Lance's Corner

AHRQ Issues Regulatory Update

Mar 25, 2025

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

March 25, 2025, Issue #951

 

AHRQ Stats: MRSA Rates by Payer Type

The rate of MRSA diagnoses on admission among expected self-pay hospitalizations decreased from 130.1 per 10,000 stays in 2019 to 114.1 per 10,000 stays in 2021, and the rate among hospitalizations billed to Medicaid decreased from 114.3 per 10,000 stays to 107 per 10,000 stays. These rates were nearly double that of hospitalizations expected to be billed to private insurance, which was 55.8 MRSA diagnoses at admission per 10,000 stays in 2019 and 49.4 per 10,000 stays in 2021. (Source: AHRQ Healthcare Cost and Utilization Project Statistical Brief #315, Overview of Methicillin-Resistant Staphylococcus aureus (MRSA)-Related Inpatient Stays, 2016-2021.)

Correction: Last week’s AHRQ News Now misidentified the funder of an AHRQ Evidence-based Practice Center Program systematic review, Behavioral Interventions for Migraine Prevention. The Patient-Centered Outcomes Research Institute funded the report.

Today's Headlines:

AHRQ Report Identifies Strategies To Reduce Emergency Department Boarding

A new AHRQ report released today shows the causes of emergency department (ED) boarding originate at the hospital or health system level and require solutions beyond the walls of the ED. ED boarding occurs after the decision is made to admit a patient to the hospital but there is no inpatient bed available, so the patient ends up waiting in the emergency department for hours, days or even weeks. Boarding has serious impacts on patients, including excess in-hospital mortality, increased medical errors and costly delays in care delivery. It also negatively impacts hospital staff and public safety. The report presents solutions from this broad contextual view and notes opportunities for health systems, states and federal partners to lead efforts moving forward. The report highlights findings from the AHRQ Summit to Address Emergency Department Boarding held on Oct. 8, 2024, in response to a bipartisan letter from 44 members of Congress to HHS.

Opportunity for Improved Patient Safety and Cost Savings in Children Prescribed Multiple Medications

An AHRQ-supported study in JAMA Network Open identified opportunities for improved patient safety and cost savings if medication therapy management coverage is made available to pediatric patients. For adult beneficiaries who meet the pharmaceutical cost threshold, Medicare covers the cost of a comprehensive management program proven to reduce spending and medication-related problems. Researchers reviewed the records of 529,055 children prescribed one or more medications annually in the 2022 Colorado All Payers Claims Database and found that 50 percent of patients had no concurrent medications, 44 percent had two to four concurrent medications and 6 percent had five or more concurrent medications. Of the $1.1 billion spent on prescriptions, 47 percent was spent for patients taking five or more medications. According to the article, 5 percent of pediatric patients in Colorado met the 2022 medication cost threshold for adults enrolled in Medicare to receive medication therapy management. Access the article.

Register for Upcoming AHRQ Webinars

AHRQ in the Professional Literature

Randomized controlled trial to evaluate a new tool to support patient decision-making on transplant centers. McKinney WT, Israni K, Schaffhausen CR, et al. Clin Transplant. 2024 Dec;38(12):e70043. Access the abstract on PubMed®.

Workflow analysis of breast cancer treatment decision-making: challenges and opportunities for informatics to support patient-centered cancer care. Salwei ME, Reale C. JAMIA Open. 2024 Jul;7(2):ooae053. Epub 2024 Jun 24. Access the abstract on PubMed®.

Birthing parent and companion verbal reactions following interactions with inpatient postpartum health care team members: an observational study using naturalistic filming. Mangas M, Saggi NS, Macias MP, et al. BMC Pregnancy Childbirth. 2024 Dec 20;24(1):841. Access the abstract on PubMed®.

Reducing stigma through conversations in primary care about unhealthy alcohol use. Bishop D, Parsons D, Villalobos G, et al. Ann Fam Med. 2025 Jan 27;23(1):83. Access the abstract on PubMed®.

Hospital-level variation in cardiac rehabilitation metrics. Pollack LM, Chang A, Thompson MP, et al. Am Heart J. 2025 Apr;282:58-69. Epub 2024 Dec 13. Access the abstract on PubMed®.

Changes in coverage stability and churning for private, individual insurance under the Affordable Care Act. Hill SC, Jacobs PD. Health Affairs Scholar. 2025 Jan;3(1):qxae169. Epub 2024 Dec 10. Access the abstract on PubMed®.

A systems engineering approach to alarm management on pediatric medical-surgical units. Ruppel H, Luo B, Rasooly IR, et al. J Hosp Med. 2025 Jan;20(1):98-103. Epub 2024 Oct 17. Access the abstract on PubMed®.

Developing a clinical decision support framework for integrating predictive models into routine nursing practices in home health care for patients with heart failure. Chae S, Davoudi A, Song J, et al. J Nurs Scholarsh. 2025 Jan;57(1):165-77. Epub 2024 Nov 7. 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