American College of Physicians: Internal Medicine — Doctors for Adults ®

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After a hectic year at AHCPR, top administrator resigns

From the January 1997ACP Observer, copyright 1997 by the American College of Physicians.

By Jennifer Fisher Wilson

Announcing that he was pleased to have led the Agency for Health Care Policy and Research (AHCPR) at a critical time in its history, Clifton R. Gaus, MD, stepped down as the agency's administrator last month after a tumultuous year of politics, negotiations and restructuring.

Dr. Gaus' resignation came at the close of a hectic year for the AHCPR, a year in which the administrator led an effort to save the agency from elimination when the government threatened to cut its budget. Shortly before Dr. Gaus announced his intention to return to the private sector, AHCPR's budget was actually increased to $144 million for the 1997 fiscal year, up from $125 million in 1996 and closer to the 1995 budget of $160 million.

"Now that the goals I set forth for AHCPR have been achieved through the hard work and dedication of its staff, it is time for me to return to the private sector," Dr. Gaus said. He said he plans to remain with the agency until the Department of Health and Human Services names his replacement.

The seven-year-old agency gained notoriety after publishing several controversial guidelines; one on cataract treatment, for example, that was viewed by some clinicians as threatening to their income received particular attention. And while guidelines work is only a small part of the agency's mission, it spurred a strong anti-AHCPR lobby amid the 1996 year's budget crisis and led to proposals to cut the agency's budget completely. Support from groups like Friends of the AHCPR and ACP helped save the agency, but it still faced a cut of more than $50 million for the current fiscal year and pressure to change how it develops guidelines.

The controversy spawned an AHCPR decision to stop developing guidelines and instead focus on producing the scientific basis for private and public sector organizations to develop their own guidelines.

"The agency will assess the science," explained Jennifer Rotchford, coordinator for Friends of the AHCPR. "The actual judgment or policy will depend on who tailors the research to suit their needs."

Sheldon Greenfield, FACP, director of the Primary Care Outcomes Research Institute at the New England Medical Center in Boston, said AHCPR's decision to stop creating guidelines was a good one. "It was ill-advised from the beginning, creating too much controversy and little evidence that the guidelines would work," he said. "It's not as if their guidelines were the final word, and they brought a huge problem for clinicians."

Herbert S. Waxman, FACP, Senior Vice President of Education for the College, blamed much of the backlash the agency received on its expensive and lengthy guideline development process. "The guidelines didn't have an impact proportionate to the investment," he said. "What they're doing now seems to be a sensible move."

Currently, the AHCPR is soliciting proposals to fund up to eight evidence-based practice centers that will produce evidence reports and technology assessments. It has also requested nominations for topics of study at these centers. A call for topics was published in the Dec. 23 issue of the Federal Register.

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