Lance's Corner

AHRQ Issues Regulatory Update

Jan 14, 2025

The Agency for Healthcare Research and Quality (AHRQ) has issued its weekly regulatory update, which can be read below.

AHRQ News Now banner updated 2023

January 14, 2025, Issue #944

Editor’s note: AHRQ News Now will not publish next week. Our next issue will publish Jan. 28.

AHRQ Stats: Median Length of Stay With an HAI Diagnosis
Among hospital inpatient stays without COVID-19 in 2021, the median length of stay with a healthcare-associated infection (HAI) was up to six times as long as stays without an HAI. Patients with cardiovascular disorders faced the greatest disparity, with stays lasting an average of 19 days with an HAI compared to an average of just three days without. (Source: AHRQ Healthcare Cost and Utilization Project Statistical Brief #313, Prevalence and Burden of Healthcare-Associated Infections (HAIs), 2016-2021.)

Today's Headlines:

Affordable Care Act Boosts Individual Health Insurance Enrollment and Stability

A new AHRQ study published in Health Affairs Scholar highlights how the Affordable Care Act strengthened the role of individual health insurance in the United States. In the study, researchers reviewed data from AHRQ’s Medical Expenditure Panel Survey and found that since the law’s implementation in 2014, the percentage of nonelderly adults with individual coverage has doubled, with nearly all the increase coming from those who were previously uninsured. In states that did not expand Medicaid, long-term individual coverage grew by 80 percent. The study also found that short-term individual coverage remained rare, indicating that the ACA primarily supported longer-lasting coverage. Access the abstract.


AHRQ Grantee Profile Highlights Work of Jennifer Anger To Provide Quality Urinary Incontinence Care

Jennifer Anger, M.D., M.P.H., a professor and vice chair of research in the Department of Urology at UC San Diego Health, has dedicated her career to improving the quality of care for underserved patients, particularly those who have developed a temporary or chronic loss of bladder control resulting in involuntary urine leak or urinary incontinence (UI). Over 25 million American adults experience UI, a condition that is two times as common in women as men. Various factors drive the development of UI, including the stresses of pregnancy and childbirth and the hormonal changes of menopause. Access Dr. Anger’s profile and the profiles of other AHRQ grantees.


Study Highlights Gaps in Questions That Could Enhance Diagnostic Safety

Most patient question guides focus on the later stages of diagnosis, such as treatment plans and outcomes, rather than critical early steps when diagnostic errors often occur, according to an AHRQ-funded review. Publishing in the Journal of Patient Safety, researchers analyzed more than 5,500 questions from 235 resources and found that most came from nonacademic sources and included around 23 questions per list. However, they found that these prompts rarely emphasized questions that could clarify symptoms or identify potential misdiagnoses early in the process. The authors said their study underscores the importance of empowering patients to ask relevant questions throughout the entire diagnostic process, not just at the end. They called for new, easy-to-use tools to help patients engage in their care and improve safety during diagnosis. Access the study.

New Insights on Treating Genitourinary Syndrome of Menopause

Three articles based on an AHRQ evidence review explored both hormonal and nonhormonal treatment options for genitourinary syndrome of menopause, a condition affecting women during and after menopause. The research concluded:
  • Vaginal estrogen, vaginal DHEA (dehydroepiandrosterone, a hormone produced by the adrenal glands), oral ospemifene and vaginal moisturizers may provide short-term relief from genitourinary syndrome of menopause symptoms. Limited evidence supported other treatments, such as lasers or testosterone. Access the abstract in the Annals of Internal Medicine.
  • A review of complementary and alternative medicine for genitourinary syndrome of menopause found that while many options are being explored, most studies are small and inconclusive. Access the abstract in the Annals of Internal Medicine.
  • An assessment of the benefits and harms of energy-based therapies (e.g., CO2 laser, Er:YAG laser and radiofrequency) for genitourinary syndrome of menopause found little to no difference in outcomes compared with sham treatments or vaginal estrogen. Access the abstract in Menopause.


Register Now: Feb. 10 Webinar Will Highlight Evidence on Advancing Rapid Response Systems and Opioid Stewardship

Registration is open for a webinar on Feb. 10 from 1 to 2 p.m. ET to highlight AHRQ evidence reports on advancing patient safety in key areas:

The webinar will be sponsored by AHRQ’s Patent Safety Network (PSNet), which provides access to patient safety resources, toolkits, opportunities for continuing education and trainings. The evidence reports are part of the agency’s Making Healthcare Safer Reports, a series developed to support patient safety improvement efforts across healthcare systems.


Highlights From AHRQ’s Patient Safety Network

AHRQ’s Patient Safety Network (PSNet) highlights journal articles, books and tools related to patient safety. Articles featured this week include:

Review additional new publications in PSNet’s current issue, including recent cases and commentaries and AHRQ’s WebM&M (Morbidity and Mortality Rounds on the Web).

