Lance's Corner

AHRQ Issues Regulatory Update

Jul 22, 2025

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

July 22, 2025 | Issue #967

In This Week's Issue: inconsistent antibiotic treatment for pneumonia; increased social needs for families; maternal safety webinar recording; Quality Indicators at Harborview Medical Center

Many Pediatric Pneumonia Patients Receive Antibiotics Outside of Guidelines

In more than 40 percent of cases, children admitted to the emergency department for community-acquired pneumonia received treatment outside of standard guidelines, according to an AHRQ-supported article in Hospital Pediatrics.  The authors studied 772 patients aged 2 to 17 and compared antibiotic prescribing with standards set by the 2011 Infectious Diseases Society of America consensus guidelines.  These standards allow treatment without antibiotics where possible and encourage the use of narrow-spectrum antibiotics instead of broad-spectrum drugs when antibiotics are necessary, unless prior narrow-spectrum treatment has failed.  In the study, patients with symptoms visible on chest radiographs and those with viral sample testing that was negative or inconclusive were more likely to receive antibiotics.  Among those who received antibiotics, those whose upper chest pulled in during breathing—a symptom known as “chest indrawing”—had 2.22 times greater odds of receiving treatment within guidelines, and those with clinically significant fluid buildup had 0.21 times lower odds.  Access the abstract to learn more.

Adult Patient Data Reveals Family-Level Social Risk Patterns

Adults living with children report more health-related social needs, according to an AHRQ-supported study in Pediatrics Open Science.  Researchers surveyed 1,252 adult primary care patients in Indianapolis from January 2022 to June 2023, including 326 (26 percent) with at least one child under 18 at home.  They compared the number and types of reported social needs—such as financial strain, housing instability, and food insecurity—between adults with and without children, adjusting for factors like income, neighborhood deprivation, and comorbidities.  Adults with children reported higher rates of housing instability (49.2 percent versus 40.7), food insecurity (53.7 percent versus 39.4), and financial strain (41.8 percent versus 35.0).  The findings suggest that incorporating a simple question about the presence of children into screenings could help identify families at risk and connect them to supportive services.  Access the study.

Enhancing Maternal Safety: Collaborations With Patient Safety Organizations Webinar Recording Now Available

Patient Safety Organizations (PSOs) can help improve maternal safety by collecting and analyzing confidential data reported by healthcare providers.  In a June 3 webinar hosted by the American College of Obstetricians and Gynecologists, presenters from AHRQ and Vizient highlighted how PSOs create a safe environment for healthcare providers to learn from mistakes without fear of punishment.  Based on the data they collect, PSOs develop and offer effective strategies, including evidence-based resources and expert guidance, to reduce maternal morbidity and mortality.  They look at how medical teams work and what affects patient care, including clinical practices, workflows, and workplace culture.  The presenters shared how these interventions and safety protocols have helped improve maternal safety and outcomes in healthcare settings.  Access the recording and presenter materials from this session.

Harborview Medical Center Uses AHRQ’s Quality Indicators To Improve Patient Safety

Harborview Medical Center in Seattle has improved patient safety across its facilities using AHRQ’s Quality Indicators (QIs)—standardized measures used to assess and monitor healthcare quality.  A level 1 trauma center and safety net hospital, Harborview uses QIs to review adverse events and integrate new, safer processes into standard care.  Specifically, the hospital makes use of Patient Safety Indicators (PSIs), a subset of QIs that target in-hospital safety issues—adverse events that were not present during patient admission.  Information on cases identified through PSI reporting is shared with clinicians for review and feedback and can be used to improve hospital practices.  Harborview uses PSI modules across its medical, surgery, inpatient rehabilitation, and behavioral health areas.  The latter two areas are primarily concerned with PSIs for pressure ulcers and falls, while the bulk of the PSI efforts are geared toward evaluating and addressing patient safety in Harborview’s medical/surgery areas.  According to clinical quality analyst Ellen Robinson, P.T., who oversees Harborview’s QI efforts, “Because we're a trauma center, our highest level of PSI was for venous thromboembolism, or blood clots, so we started by looking at those.”  Since adopting QIs in 2011, the hospital has reduced the percentage of potentially preventable blood clots after surgery.  Using QIs has also improved Harborview’s rating in the Patient Safety and Adverse Events Composite (PSI 90).  Learn more in a new AHRQ impact story.

AHRQ Stats: Use of High Blood Pressure Medications and Medical Visits

In 2021–22, 74.5 percent of U.S. adults diagnosed with or treated for high blood pressure received medications for that condition, including 56.5 percent who also had medical visits for high blood pressure and 18.0 percent who received medications without any visits.  (Source: AHRQ Medical Expenditure Panel Survey Statistical Brief #563, Recent Changes in Treatment Patterns for Diagnosed or Treated Hypertension, 2018–19 to 2021–22).

New Research and Evidence

AHRQ in the Professional Literature

The effect of registered nurse staffing and skill mix on length of stay and hospital costs.  Li Y, Aiken LH, Becker ER, et al. Nurs Outlook. 2025 Mar–Apr;73(2):102356.  Access the abstract on PubMed®.

Opportunities and risks of artificial intelligence in patient portal messaging in primary care.  Biro JM, Handley JL, McCurry JM, et al. NPJ Digit Med. 2025 Apr 24;8(1):222.  Access the abstract on PubMed®.

Machine-learned codes from EHR data predict hard outcomes better than human-assigned ICD codes.  Yin Y, Shao Y, Ma P, et al. Mach Learn Knowl Extr. 2025 Jun;7(2):36. Epub 2025 Apr 17.  Access the abstract on PubMed®.

The association between smoking, chronic pain, and prescription opioid use: 2013–2021.  Encinosa W, Bernard D, Valdez RB. J Pain. 2025 Jan; 26:104707.  Access the abstract on PubMed®.

Saving shared decision-making.  Opel DJ, Gerstein MT, Carle AC, et al. J Gen Intern Med. 2025 Jun;40(8):1844–47. Epub 2025 Feb 14.  Access the abstract on PubMed®.

A scoping review of risk presentation in patient decision aids: communicating risk in imaging.  Baird TA, Previtera M, Brady S, et al.  J Am Coll Radiol. 2025 Feb;22(2):172–82. Epub 2024 Oct. 18.  Access the abstract on PubMed®.

Interventions to improve timely cancer diagnosis: an integrative review.  Graber ML, Winters BD, Matin R, et al. Diagnosis. 2025 May 1;12(2):153–62.  Access the abstract on PubMed®.

Evaluating potential missed opportunities to prevent, treat, or diagnose sepsis: a population-based retrospective study of insurance claims.  Struble RD, Arakkal AT, Cavanaugh JE, et al. Crit Care Explor. 2025 Apr 2;7(4): e1240.  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