Lance's Corner

AHRQ Issues Regulatory Update

Oct 29, 2024

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

October 29, 2024, Issue #935

AHRQ Stats: Long COVID Rates by Geographic Area

As of spring 2023, 19.7 percent of adults with a prior COVID-19 infection living outside of metropolitan statistical areas reported having experienced Long COVID, compared with 12.7 percent of those living in a metropolitan statistical area. (Source: AHRQ Medical Expenditure Panel Survey Statistical Brief #557, Prevalence of Long COVID Among Adults Who Have Ever Had COVID-19, by Selected Demographic and Socioeconomic Characteristics, U.S. Civilian Noninstitutionalized Population, Spring 2023.)

Today's Headlines:

AHRQ Views: Healthcare’s Next Technological Frontier—21st Century Artificial Intelligence

AHRQ’s support for research to advance artificial intelligence (AI) as a revolutionary force in healthcare delivery is the subject of a new AHRQ Views blog post. Enthusiasm has been high in response to a recent AHRQ Notice of Funding Opportunity for grant proposals to leverage AI to improve patient safety. This funding opportunity coincided with the 20th anniversary of AHRQ’s Digital Healthcare Research Program, which has helped to advance technologies like clinical decision support and telehealthcare. AHRQ has funded or is funding more than 50 research projects with an AI component, but the great promise of AI will only be achieved when current challenges are addressed, according to blog authors. Access the blog post, authored by AHRQ Director Robert Otto Valdez, Ph.D., M.H.S.A.; Chris Dymek, Ed.D., director of AHRQ’s Digital Healthcare Research Division; and Kevin Chaney, M.G.S., the division’s senior advisor for dissemination and innovation. To receive all blog posts, submit your email address.

Research Series Links Low Nurse Staffing to Workplace Quality

nursesWorkplace challenges are significant contributors to the nation’s hospital nursing staffing shortages, according to a series of AHRQ-funded studies. Authors asserted that addressing these concerns could substantially reduce nursing staff losses. Among the findings:
  • Before the COVID-19 pandemic, 69 percent of nurses lacked confidence in hospital leadership – a percentage that rose to 78 percent after the pandemic began. (Nursing Outlook)
  • Emotional exhaustion, insufficient staffing and family obligations were among the most significant reasons nurses quit their jobs. (JAMA Network Open)
  • High patient volume with limited staff support leading to unanswered patient calls contributed to nurses not recommending their workplace to other clinicians. (JAMA Network Open)
  • Each additional patient in the average nurse's workload before the pandemic was linked to a 20 percent increase in the chance of patient death. (International Journal of Nursing Studies)
  • Increasing the quality of emergency department working conditions for nurses from “poor” to “mixed” or “mixed” to “better” significantly decreased average lengths of stay. (Journal of Emergency Nursing)
  • Nurses who reported being overwhelmed by alarms faced 2.47 times greater odds of burnout. (Nursing Outlook)

Register Now for Nov. 14 Webinar on Implementing Urinary Incontinence Management in Primary Care

urinary A webinar on Nov. 14 from 2:30 to 4 p.m. ET will explore real-world case studies on implementing urinary incontinence management. The webinar from AHRQ’s EvidenceNOW: Managing Urinary Incontinence initiative will highlight how two grantees implemented nonsurgical urinary incontinence interventions within primary care settings, focusing on provider education, feedback loops and workflow integration. Presenters will discuss the challenges and benefits of these approaches, as well as the publicly available tools and resources to enhance care and bridge the gap between evidence and practice. Register now.

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).

Evidence Review Finds Evolving Definitions and Care Models for Long COVID

Long COVIDA new AHRQ evidence review sheds light on the evolving definitions and care models for Long COVID. Published in Annals of Internal Medicine in conjunction with an AHRQ technical brief, the article identified five definitions of Long COVID and examined 51 care models. The models were characterized by designation of a clinical department lead, implementation of a multidisciplinary approach, coordination of services and use of telehealth. While all models could serve underserved populations, they lack approaches specifically designed to address such populations. The authors noted that some efforts to implement Long COVID models of care have faced challenges due to burnout or concerns about financial sustainability. More detailed research is needed to optimize and evaluate these care models, the authors concluded, noting that current literature often lacks critical details and outcome data.

New Research and Evidence From AHRQ

Nov. 13 Webinar Will Honor Veterans and Explore Science and Medicine Careers at HHS

A webinar on Nov. 13, from 1 to 3 p.m. ET, will showcase veterans excelling in diverse career opportunities in health science and medicine across HHS. Hosted by the HHS Assistant Secretary for Administration’s Office of Human Resources, the event will feature three veteran panelists from Centers for Disease Control and Prevention, the Food and Drug Administration, and the National Institutes of Health who will discuss how their military service shaped their career paths. The event is open to the public but is geared toward veterans, military service members and those interested in military service. Register now or contact the Veterans Employment Program Officer at vets@hhs.gov with questions.

AHRQ in the Professional Literature

Pediatric open notes: caregiver experiences since the 21st Century Cures Act. Kelly MM, Kieren MQ, Coller RJ, et al. Acad Pediatr. 2024 May-Jun;24(4):556-8. Epub 2023 Oct 2. Access the abstract on PubMed®.

Universal substance use care for adolescents with chronic medical conditions: a protocol to examine equitable implementation determinants and strategies for SBIRT at a pediatric hospital. Williams FS, Garofalo R, Karnik NS, et al. Addict Sci Clin Pract. 2024 Sep 11;19(1):67. Access the abstract on PubMed®.

Care transition management and patient outcomes in hospitalized Medicare beneficiaries. Ouayogodé MH, Hardy B, Mullahy J, et al. Am J Manag Care. 2024 Sep;30(9):e266-e73. Access the abstract on PubMed®.

Association between mandatory bundled payments and changes in socioeconomic disparities for joint replacement outcomes. Kilaru AS, Liao JM, Wang E, et al. Health Serv Res. 2024 Oct;59(5):e14369. Epub 2024 Aug 11. Access the abstract on PubMed®.

Antibiotics not associated with shorter duration or reduced severity of acute lower respiratory tract infection. Merenstein DJ, Barrett B, Ebell MH. J Gen Intern Med. 2024 Aug;39(10):1887-94. Epub 2024 Apr 15. Access the abstract on PubMed®.

Impact of hospitalizations on problematic medication use among community-dwelling persons with dementia. Deardorff WJ, Jing B, Growdon ME, et al. J Gerontol A Biol Sci Med Sci. 2024 Nov;79(11). Access the abstract on PubMed®.

Incorporating patient, caregiver, and provider perspectives in the co-design of an app to guide Hospital at Home admission decisions: a qualitative analysis. Kowalkowski M, Eaton T, Reeves KW, et al. JAMIA Open. 2024 Oct;7(3):ooae079. Epub 2024 Aug 16. Access the abstract on PubMed®.

An explainable long short-term memory network for surgical site infection identification. Kiser AC, Shi J, Bucher BT. Surgery. 2024 Jul;176(1):24-31. Epub 2024 Apr 18. 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