AHRQ Recruiting Participants in Program To Advance Diagnostic Excellence

A new diagnostic safety improvement program is recruiting healthcare organizations to use and evaluate AHRQ resources including Calibrate Dx, Measure Dx and the Toolkit for Engaging Patients in Diagnostic Safety. Organizations that participate in AHRQ’s Implementing Diagnostic Excellence Across Systems (IDEAS) project will receive support and training to implement sustainable improvement. Continuing education credits and American Board of Medical Specialties Maintenance of Certification points will be available. Learn more, including how to participate in the project and register for a Jan. 16 webinar. Send questions to IDEASproject@rand.org.

AHRQ Seeks Input on Measures of Diagnostic Excellence

A Request for Information published by AHRQ requests public comments by Feb. 13 on the development of measures of diagnostic excellence that may be calculated using administrative data or electronic health record data. The purpose of diagnostic excellence measurement is to identify potential opportunities to improve the diagnostic process at a health system or geographic level. AHRQ welcomes comments on the importance and usability of existing measures and those that may be under development. Submit comments to qisupport@ahrq.hhs.gov with the subject line “Diagnostic Excellence Measurement.”

Toolkit Designed To Increase Climate Resilience in Healthcare

A new HHS toolkit provides evidence-based recommendations to increase healthcare organizations’ resilience to climate-related disasters and extreme weather events. Extreme weather events exacerbated by climate change can stress healthcare systems by damaging buildings, transportation infrastructure, power grids and supply chains. The Climate Resilience for Health Care Toolkit (CR4HC) includes case studies that illustrate real-world applications of recommended actions, plus links to additional tools and resources.

New Research and Evidence From AHRQ

AHRQ in the Professional Literature

Comparative analysis of machine learning versus traditional method for early detection of parental depression symptoms in the NICU. Sadjadpour F, Hosseinichimeh N, Abedi V, et al. Front Public Health. 2024 May 28;12:1380034. Access the abstract on PubMed®.

The high prevalence and complexity of over-the-counter medication misuse in older adults. Chladek JS, Gilson AM, Stone JA, et al. Innov Aging. 2024 Sep 10;8(10):igae083. Access the abstract on PubMed®.

Precision emergency medicine. Strehlow M, Alvarez A, Blomkalns AL, et al. Acad Emerg Med. 2024 Nov;31(11):1150-64. Epub 2024 Jun 28. Access the abstract on PubMed®.

Use of pulmonary rehabilitation after chronic obstructive pulmonary disease hospitalization: an analysis of statewide patient and hospital data. Fu WW, Hassett KP, Labaki WW, et al. Ann Am Thorac Soc. 2024 Dec;21(12):1698-1705. Access the abstract on PubMed®.

Facilitators and barriers to integrating patient-generated blood pressure data into primary care EHR workflows. Canfield SM, Koopman RJ. Appl Clin Inform. 2024 Oct;15(5):942-51. Epub 2024 Nov 13. Access the abstract on PubMed®.

Community-acquired pneumonia diagnosis following emergency department visits for respiratory illness. Geanacopoulos AT, Amirault JP, Michelson KA, et al. Clin Pediatr. 2025 Jan;64(1):83-90. Epub 2024 May 17. Access the abstract on PubMed®.

Children with chronic health conditions and social needs: investigating outcomes to drive health system improvements. McKenna KJ, Fiori KP, Chambers EC. Clin Pediatr. 2024 Dec;63(12):1698-1707. Epub 2024 Mar 30. Access the abstract on PubMed®.

A randomized-controlled pilot trial of telemedicine-delivered cognitive-behavioral therapy tailored for interstitial cystitis/bladder pain syndrome. McKernan LC, McGonigle T, Vandekar SN, et al. Pain. 2024 Aug;165(8):1748-60. Epub 2024 Feb 27. Access the abstract on PubMed®.

Contact Information
For comments or questions about AHRQ News Now, contact Bruce Seeman,
(301) 427-1998 or
Bruce.Seeman@ahrq.hhs.gov.

 

USDOL Issues Comprehensive Employer Guidance on Long COVID

The United States Department of Labor (USDOL) has issued a comprehensive set of resources that can be accessed below for employers on dealing with Long COVID.

Supporting Employees with Long COVID: A Guide for Employers

The “Supporting Employees with Long COVID” guide from the USDOL-funded Employer Assistance and Resource Network on Disability Inclusion (EARN) and Job Accommodation Network (JAN) addresses the basics of Long COVID, including its intersection with mental health, and common workplace supports for different symptoms.  It also explores employers’ responsibilities to provide reasonable accommodations and answers frequently asked questions about Long COVID and employment, including inquiries related to telework and leave.

Download the guide

Accommodation and Compliance: Long COVID

The Long COVID Accommodation and Compliance webpage from the USDOL-funded Job Accommodation Network (JAN) helps employers and employees understand strategies for supporting workers with Long COVID.  Topics include Long COVID in the context of disability under the Americans with Disabilities Act (ADA), specific accommodation ideas based on limitations or work-related functions, common situations and solutions, and questions to consider when identifying effective accommodations for employees with Long COVID.  Find this and other Long COVID resources from JAN, below:

Long COVID, Disability and Underserved Communities: Recommendations for Employers

The research-to-practice brief “Long COVID, Disability and Underserved Communities” synthesizes an extensive review of documents, literature and data sources, conducted by the USDOL-funded Employer Assistance and Resource Network on Disability Inclusion (EARN) on the impact of Long COVID on employment, with a focus on demographic differences.  It also outlines recommended actions organizations can take to create a supportive and inclusive workplace culture for people with Long COVID, especially those with disabilities who belong to other historically underserved groups.

