Lance's Corner

AHRQ Issues Regulatory Update

Oct 15, 2024

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

October 15, 2024, Issue #933

AHRQ Stats: In-Hospital Sepsis Mortality by Hospital Type

The in-hospital mortality rate for sepsis stays that did not involve COVID-19 increased by 37.3 percent between 2019 and 2021 at private, for-profit rural hospitals. Mortality rates at private, not-for-profit, and public non-federal rural hospitals did not change significantly during the same time frame. (Source: AHRQ Healthcare Cost and Utilization Project Statistical Brief #308, Rural and Urban Hospital Differences in Inpatient Stays Involving Sepsis, 2019 and 2021.)

Today's Headlines:

AHRQ Views: Taking Needed Steps To Strengthen Primary Care

AHRQ’s growing effort to address steep challenges in the delivery of high-quality primary care is the subject of a new AHRQ Views blog post. In the United States today, primary care clinicians are battling burnout, and patients are losing access to high-quality coordinated, comprehensive and continuous care. As noted during National Primary Care Week, AHRQ continues its broad support for primary care improvement, not only with resources for clinical teams, but with evidence for policymakers to make informed decisions. A report from AHRQ’s National Center for Excellence in Primary Care Research (NCEPCR) describes recent investments in primary care research. Two current funding opportunities—one soliciting large project proposals (R01), another for small research grants (R03)—are aimed at improving patient outcomes and advancing health equity. Access the blog post by Aimee Eden, Ph.D., M.P.H., acting director of NCEPCR, and Tess Miller, Dr.PH., director of AHRQ’s Center for Evidence and Practice Improvement. To receive all blog posts, submit your email address.

New Project Offers Help Implementing AHRQ Resources for Diagnostic Excellence

Dx safetyA new diagnostic safety improvement project 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) initiative 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 an Oct. 29 informational webinar, the first of four. Send questions to IDEASproject@rand.org.

Researchers Recommend Strategic Research Agenda for Precision Medicine in Emergency Medicine Education and Training

ED medicineAHRQ-supported researchers recommend a strategic research agenda for health professionals and educators to create a training framework to integrate precision medicine into emergency medicine. In the first of two articles published in Academic Emergency Medicine, the authors presented the findings of a national consensus conference convened to define precision emergency medicine, develop an evidence-based research agenda and identify educational gaps. Conference activities led to a definition of precision emergency medicine—using information technology to deliver acute care effectively—and the development of key research questions for a 10-year precision emergency medicine research agenda. In the second article, researchers identified key drivers of integrating precision medicine into clinical practice. A third article, published in Academic Emergency Medicine Education & Training, presented the eight education research questions that reflect challenges and opportunities for precision medicine education in emergency medicine.

Grantee Focuses on Translating Evidence-Based Research Into Practice

grnateeAHRQ grantee Ralph Gonzales, M.D., M.S.P.H., is working to develop career and scientific training programs to accelerate learning health systems research and implementation science. With agency funding, Dr. Gonzales, professor of medicine epidemiology and biostatistics, and health policy at the University of California San Francisco, School of Medicine, fast tracked his translational research work and put evidence into practice. He has played a significant role in national and global efforts to combat antimicrobial resistance by improving antibiotic prescribing. Dr. Gonzales is also the Associate Dean for Clinical Innovation at the University of California San Francisco, School of Medicine and Chief Innovation Officer at the UCSF Health. Access Dr. Gonzales' profile and profiles of other AHRQ grantees.

Updated Chartbook Highlights New Maternal Health Data

chartbookAn updated Maternal Health Chartbook from AHRQ provides data from 2010 through 2019 on key trends in delivery stays with coexisting conditions such as diabetes, hypertension, mental health and substance use disorders, and severe maternal morbidity. Key findings include hypertension as the most common co-existing condition among deliveries. Each of the selected maternal health conditions was most common in delivery stays for Black non-Hispanic women, and for women aged 35–55 years. Access the chartbook and other topical reports from AHRQ's Healthcare Cost and Utilization Project.

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).

Article Reviews 20 Years of Accomplishments From AHRQ’s Digital Healthcare Research Program

A new article in the Journal of the American Medical Informatics Association reflects on the achievements of the AHRQ Digital Healthcare Research Program on the occasion of its 20th anniversary. The article, co-authored by AHRQ leaders including Director Robert Otto Valdez, Ph.D., M.H.S.A., evaluates the program’s impact on U.S. healthcare quality and safety and outlines current and future priorities for digital healthcare research and innovation. It reviews key milestones in AHRQ’s digital healthcare initiatives, including its founding and its advances in telehealthcare and clinical decision support. It highlights AHRQ’s contributions to advancing technology integration in healthcare, promoting patient safety and addressing equity gaps. The article also examines the evolving role of artificial intelligence in healthcare delivery. Access the article.

New Research and Evidence From AHRQ

AHRQ Issues Guidance to Grantees Affected by Hurricanes

A special reminder issued by AHRQ provides policy updates on grant activities affected by hurricanes Helene and Milton. The reminder acknowledges the storms may have interrupted work and offers guidance on how to notify AHRQ about delays in grant applications and reports.

AHRQ in the Professional Literature

Enhancing qualitative and quantitative data linkages in complex mixed methods designs: illustrations from a multi-phase healthcare delivery study. Chandanabhumma PP, Swaminathan S, Cabrera LM, et al. J Mix Methods Res. 2024 Jul;18(3):235-46. Epub 2024 Jun 6. Access the abstract on PubMed®.

A coproduced family reporting intervention to improve safety surveillance and reduce disparities. Khan A, Baird J, Mauskar S, et al. Pediatrics. 2024 Oct 1;154(4). Access the abstract on PubMed®.

Implementing a staff-led smoking cessation intervention in a diverse safety-net rheumatology clinic: a pre-post scalability study in a low-resource setting. Brandt J, Ramly E, Lim SS, et al. Arthritis Care Res. 2024 Sep;76(9):1342-50. Epub 2024 Jun 3. Access the abstract on PubMed®.

Learner evaluation of an immersive virtual reality mass casualty incident simulator for triage training. Way DP, Panchal AR, Price A, et al. BMC Digit Health. 2024;2(1):56. Epub 2024 Sep 16. Access the abstract on PubMed®.

Medical visits and mortality among dementia patients during the COVID-19 pandemic compared to rates predicted from 2019. Ghosh K, Stewart ST, Raghunathan T, et al. BMC Geriatr. 2024 Sep 2;24(1):727. Access the abstract on PubMed®.

Diagnostic error in mental health: a review. Bradford A, Meyer AND, Khan S, et al. BMJ Qual Saf. 2024 Sep 19;33(10):663-72. Access the abstract on PubMed®.

Adverse childhood experiences: health care utilization and expenditures in adulthood. Selden TM, Bernard DM, Decker SL, et al. Health Aff. 2024 Aug;43(8):1117-27. Epub 2024 Jul 24. Access the abstract on PubMed®.

Postpartum menstrual equity: video and audio analysis of vaginal bleeding counseling during postpartum inpatient care at a southeastern US tertiary hospital. Darivemula SM, Massengale KE, Montiel C, et al. Womens Health. 2024 Jan-Dec;20:17455057241274897. 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