NIH's ‘forward-funding scheme'

Politico

a day ago

FOLLOW THE MONEY
NIH Director Jay Bhattacharya and Sen. Tammy Baldwin (D-Wis.) sparred over a proposal in the White House budget plan to give more grant recipients their money up front during a Senate Appropriations panel hearing on the agency's budget Tuesday.
At the hearing, Baldwin asked Bhattacharya to explain the proposal's 'forward-funding scheme,' which she said would result in even deeper cuts to the NIH than the 40 percent cut proposed by the White House.
By the numbers: Typically, NIH research grants are awarded for multiple years and funded incrementally. In the case of a $1 million award, for example, which might normally be paid out over four years with $250,000 paid out yearly, the full $1 million would now be paid in year one.
'It means billions will effectively be put in escrow and won't actually be spent on research for a number of years to come,' Baldwin said at the hearing.
It would also mean awarding fewer new grants.
The fiscal 2026 budget proposal estimates that NIH research grant awards would drop from 42,143 in 2024, to 38,069 in 2025, to 27,477 in 2026. First-time awards are estimated to fall from 10,086 in 2024, to 6,095 in 2025, to 4,312 in 2026.
Big picture: The change could deter grant applicants, said Erik Fatemi, a principal at lobbying firm Cornerstone Government Affairs and former Democratic staffer on the Senate Appropriations subcommittee with authority over health care spending.
'When the success rate goes down to 7 percent, the odds are so low of winning an award that many researchers will ask themselves: 'Why even bother?'' Fatemi said.
Baldwin vs. Bhattacharya: 'It clearly shows the administration's intent,' Baldwin told Bhattacharya. 'You can cut $7 billion and dramatically reduce the number of NIH awards next year on your own, unless Congress steps in to stop that.'
Bhattacharya stood behind the proposal.
'In the long run, what it does is allow you to spend more money and have more flexibility for new research projects,' he said.
'That's funny math,' remarked Baldwin, a college math major, to which Bhattacharya shot back: 'That's just the math. I'm an economist also.'
When asked about the exchange, Baldwin told Erin: 'I can't get into his head to see how he can twist the facts around that much. But again, it's funny math if he's trying to insist that it won't negatively impact their research enterprise.'
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FORWARD THINKING
POLITICO EXCLUSIVE: The Joint Commission, an Illinois-based nonprofit that accredits health care organizations, and the Coalition for Health AI, an alliance of health systems and tech companies, are teaming up to certify that hospitals using AI are doing so responsibly, Ruth reported yesterday.
Through partnering with CHAI, the Joint Commission plans to launch tools, best practices, as well as certifications that accelerate responsible use of AI. The Joint Commission will lean on CHAI for technical expertise. The certification program is expected this fall.
The new AI standards will focus on ensuring AI is implemented correctly and managed safely. They will also offer a framework for assessing the technology's impacts. Dr. Jonathan B. Perlin, CEO of the Joint Commission, said the standards will cover AI's use in medical care as well as operational functions.
Why it matters: Health systems are increasingly interested in using AI and adoption of the technology is expected to explode. As health care continues to get more expensive and the supply of physicians grows short, health systems are looking to AI to fill in the gaps.
'If we can reduce some of the administrative burden through [large language models], the sitting on hold, prior authorizations, documentation, if we can remove those things to allow providers to do the work that providers are best at,' said Matt Kull, chief digital officer at Inova, a North Carolina-based health system. 'I think we're going to do a lot for making people feel better in this country.'
But, but, but: There are not agreed upon standards for how AI should be implemented, managed, validated, or monitored across the industry. And health systems technology infrastructure, resources, and patient populations vary widely, making it especially difficult to come to a consensus on the issue.
How it could work: The Joint Commission already accredits large health systems, clinics, and hospitals. And it works with regulators, like the Centers for Medicare and Medicaid Services, which uses the Joint Commission to determine whether an institution meets or exceeds Medicare and Medicaid requirements for reimbursement.
As far as AI is concerned, the Joint Commission has already launched a responsible-use-of-health-data certification, which lays the groundwork for AI's adoption in medicine by ensuring data is properly de-identified and safeguarded.