AHRQ and ONC.
Chief among the major savings and reforms within HHS is the proposed elimination of AHRQ, which would amount to a $333-million reduction in funding:
AHRQ, which has not been authorized since 2005, has had a mandate to enhance the quality, appropriateness, and effectiveness of health services through research and promotion of best practices to improve health systems and outcomes. However, other agencies also conduct health services research and promote best practices that improve delivery of care and enhance patient safety. In particular, NIH already conducts $1.5 billion in health services research, but it is conducted by individual institutes across NIH. Consolidating AHRQ into NIH will reduce duplication and improve the effectiveness of existing health services research.
Meanwhile, the President 2018 budget proposal calls for a significant reduction in funding at ONC. The proposal to Congress would reduce the federal agency’s budget by $22 million, a 36-percent reduction over the previous year.
“When ONC was created, a small minority of physicians and hospitals used health information technology,” it reads. “Now that the vast majority of physicians and hospitals have adopted electronic health records through Federal incentive payments, it is time for a renewed, more focused role for ONC.”
“A restructured ONC will maintain a focus on core health IT functions, such as policy development and coordination and standards and certification activities,” the document goes on to say. “The Budget would eliminate or significantly reduce lower-priority activities or activities that can be performed by other entities. The Budget also would reduce administrative costs. These changes would improve ONC's ability to be an effective coordinator of nationwide health IT activities and increase the Agency's efficiencies.”
Other reductions are proposed at NIH, CDC, FDA, SAMHSA, and CMS. And the proposals are drawing criticism from industry groups such as AHIMA and AMIA.
“We are disappointed by the Administration’s proposed cuts to the Office of the National Coordinator for Health IT,” said AHIMA CEO Lynne Thomas Gordon, MBA, RHIA, CAE, FACHE, FAHIMA. “The bipartisan passage of the Cures Act by Congress last year made clear that investment in our nation’s health IT infrastructure is critically important if we are to advance new drugs and devices and fully realize the benefits of a learning healthcare system. ONC is a critical partner in this endeavor.”
The organization is calling on Congress to ensure that ONC receives funding for properly supporting the goals of the 21st Century Cures Act.
AMIA Board Chair Thomas H. Payne, MD, FACMI, called the proposal a threat to progress for multiple federal healthcare initiatives.
“At a time when we should be acting on bipartisan agreements, such as passage of the 21st Century Cures Act or the Precision Medicine Initiative, and building on our nationwide investment in EHR adoption, this budget request stops progress in its tracks. Worse, this budget will imperil long-standing and important activities at the NIH, FDA and ONC intended to deliver new cures, safer treatments, and higher quality care for all Americans,” he stated.
The organization warned of the budget proposal could lead to “a stagnant patchwork of IT-enabled patient care” among other downsides to be felt by clinicians and scientists focus on improving care coordination and delivery.