fall09stimulus

Researchers Tap into a New Source of Government Dollars

[Fall 2009]

Scientists at the Harvard School of Public Health and around the country are hoping that a busy spring will pay off in an ample fall harvest of new research funding. The bounty could come courtesy of the American Recovery and Reinvestment Act (ARRA), more commonly known as the federal stimulus package. Flat funded for the past five years, the National Institutes of Health (NIH) received $10.4 billion as part of the $787 billion package, passed by Congress and signed into law by President Barack Obama on February 17. Of that, $8.2 billion will flow to scientific research. Faculty members from every department at HSPH quickly pulled together proposals this spring totaling more than $72 million.

Under the stimulus package’s mandate, the NIH’s 27 centers and institutes can distribute the money through an array of grant programs, but will collectively support projects that stimulate the economy, create or retain jobs, and have the potential for making scientific progress in two years. The funding is divided between promising new projects, previously submitted grants that were well reviewed but not funded due to budget constraints, and supplements to grants already under way. Funds were being awarded as the Review went to press.

Funding in all of the NIH’s stimulus grant programs comes with more stringent reporting requirements than usual. As with all ARRA funds, there will be heightened scrutiny from public and government auditors. Researchers will be required to submit financial and scientific progress reports quarterly, rather than annually. And the government reserves the right to rescind funding if it’s not being spent quickly enough. Scientific progress reports will be posted to ARRA’s website.

Among the first faculty members at the School to receive ARRA funding is I-Min Lee, associate professor of epidemiology. Her study examining the effects of physical activity on cancer patients originally fell below the NIH funding cut-off, but was given new life when more resources became available.

Like many other researchers, Lee wonders what will happen to the research generated by ARRA when the funding runs out in two years. “Everything goes through a cycle so we just keep our fingers crossed.”

Amy Roeder is the development communications coordinator in the Office for External Relations at HSPH.

$19 BILLION FOR HEALTH I.T.
The stimulus package also seeks to promote the adoption of electronic medical records through the Health Information Technology for Economic and Clinical Health (HITECH) Act. Under the act, $19 billion will be distributed through Medicare and Medicaid payment incentives to physicians and hospitals using certified electronic health information systems in a “meaningful”-but as yet undefined-way beginning in 2011 and continuing for the next five years.

“This mechanism is smart,” says Ashish Jha, associate professor of health policy and management, who published a study in March on the slow adoption of electronic health records. “If Congress had created a grant mechanism, adoption would be slower. No one is going to want to buy a system now if the government is going to pay for it later. And this way it doesn’t penalize those who have already purchased systems.”

The program will provide enough money to cover the systems used in most doctors’ offices, although probably not enough for most hospitals, Jha says. He is optimistic that the program will spawn adoption of electronic health records, which will eventually lead to health care quality improvements and cost reductions.

For more on electronic health records, read the Harvard Public Health Review’s “Doctoring in a Digital World“. Learn more about Jha’s study at: http://www.hsph.harvard.edu/news/press-releases/us-hospitals-extremely-slow-to-adopt-electronic-health-records/.

$1.1 BILLION FOR COMPARATIVE EFFECTIVENESS RESEARCH
With health care costs now exceeding 15 percent of Gross Domestic Product (GDP), the Obama administration and Congress are taking another look at comparative effectiveness research, which weighs the medical benefits, harms, and costs of treatment alternatives—such as watchful waiting, surgery, or radiation for prostate cancer.

ARRA funds totaling $1.1 billion will be distributed between several government agencies, including the Department of Health and Human Services, which will receive recommendations on setting research priorities from a new 15-member council. Researchers will then be able to apply for funding, which will carry ARRA’s stringent reporting requirements.

Milton Weinstein, Henry J. Kaiser Professor of Health Policy and Management, is cautiously optimistic that this new effort will produce results. But he’s concerned that the funding effort does not explicitly mention cost-effectiveness analysis, a component of the field’s research agenda used to measure the value of medical treatment. “It will be necessary for public and private payers to address cost-effectiveness to contain costs,” he says. “The more effective treatment for a particular medical condition is often the more expensive one, which means that it is possible to contain costs only by allocating resources more wisely.” For example, spending money on treating high blood pressure in a large number of patients would yield greater health improvement—gains in life expectancy and quality of life—than spending the same amount of money on lung transplants for only a few people.

Weinstein does not believe that the new legislation will result in mandates for doctors and rationing of care, as some opponents fear. But it remains to be seen, he says, whether Medicare and private insurers will take comparative effectiveness research findings into account in their coverage and reimbursement decisions.

What is now known as comparative effectiveness research was developed at HSPH’s Center for the Analysis of Health Practices in the 1970s, under the leadership of former dean Howard Hiatt.