CONTENTS Page 4 Woolley, Mary, President, Research!America Material submitted for the record by: American Academy of Family Physicians, prepared statement of REAUTHORIZATION OF THE AGENCY FOR HEALTH CARE POLICY AND RESEARCH THURSDAY, APRIL 29, 1999 HOUSE OF REPRESENTATIVES, SUBCOMMITTEE ON HEALTH AND ENVIRONMENT, Washington, DC. The subcommittee met, pursuant to notice, at 10 a.m., in room 2322, Rayburn House Office Building, Hon. Michael Bilirakis (chairman) presiding. Members present: Representatives Bilirakis, Deal, Ganske, Cubin, Bryant, Brown, Deutsch, Green, Barrett, Capps, and Eshoo. Staff present: Jason Lee, majority counsel; Thomas Giles, majority counsel; Penn Crawford, clerk; John Ford, minority counsel, Karen Folk, minority professional staff. Mr. BILIRAKIS. The hearing will come to order. Good morning. I now call to order this hearing on reauthorization of the Agency for Health Care Policy and Research. Today we will hear testimony from the administrator of the agency as well as experts from both the public and private sectors. I would like to thank all of our witnesses for their willingness to testify on such short notice and for the cooperation of the ranking member, Mr. Brown, and the minority staff in helping us prepare for this hearing. Working on a bipartisan basis, I am hopeful that we can pass legislation to reauthorize the agency this year. This agency serves a critical function in efforts to improve the quality of health care in our Nation. It directly funds the collection and analyses of critical health data needed by Congress to make sound decisions on health care access, quality and cost effectiveness issues. And equally important, it provides technical assistance to private sector organizations that seek its expertise to support their initiatives. I would note that one of our witnesses today played a key role in the agency's creation. As minority counsel of the Ways and Means Health subcommittee, Chip Kahn spearheaded the legislative effort to establish this agency through the Omnibus Budget Reconciliation Act of 1989. And I want to extend a special welcome to Dr. Mahan, dean of the College of Public Health at the University of South Florida in Tampa. He is also the director of the Lawton and Rhea Chiles Center for Healthy Mothers and Babies. Dr. Mahan will describe the Chiles Center's efforts to overcome barriers to access to preventive health care through a public-private partnership. He will also ex (1) plain the potential role of the Agency for Health Care Policy and Research in achieving that objective. Again I want to thank all of our witnesses for their time and effort in joining us. I look forward to their testimony on how reauthorization of this agency can improve the quality of health care nationwide and would now yield to Mr. Brown. Mr. BROWN. Thank you, Mr. Chairman, and special thanks to John Eisenberg and our other distinguished panelists. Tapping into an expanding agency, AHCPR, is an opportunity to do something legislatively that is unequivocally positive for the future of health care in this country. Success or failure of health care financing and delivery hinges on three variables, access, quality and cost. These variables are obviously interdependent. Optimizing access and quality is a process of spending limited dollars in ways that reaches as many people as possible with the most effective, efficient care as possible. The work that AHCPR does is fundamental to this process. It is the agency that evaluates the current systems so that we can improve it. With health care dollars as scarce as they are, this is a crucially important role. AHCPR conducts and supports health services research and communicates the results of that research to the health care community and to the public. It sounds dry, but it translates into tangible improvements into public health, fewer wasted dollars in policy changes grounded in knowledge rather than simply wishful thinking. Through initiatives such as Friendly Access, which Dr. Mahan will discuss, AHCPR also helps the Nation expand its reach to deliver care disenfranchised populations. We know that an estimated 2 to 3 million children eligible for Medicaid coverage have not been enrolled in the program. These children fell through the cracks. AHCPR's research and collaborations like Friendly Access, that help us get care to these children and our hard-to-reach populations, are a solid investment for the Nation. I am pleased to be working with the chairman on legislation to reauthorize AHCPR and look forward to hearing from our witnesses this morning. Mr. BILIRAKIS. I thank the gentleman. The gentleman from Tennessee, Mr. Bryant. Mr. BRYANT. Thank you, Mr. Chairman. I have no formal statement, but I do want to thank both you and the ranking member Brown for the work you have done in this, and I understand that you will be introducing a bill reauthorizing the Agency for Health Care Policy and Research. There will be a companion bill filed in the Senate by my colleague