Lance's Corner

AHRQ Issues Regulatory Update

Jul 29, 2025

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

July 29, 2025 | Issue #968

In This Week's Issue: cost of heart disease; advances in breast cancer screening; Marketplace health plan premiums; diagnostic safety and AI

Statistical Brief Highlights Cost of Heart Disease

In the United States, the cost of treating adults with heart disease totaled $100 billion in 2022.  A new statistical brief from AHRQ’s Medical Expenditure Panel Survey (MEPS) presents data on the costs associated with treating heart disease that year, including the age groups most impacted, annual costs, and ranking of costs by type of service.  Explore the impact of heart disease by insurance type, service, and more.

Advancing Breast Cancer Screening: New Insights and Innovations

Improving Breast Cancer Screening Practices for Survivors

Patients with a personal history of breast cancer are living longer due to early detection and improved treatments; however, they remain at higher risk for cancer recurrence or development of a new cancer.  An AHRQ-funded study, published in RadioGraphics, examines current guidelines, including when to start or stop screening, how to choose between screening and diagnostic mammograms based on breast density and prior treatments, and how to use supplemental imaging tools like breast magnetic resonance imaging and ultrasound.  While national guidelines recommend annual mammograms starting at age 40 and additional imaging for some patients, screening practices still vary widely.  Additionally, adherence to screening varies and generally tends to drop over time.  Understanding these recommendations and educating patients about their options is key to providing the best care for breast cancer survivors.  Access the abstract.

Artificial Intelligence Shows Promise in Catching Interval Breast Cancers

According to an AHRQ-funded study in Journal of the National Cancer Institute, AI can significantly aid in detecting interval breast cancers, potentially reducing missed diagnoses by up to 30 percent.  Researchers retrospectively reviewed 148 cases of breast cancer diagnosed within 12 months of a negative screening mammogram, and they found that 64 percent of the mammograms had visible signs of cancer in hindsight.  When an AI tool analyzed the same images, it flagged 76 percent of the cases overall and accurately localized the cancer site in 47 percent of those with visible findings.  These results suggest AI could improve the sensitivity of mammography by helping radiologists detect subtle or previously overlooked cancers, particularly in annual screening programs using digital breast tomosynthesis.  Access the article.

Premium Changes Reduce Marketplace Plan Retention

An AHRQ-funded study in JAMA Health Forum found that when zero-premium Health Insurance Marketplace plans became paid plans, automatic reenrollment dropped by 7 percentage points, leaving an estimated 250,000 lower income enrollees without coverage in 2024.  Researchers analyzed plan selection data for roughly 10 million HealthCare.gov enrollees per year across 29 states from 2022 to 2024.  They also found that when zero-premium plans began requiring a premium—often due to changes in plan pricing, availability, or subsidy levels—plan retention among returning enrollees decreased by 13 percentage points, while plan switching increased by 15 percentage points.  The study suggests that when expanded premium tax credit subsidies expire and premiums rise, lower income enrollees are likely to lose coverage, especially with the administrative burdens that come with switching plans.  Access the article.

New Issue Brief Guides Healthcare Leaders on Safe, Effective AI Use

Artificial intelligence (AI) is no longer a distant prospect—it is transforming healthcare delivery, diagnosis, and clinical decision making.  As AI becomes increasingly embedded across the care continuum, uncertainty about how to safely and effectively integrate AI tools is rising quickly.  Understanding the AI Wave: Foundational Knowledge for Improving Diagnosis and Beyond, a new issue brief from AHRQ, demystifies core AI concepts and offers real-world examples to build foundational understanding.  Grounded in evidence and informed by lessons from other high-risk industries, this issue brief provides practical, actionable guidance for healthcare leaders, clinicians, and patients.  This resource supports all stakeholders—whether they are making decisions about AI adoption, using AI tools in clinical practice, or seeking to understand AI’s role in care delivery—in navigating AI thoughtfully while safeguarding quality and safety, improving efficiency, and maintaining patient trust.

AHRQ Stats: Availability of Medical Care in Rural and Urban Areas

Over one-quarter of adults in small rural areas considered their access to medical care to be either poor or fair in 2021.  Only 14 percent of those in larger rural areas, 8.6 percent of those in suburban areas, and 8.1 percent of those in urban areas considered availability to be similarly poor.  (Source: AHRQ Medical Expenditure Panel Survey Statistical Brief #564, Adult Ratings of Neighborhood Medical Care Availability in Nonmetropolitan and Metropolitan Areas, United States 2021.)

New Research and Evidence

AHRQ in the Professional Literature

A theoretical framework to quantify the tradeoff between individual and population benefits of expanded antibiotic use.  LaPrete CR, Ahmed SM, Toth DJA, et al. Bull Math Biol. 2025 Apr 30;87(6):68.  Access the abstract on PubMed®.

A behind-the-scenes look at practice facilitation to improve delivery of unhealthy alcohol use screening and management services in primary care: a qualitative study.  Rockwell MS, Villalobos G, Bannon J, et al. J Prim Care Community Health. 2025 Jan-Dec;16:21501319251351144. Epub 2025 Jul 9.  Access the abstract on PubMed®.

Epidemiology of diagnostic errors in pediatric emergency departments using electronic triggers.  Mahajan P, White E, Shaw K, et al. Acad Emerg Med. 2025 Mar;32(3):226-45. Epub 2025 Jan 15.  Access the abstract on PubMed®.

Building an allergy reconciliation module to eliminate allergy discrepancies in electronic health records.  Blackley SV, Lo YC, Varghese S, et al. J Am Med Inform Assoc. 2025 Apr;32(4):648-55.  Access the abstract on PubMed®.

Development of a tool to measure Potentially Inappropriate Inter-Hospital Transfer (IHT): The POINT Study.  Mueller SK, Kelly C, Singleton S, et al. J Gen Intern Med. 2025 Jun;40(8):1917-23. Epub 2025 Mar 27.  Access the abstract on PubMed®.

A toolkit to implement opioid quality improvement efforts in primary care: findings from a mixed-methods study.  Childs E, Swan H, Evans L, et al. J Opioid Manag. 2025 Jan-Feb;21(1):29-40.  Access the abstract on PubMed®.

Loss of subsidized drug coverage and mortality among Medicare beneficiaries.  Roberts ET, Phelan J, Schwartz AL, et al. N Engl J Med. 2025 May 29;392(20):2025-34. Epub 2025 May 14.  Access the abstract on PubMed®.

Multidisciplinary clinician perspectives on avoidable emergency department use by patients during cancer treatment.  Hong AS, Halm EA, Courtney DM, et al. Support Care Cancer. 2025 Apr 23;33(5):410.  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