Blog Post August 29, 2018 Unpacking the Omnibus Spending Measure’s Impact on Research in Academic Medical Centers Authors Keith Graff On March 23, 2018, Congress passed one of the largest research funding increases in nearly a decade (since the American Recovery and Reinvestment Act of 2009) through the omnibus spending measure. Since this time, many organizations have been noticeably aligning their research initiatives with the funding sources of the bill. Areas such as biomedical, energy, defense, and space all saw sizable increases. According to the AAAS, R&D spending in the FY 2018 omnibus increased almost 13% above FY 2017 estimated R&D. This includes an increase of approximately $8 billion for basic and applied research, with an overall increase of $83 billion for total research funding, excluding development and R&D facilities.A Closer Look at the Omnibus Spending MeasureWhile the increase in funding is significant on its own, let’s distill six of the significant changes caused by the legislation. 1. 5% Increase in Scientific Funding over FY 2017 Within the National Institutes of Health (NIH), almost every agency received a 5% increase above its FY 2017 funding. As one of the most supported organizations in the scientific community, the NIH received an approximately $3 billion increase to reach $37 billion in total funding—the largest since the 2009 stimulus. The bill also has a condition that requires NIH to continue reimbursing grantee research institutions for facilities and administrative costs.2. NIH Research Initiatives Receive Increases The bill provides additional substantial increases for other NIH research initiatives, including $400 million (an increase of $140 million) for Brain Research through Advancing Innovative Neurotechnologies (BRAIN) and $290 million (an increase of $60 million) for the All of Us Research Program (previously the Precision Medicine Initiative). 3. More Funding for Alzheimer’s Research and Opioids The Institute on Aging received $414 million in total funding for Alzheimer’s research, while institutes focusing on drug abuse (e.g., opioids addiction) received an additional $500 million.4. Sustaining the Cancer Moonshoot Initiative The bill also provides $300 million in total funding for the Cancer Moonshot initiative to accelerate cancer research with the goal of creating additional therapies for patients while also improving cancer detection.5. Funding Down Syndrome ResearchThe bill further supports multiyear funding that expands NIH support for research on Down syndrome/Trisomy 21 and related diseases and disorders.6. Additional Funding Recipients Other major research initiatives of funding include increases of $8 million for regenerative medicine, $40 million for research on developing a universal flu vaccine, $17 million for research on combating antibiotic-resistant bacteria, and $27 million for clinical and translational science awards.What Should Researchers in Academic Medical Centers Expect?The unprecedented boost in funding accelerates medical research, healthcare, and scientific innovation across the research community. Such increases will allow academic medical centers (AMCs) to use the funds to deepen their understanding of complex diseases. However, with competition for funding continuing to increase, AMCs will have to be strategic on how they prioritize their research initiatives. Principal investigators (PIs) will have to continue performing more innovative research while limiting unfunded research to create long-term strategic investments and partnerships. Furthermore, as the research community shifts to more efficient and lean operations, AMCs will be pressured to improve outcomes and lower costs while fostering progress in bench-to-bedside research. Organizations will need to develop strategies to align their research with the investments made through the omnibus. AMCs will also need to consider that the FY 2019 budget for research remains unknown due to projected spending caps and rumored cuts to agencies’ research budgets. Therefore, applying for grants and securing long-term research initiatives becomes imperative for PIs to plan for the future by aligning their research interests with the scientific investments where agencies plan to focus their additional funding. What Next?Translating basic and clinical scientific discoveries into practical applications will require AMCs to strengthen their infrastructure for translational and applied research—a critical bridge that is often lacking at these organizations. AMCs must also consider that future anticipated large shifts in research funding and current administration economic and noneconomic policies may weaken US capacity to recruit and train the next generation of scientists and engineers for a variety of jobs in industry, government, and academia.In an effort for AMCs to hedge against the instability of the funding environment and capacity to recruit, they must consider a redirection of research dollars toward translational research that can unite traditionally siloed efforts. Creating a culture of collaboration within an institution as well as externally is a factor in attracting industry partners, thereby strengthening the research enterprise. To accomplish this, AMCs must engage in research strategic planning to assess their current operations and funding investments in an effort to strategically align their goals with their future research model. Key questions that AMCs must ask during the strategic planning process include: What is the research vision of the organization?How does the research vision align with the core clinical growth strategies of the academic health system?What are the greatest strengths and weakness in the AMC’s research programs related to the basic, translational, and clinical sciences?What is the multiyear recruitment strategy, including institutional support/investment for start-up funding?What financial and infrastructure investments are necessary to advance research innovation and grow the research portfolio of an AMC? How do you define the tangible and intangible ROI to investors?What external partnerships are required to advance the strategic research mission of the AMC (e.g., affiliated providers, private industry partners)?By developing and executing on a prioritized research strategic plan, AMCs:Improve resources, build the infrastructure, and provide the financial support to advance the research mission across basic, translational, and clinical research.Establish a research environment of national prominence.Recruit, employ, and develop “world-class” research teams and researchers.Measure and reward research quality and productivity.Advance medical science through bench-to-bedside basic, translational, and clinical research.With historically unpredictable funding patterns coming from Congress, organizations’ abilities to consistently generate new science and technology in research fields that contribute to economic growth, national defense, and other national goals will remain challenging for AMCs. However, with a prioritized strategic plan for research, AMCs can significantly improve the quality and level of research performed while managing their costs in an increasingly complex research environment.