from Tennessee, Senator Frist. I do have other commitments, as all members do; and I look forward to hearing the testimony of the panel here. If I am not here reviewing their testimony, I might lay out-I understand that there is an increase in your budget of $250 million, and certainly it would be welcome if you could explain the needs that are there— the justification for this increase-and certainly I will review that. I have some understanding of why, but, again, for the record I would appreciate, in my absence, if you would answer that question. Again, I thank the distinguished panelists that are coming, and again thank our chairman and ranking member. Mr. BILIRAKIS. Thank you. There appear not to be any other opening statements from the members of the subcommittee. They will be made a part of the record with unanimous consent. [Additional statements submitted for the record follow:] PREPARED STATEMENT OF HON. TOM BLILEY, CHAIRMAN, COMMITTEE ON COMMERCE Mr. Chairman, thank you for calling this hearing today. I am pleased to see so many distinguished leaders in health policy before us to share their views on the value of the Agency for Health Care Policy and Research, commonly referred to as AHCPR. It was a decade ago that Congress created this Agency to enhance the quality, appropriateness, and effectiveness of health care services and access to care. AHCPR plays a vital role in empowering consumers with the objective information they need to make informed health care purchasing decisions. Informed consumers are what drives the private market to provide quality services and products. The role of AHCPR as a nonpartisan agency able to provide evidence-based science to the market place is an invaluable resource from which all Americans will benefit. We take great interest in what AHCPR has to say about the best practices in medicine, and want to ensure that any legislation that moves through this Committee reflects the latest advances in science and medicine. In the prevention and early diagnosis of breast cancer, an area this Committee has given a great amount of work and attention, AHCPR recommended that both physicians and their patients receive written notification of the results of mammograms from the facilities performing them. When it came time to reauthorize the Mammography Quality Standards Act last year, we put the AHCPR recommendation into law. As of yesterday, all women will receive letters, or e-mail notices about test results as soon as possible, and are encouraged to follow-up with their physicians for conditions that cannot be detected by mammography. This Committee excels in reviewing public laws within its jurisdiction in light of advances such as electronic commerce. The Committee's approach to AHCPR demonstrates as well. We plan to seek authorizing legislation that would give the agency more direction in using new technologies including electronic commerce to enhance the latest medical breakthroughs in the public and private sectors, to help ensure that patients receive high quality, effective and appropriate care. Once again Mr. Chairman, I applaud you for holding a hearing on the reauthorization of AHCPR. I look forward to hearing from our distinguished panelists. PREPARED STATEMENT OF HON. GENE GREEN, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF TEXAS Thank you for scheduling today's hearing on the reauthorization of the Agency for Health Care Policy and Research. I believe their research efforts to improve the standards for care will be critical as this Committee and Congress moves forward with reforming different parts of the health care system. I hope today's hearing will lead to legislation that will update and strengthen the agency's core mission. Not only should the agency retain its research and grantmaking focus to improve knowledge about health quality and practices, but we must improve its role and ability to disseminate information to health care providers as well. The value of the research will only be as great as the number of providers who know about it and can apply those results in the examination and treatment rooms of America's doctors offices and hospitals. Clearly, there is a great potential upside to having an agency solely dedicated to improving and updating the "best practices" standards for care. However, I think it is even more important to recognize that these developed and widely accepted standards must serve as a model or a guide-not an inflexible rule. One thing I have learned about health care during my brief tenure on the Health and Environment Subcommittee is that there is no such thing as always or never. All health care providers must have some basic flexibility to model the care of a particular patient to the needs of that patient. I believe we have an opportunity to substantially improve the quality of health care by strengthening the agency to serve as a valuable resource and guide to doctors who can then apply the research results to the individual needs of their patients. |