Lance's Corner

AHRQ Issues Regulatory Update

May 28, 2025

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

May 28, 2025, Issue #959

 

AHRQ Stats: Insurance Types Among High Spenders

Medicare and private insurance paid for over three-quarters of expenses among people with the top 5 percent of healthcare expenses between 2018 and 2022. (Source: AHRQ Medical Expenditure Panel Survey Statistical Brief #560, Concentration of Healthcare Expenditures and Selected Characteristics of People with High Expenses, United States Civilian Noninstitutionalized Population, 2018–2022.)

Today's Headlines:

Lab Results Improve Accuracy of AI-Generated Diagnoses

An AHRQ-funded study published in NPJ Digital Medicine found that including lab results significantly improved the accuracy of differential diagnoses generated by large language models.  Researchers tested five models—GPT-4, GPT-3.5, Claude-2, Llama-2-70b, and Mixtral-8x7B—using 50 clinical vignettes based on real patient cases.  Each model generated a list of possible diagnoses with and without lab data.  Adding lab results improved diagnostic accuracy by up to 30 percent across models.  GPT-4 performed the best, achieving 55 percent Top-1 accuracy and 79 percent lenient accuracy.  The models correctly interpreted common lab tests such as liver function and toxicology panels.  These findings underscore the potential of large language models as supplemental diagnostic tools and the importance of structured clinical data in AI-driven decision support.  Access the abstract.

Addressing Food Insecurity During Pediatric Hospitalizations

Identifying and helping families who are experiencing food insecurity, or a lack of consistent access to enough food, is not yet done as part of routine clinical care at children’s hospitals across the country.  In an AHRQ-funded study published in Hospital Pediatrics, researchers aimed to increase food insecurity screening for hospitalized children from 0 to 60 percent and provide location-based food resources to eligible families.  Researchers screened 2,800 patients in a tertiary, freestanding children’s hospital from 2021 to 2023.  With the Model for Improvement developed by Associates in Process Improvement, screening rates for food insecurity increased from 0 to 77 percent.  Researchers concluded that integrating food insecurity screening is a feasible and effective approach to addressing the issue, leading to better health outcomes for children.  Access the study.

New Research and Evidence

Recording of Safety Culture in Healthcare Webinar Available

Safety Culture in Healthcare: Measuring and Responding, a webinar sponsored by the AHRQ-led  National Action Alliance for Patient and Workforce Safety, highlights the importance of safety culture and teamwork in healthcare settings.  This webinar, held April 15, was the third in a three-part series on safety culture in healthcare.  Speakers from AHRQ, Duke Center for the Advancement of Well-being Science, and Westat discussed how strategies such as conflict resolution and leader engagement are essential for improving healthcare worker well-being and patient outcomes.  Panelists answered audience questions on how to get physicians to participate in the patient safety culture surveys and recommended ways to encourage a teamwork climate.  Access the recording and presenter materials from this event.

Stronger Primary Care Starts With Support From EvidenceNOW

Primary care providers face mounting pressure to deliver better outcomes with limited resources.  AHRQ’s EvidenceNOW initiative helps practices overcome these challenges with evidence-based strategies that work in real-world settings.  From improving heart health to advancing behavioral health integration, EvidenceNOW offers tailored guidance for small and medium-sized practices, including access to performance feedback, quality improvement coaching, and easy-to-implement clinical tools designed to build sustainable improvements in quality and patient care.  The EvidenceNOW Model is a blueprint for delivering external support to primary care practices to improve healthcare quality and implement new evidence into care delivery.  It is also designed to help primary care practices increase their capacity for quality improvement with the goals of improving patient and practice health.  Explore tools to help strengthen your practice.

Register for Upcoming Webinars

AHRQ in the Professional Literature

Ophthalmology examinations in children with skull fractures and underlying focal hemorrhage. Breeden K, Christian CW, Wood JN, et al. Pediatr Emerg Care. 2025 Mar 12. [Epub ahead of print.] Access the abstract on PubMed®.

"Everything is electronic health record-driven": the role of the electronic health record in the emergency department diagnostic process. James TG, Mangus CW, Parker SJ, et al. JAMIA Open. 2025 Apr;8(2):ooaf029. Epub 2025 Apr 23. Access the abstract on PubMed®.

Association between left ventricular assist device infections and number of shared patients among care providers: a network analysis. Hawkins RB, Stewart JW, Kim KD, et al. Ann Thorac Surg. 2025 May 10. [Epub ahead of print.] Access the abstract on PubMed®.

Ambulatory medication safety events in high-risk patients with diabetes before and after a COVID-19 clinic slowdown. Young RA, Blair S, Teigen K, et al. J Patient Saf. 2025 Jun 1;21(4):240-5. Epub 2025 Apr 10. Access the abstract on PubMed®.

Development of secure infrastructure for advancing generative artificial intelligence research in healthcare at an academic medical center. Ng MY, Helzer J, Pfeffer MA, et al. J Am Med Inform Assoc. 2025 Mar;32(3):586-8. Access the abstract on PubMed®.

Antibiotic Diversity Index: a novel metric to assess antibiotic variation among hospitalized children. Markham JL, Hall M, Shah SS, et al. J Hosp Med. 2025 Jan;20(1):8-16. Epub 2024 Aug 4. Access the abstract on PubMed®.

The foundational capabilities of large language models in predicting postoperative risks using clinical notes. Alba C, Xue B, Abraham J, et al. NPJ Digit Med. 2025 Feb 11;8(1):95. Access the abstract on PubMed®.

A survey of team culture and learning organization in the resuscitation of neonates with congenital anomalies: a single center experience. Bostwick A, Ades A, Rodriguez-Paras C, et al. Resusc Plus. 2025 Mar;22:100877. Epub 2025 Jan 24. Access the abstract on PubMed®.

Contact Information
For comments or questions about AHRQ News Now, contact Karen Fleming-Michael at Karen.FlemingMichael@ahrq.hhs.gov or (301) 427-1798.

 

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