Lance's Corner

AHRQ Issues Regulatory Update

Jul 15, 2025

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

July 15, 2025 | Issue #966

In This Week's Issue: diagnostic safety project recruitment; Quality Indicators user survey; key aspects of diagnostic expertise; promoting patient safety with electronic health records

Join the IDEAS Project To Advance Diagnostic Safety

Diagnostic safety events are common and pervasive across all healthcare settings.  AHRQ recently developed several resources, including Calibrate Dx, to help healthcare organizations improve diagnostic safety.  Calibrate Dx provides clinicians with guidance for calibrating diagnostic performance for the purposes of learning and improvement.  The AHRQ-funded Implementing Diagnostic Excellence Across Systems (IDEAS) project is recruiting groups of clinicians within healthcare organizations to use and evaluate Calibrate Dx.  If clinicians in your organization are interested in lifelong learning strategies to improve diagnostic safety with added support and other benefits, visit the IDEAS website for Calibrate Dx.  Enroll in the program by September 30.

Help Shape the Future of AHRQ’s Quality Indicators

AHRQ has launched a brief user survey, and we want to hear from you.  Whether you use AHRQ’s Quality Indicators for quality improvement, benchmarking, reporting, or research, your insights are key to ensuring these tools remain relevant, effective, and impactful.  This is your opportunity to share how the Quality Indicators work for you and how they could work even better.  Your feedback will help us make meaningful enhancements that support smarter, data-driven improvements across the healthcare system.  Your experience matters.  Thank you in advance for helping shape the next generation of Quality Indicators.  Take the survey now.

Study Identifies Key Areas of Expertise Behind Diagnostic Success

Story building, technical expertise, and teamwork are among the most common clinical skills linked to diagnostic success in the emergency department (ED), according to a recent AHRQ-funded study in the Journal of Cognitive Engineering and Decision Making.  Unlike much existing research, the article examines aspects of diagnostic expertise rather than error.  Researchers conducted in-depth interviews with 43 providers from diverse roles and hospital settings, eliciting a total of 60 diagnostically challenging incidents that occurred in an ED.  Following multiple iterations of qualitative analysis, the study found that in 63 percent of cases, providers used story building—making sense of a patient’s symptoms by “connecting the dots” with a feasible narrative—to reach a correct diagnosis.  Technical expertise contributed to 58 percent, and teamwork with other healthcare providers played a role in 55 percent of the incidents.  Access the abstract to learn more about these and other areas of diagnostic expertise.

Refining Electronic Health Records To Support Patient Safety

Updated Guides Improve Safety and Usability of Electronic Health Records

The Safety Assurance Factors for Electronic Health Record Resilience (SAFER) Guides help healthcare organizations routinely assess and improve their electronic health record systems and are a required annual attestation by the Centers for Medicare and Medicaid Services.  A new AHRQ-funded study, published in the Journal of the American Medical Informatics Association, outlines updates to the 2025 guidelines that reflect current evidence and clinical practice.  A multidisciplinary team of researchers implemented changes that include new guidance on artificial intelligence and medical device data, strategies to reduce clinician burden, and real-world implementation examples.  The revised guidelines streamline content, reduce the number of recommended practices by 40 percent, and make it easier for healthcare teams to assess and improve electronic health record systems.  Access the abstract.

Algorithms Use Electronic Health Records To Track Penicillin Delabeling

Because most patients with a documented penicillin allergy label do not have a true allergy, “delabeling” those who can safely take associated antibiotics can improve outcomes and slow the development of antimicrobial resistance.  Funded with AHRQ support, two novel algorithms described in Clinical Infectious Diseases have shown accuracy in tracking the prevalence of delabeling through electronic health records.  While both performed equally well when compared against a human expert review, the simpler algorithm that does not require free-text or manual review achieved 100 percent sensitivity.  The algorithms were tested using over 77,000 records at two Boston-based health systems and successfully found a 6.8 percent delabeling rate, highlighting the potential use of the simpler variant for quality improvement and for other projects, as well as the importance of further strategies to improve effective delabeling.  Access the abstract.

AHRQ Stats: Heart Disease in Adults by Sex

Overall, 7.8 percent of U.S. adults aged 18 and older received heart disease treatment in 2022.  Heart disease impacted 8.4 percent of men and 7.2 percent of women.  (Source: AHRQ Medical Expenditure Panel Survey Statistical Brief #562, Healthcare Expenditures for Heart Disease among Adults Aged 18 and Older in the U.S. Civilian Noninstitutionalized Population, 2022).

New Research and Evidence

AHRQ in the Professional Literature

Trends in end-of-life care and satisfaction among veterans undergoing surgery.  Dualeh SHA, Anderson MS, Abrahamse P, et al. Ann Surg. 2025 Apr;281(4):682-88. Epub 2024 Feb 23.  Access the abstract on PubMed®.

One hundred years of seeking respectful maternity care: History and evolution.  Tilden EL, Jungbauer R, Hart EL, et al. Birth. 2025 Mar;52(1):129-37. Epub 2024 Oct 16.  Access the abstract on PubMed®.

Association of emergency department nurse and physician work environment agreement on clinician job and patient outcomes.  Muir KJ, Agarwal AK, Golinelli D, et al. BMC Health Serv Res. 2025 May 16;25(1):709.  Access the abstract on PubMed®.

Prevention in adults of transmission of infection with multidrug-resistant organisms: an updated systematic review from Making Healthcare Safer IV.  McCarthy S, Motala A, Shekelle PG. BMJ Qual Saf. 2025 Mar 19;34(4):244-56.  Access the abstract on PubMed®.

Better end-of-life care in surgical patients: Veterans Affairs Bereaved Family Survey - a qualitative analysis.  Shabet C, Vitous CA, Evans E, et al. BMJ Support Palliat Care. 2025 Feb 26;15(2):270-80.  Access the abstract on PubMed®.

Neurodevelopmental and behavioural disorders after perioperative invasive mechanical ventilation in paediatric surgical admissions.  Isik OG, Guo L, Ben-Ezra A, et al. Br J Anaesth. 2025 May;134(5):1440-49.  Access the abstract on PubMed®.

Shared medical appointments to improve equitable access to rehabilitative care for Long COVID.  Cheng AL, DeFranco AR, Furman M, et al. Cardiopulm Phys Ther J. 2025 Jan;36(1):50-7.  Access the abstract on PubMed®.

Epidemiology and outcomes of antibiotic de-escalation in patients with suspected sepsis in US hospitals.  Kam KQ, Chen T, Kadri SS, et al. Clin Infect Dis. 2025 Feb 5;80(1):108-17.  Access the abstract on PubMed®.

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