September 11: World Trade Center Health Programs Business Process Center Proposal and Subsequent Data Collection

From the September 11, 2001, attack on the World Trade Center (WTC) through fiscal year 2010, approximately $475 million in federal funds was made available for screening, monitoring, or treating responders for illnesses and conditions--such as asthma and depression--related to the WTC disaster. Within the Department of Health and Human Services, the Centers for Disease Control and Prevention's (CDC) National Institute for Occupational Safety and Health (NIOSH) awards funds to and oversees the programs that provide screening, monitoring, and treatment services for responders to the WTC attack. The two largest programs, which we refer to here as the WTC health programs, are the New York City Fire Department's (FDNY) WTC Medical Monitoring and Treatment Program, and the New York/New Jersey (NY/NJ) WTC Consortium. These programs began as screening and monitoring programs, tracking the health status of responders related to the WTC disaster. In December 2005, the Congress first appropriated funds that were specifically available for treatment programs for certain responders with health conditions related to the WTC disaster, and in fall 2006, NIOSH began awarding funds for outpatient and inpatient treatment. According to NIOSH, as of June 30, 2010, a total of about 44,000 responders had been screened by the WTC health programs; from July 1, 2009, to June 30, 2010, about 23,000 were monitored and about 13,000 were treated. In 2007 we reported that NIOSH did not have a reliable estimate of the cost of providing monitoring and treatment services because, in part, it did not have actual cost data from the programs. In addition, a task force established by the Secretary of Health and Human Services to assess the WTC health programs found that the programs lacked financial accountability measures and that NIOSH needed to collect reliable data necessary for program management and planning for the future. In 2007, NIOSH proposed establishing a business process center (BPC) to, among other things, provide such data.6 In October 2007, CDC published a solicitation for the purpose of awarding a BPC contract, and in November it held a conference in New York City for interested parties. However, on December 13, 2007, CDC canceled the solicitation. In light of issues raised about NIOSH's data collection efforts and the cancellation of the BPC solicitation, you requested that we report on NIOSH's efforts to collect data from the WTC health programs without the BPC. In this report, we describe (1) the purpose of NIOSH's proposed BPC with regard to data collection from the WTC health programs, and (2) any action NIOSH has taken since the cancellation of the BPC solicitation in an effort to improve data collection.