Read the brief

Long COVID and Disability Accommodations in the Workplace

The policy brief “Long COVID and Disability Accommodations in the Workplace” explores Long COVID’s impact on the workforce and provides examples of policy actions different states are taking to help affected people remain at work or return when ready.  It was developed by the National Conference of State Legislatures (NCSL) as part of its involvement in USDOL’s State Exchange on Employment and Disability (SEED) initiative.

Download the policy brief

Understanding and Addressing the Workplace Challenges Related to Long COVID

The report “Understanding and Addressing the Workplace Challenges Related to Long COVID” summarizes key themes and takeaways from an ePolicyWorks national online dialogue through which members of the public were invited to share their experiences and insights regarding workplace challenges posed by Long COVID.  The dialogue took place during summer 2022 and was hosted by USDOL and its agencies in collaboration with the Centers for Disease Control and Prevention and the U.S. Surgeon General.

Download the report

Working with Long COVID

The USDOL-published “Working with Long COVID” fact sheet shares strategies for supporting workers with Long COVID, including accommodations for common symptoms and resources for further guidance and assistance with specific situations.

Download the fact sheet

COVID-19: Long-Term Symptoms

This USDOL motion graphic informs workers with Long COVID that they may be entitled to temporary or long-term supports to help them stay on the job or return to work when ready, and shares where they can find related assistance.

Watch the motion graphic

A Personal Story of Long COVID and Disability Disclosure

In the podcast “A Personal Story of Long COVID and Disability Disclosure,” Pam Bingham, senior program manager for Intuit’s Diversity, Equity and Inclusion in Tech team, shares her personal experience of navigating Long COVID symptoms at work.  The segment was produced by the USDOL-funded Partnership on Employment and Accessible Technology (PEAT) as part of its ongoing “Future of Work” podcast series.

Listen to the podcast

HHS OIG Issues Annual Report on State MFCUs

Per the notice below, the Office of the Inspector General (OIG) of the United States Department of Health and Human Services (HHS) has issued its annual report on the performance of state Medicaid Fraud Control Units (MFCUs).

Medicaid Fraud Control Units Fiscal Year 2023 Annual Report (OEI-09-24-00200) 

Medicaid Fraud Control Units (MFCUs) investigate and prosecute Medicaid provider fraud and patient abuse or neglect. OIG is the Federal agency that oversees and annually approves federal funding for MFCUs through a recertification process. This new report analyzed the statistical data on annual case outcomes—such as convictions, civil settlements and judgments, and recoveries—that the 53 MFCUs submitted for Fiscal Year 2023.  New York data is as follows:

Outcomes

  • Investigations1 - 556
  • Indicted/Charged - 9
  • Convictions - 8
  • Civil Settlements/Judgments - 28
  • Recoveries2 - $73,204,518

Resources

  • MFCU Expenditures3 - $55,964,293
  • Staff on Board4 - 257

1Investigations are defined as the total number of open investigations at the end of the fiscal year.

2Recoveries are defined as the amount of money that defendants are required to pay as a result of a settlement, judgment, or prefiling settlement in criminal and civil cases and may not reflect actual collections.  Recoveries may involve cases that include participation by other Federal and State agencies.

3MFCU and Medicaid Expenditures include both State and Federal expenditures.

4Staff on Board is defined as the total number of staff employed by the Unit at the end of the fiscal year.

Read the Full Report

View the Statistical Chart

Engage with the Interactive Map

GAO Issues Report on Medicaid Managed Care Service Denials and Appeal Outcomes

The United States Government Accountability Office (GAO) has issued a report on federal use of state data on Medicaid managed care service denials and appeal outcomes.  GAO found that federal oversight is limited because it doesn't require states to report on Medicaid managed care service denials or appeal outcomes and there has not been much progress on plans to analyze and make the data publicly available.  To read the GAO report on federal use of state data on Medicaid managed care service denials and appeal outcomes, use the first link below.  To read GAO highlights of the report on federal use of state data on Medicaid managed care service denials and appeal outcomes, use the second link below.
https://www.gao.gov/assets/d24106627.pdf  (GAO report on federal use of state data on Medicaid managed care service denials and appeal outcomes)
https://www.gao.gov/assets/d24106627_high.pdf  (GAO highlights on federal use of state data on Medicaid managed care service denials and appeal outcomes)

CMS Issues Latest Medicare Regulatory Activities Update

The Centers for Medicare and Medicaid Services (CMS) has issued its latest update on its regulatory activities in the Medicare program.  While dentistry is only minimally connected to the Medicare program, Medicare drives the majority of health care policies and insurance reimbursement policies throughout the country.  Therefore, it always pays to keep a close eye on what CMS is doing in Medicare.  To read the latest CMS update on its regulatory activities in Medicare, use the link below.
https://www.cms.gov/training-education/medicare-learning-network/newsletter/2024-03-14-mlnc