Thursday, May 11, 2017

Don't Know Much About Health Care, Health Care Research or Quality - Yet Appointed New Director of Agency for Healthcare Research and Quality (AHRQ)!?

The Agency for Healthcare Research and Quality (AHRQ) is a US government agency, part of the Department of Health and Human Services (DHHS), whose mission is to

produce evidence to make health care safer, higher quality, more accessible, equitable, and affordable, and to work within the U.S. Department of Health and Human Services and with other partners to make sure that the evidence is understood and used.

It is known for providing grants for sophisticated clinical and health services research, some that uses complex statistical methods, often informed by the the precepts of evidence-based medicine and medical decision making.  It also provides resources for related professional education, and has worked to improve both professional and patient understanding of such evidence to inform health care decision making.  (Disclosure: I have served on two study sections, that is, grant review committees, for AHRQ, and reviewed numerous additional grants on an ad hoc basis.)

Unfortunately, AHRQ has historically had a very small budget for a federal health care research agency with potentially such  wide-ranging scope of interest.   As discussed, for example, by Gail Wilensky in 2015, in 1995 the agency aroused the ire of some politically powerful back surgeons for questioning the value to patients of some of the procedures they advocated.  Of course, if one actively tries to study "safety, quality, and efficiency of delivering health care in different health care settings, as well as on the use of health information technology in achieving these goals," one may produce results that offend certain practitioners, health care provider organizers, or health care corporations.  So the agency has been under constant legislative threat of budget reductions or even closure.

Despite that, IMHO, the agency has managed to attract scientifically knowledgeable and dedicated staff, and has had a string of renowned directors, most recently Dr Andrew Bindman, and previously Prof Richard Kronick, Dr Carolyn Clancy, and Dr John Eisenberg, three very distinguished academic physicians and one equally distinguished academic health services researcher.

That was then....  Yesterday, rather abruptly a story appeared in Modern Healthcare about the Trump regime's new appointment to lead the AHRQ, Mr Gopal Khanna.  His background was described thus:

Khanna was most recently director since June 2015 of the Illinois Healthcare and Human Services Innovation Incubator, an initiative spearheaded by Gov. Bruce Rauner, a Republican. In that role, Khanna collaborated with other state and federal health agencies to aggregate patient data to better understand the population and efficiency of care.

Prior to that, Khanna was the state of Minnesota's first chief information officer. He also held various positions within George W. Bush's administration.
His official bio which suddenly appeared on the AHRQ website stated he

specializes in data-driven strategies to improve organizational performance.

Also, in his most recent job, he

led a cross-functional team to build a secure data pool with data from Illinois' HHS agencies and other government entities to provide a 360-degree view of each person and family who receives State services to provide efficient program management, strategic policymaking, and customer-centric services delivery.

While he may have worked recently with patient data, I cannot find any evidence that his knowledge of that data went beyond how to handle it within IT systems. Note that his official Agency for Healthcare Research and Quality bio says nothing about health care, health care research, or health care quality per se.   

In a 2009 Interview by IT World, Mr Khanna described a long career in information technology, including positions with the National Council on Compensation Insurance, the American Hardware Insurance Group, and International Technology Consultants.  He served in President George W Bush's administration as CIO/ CFO of the Peace Corps, and then of the Office of Administration.  His highest academic degree appears to be an MBA.

I must admit he seems to be a hard working gentleman who has had recent dedication to public service.

That said, I cannot find any evidence that he has any knowledge or training in health care, health care/ health services research, or health care quality.  I cannot find any evidence that he has any previous knowledge about any aspect of the health care research and quality that AHRQ is supposed to foster.

However nice and dedicated he may be, it borders on insulting to those of us who have labored to promote high quality health care/ health services research to promote safe, effective, accessible, affordable health care for him to be the successor to Doctors Bindman, Clancy, Eisenberg, and Professor Kronick.  He appears no more qualified to run the AHRQ than I do to captain an aircraft carrier.

Is this some sardonic joke by the ultimate perpetrators of managerialism, the notion that every human organization ought to be run by and ultimately for the the benefit of professional "managers" who know nothing about the goals and values of particular organizations? 

The AHRQ is only one small, but I would argue important and high-quality piece of the US health care puzzle.  This appointment by the Trump regime is only one small appointment in the midst of much bigger and more more controversial, or outrageous appointments, and terminations.  However, it is in wheel house, and I do believe I can add this to evidence that at best, Trump health care policy appears to be mired in confusion, and at worst, risks the destruction of US health care.  


Matthew Holt said...

How was Trump supposed to find a health services researcher who was a Republican who would also take the job, especially as AHRQ will probably be dismantled in the next year or 2?

You're just not cynical enough, Roy!

3h care said...

Heard a lot about Trump's health policies and his take on Obamacare.
Why is he imposing all kind of chaotic changes in the system? Is he really a well wisher of Americans?

Initial Truth said...

Wait: they 1) actually filled the vacancy; 2) filled it with someone who did not hate health services research and was committed to abolishing the agency; 3) seems to be pretty smart and is linked to moderate GOP governors.

Remember, Ted Cruz went to Harvard and Princeton and was a radical foe of intellectualism. Be grateful.

Roy M. Poses MD said...

Initial Truth,

You seem to have set the bar pretty low.

Yang Kuo said...

Is he really a well wisher of Americans?

thanks for sharing...

Medylife said...

The ObamaCare is indeed under threat with the new Govt in Place in the United States.Trump had made it very clear from the very onset that he is totally opposed to Obama Health Care Reforms.But he has not been able to come out with a concrete plan as to how he will go about doing it and the alternatives that will be presented for the people of United States