Lance's Corner

AHRQ Issues Regulatory Update

Sep 3, 2025

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

September 3, 2025 | Issue #973

In This Week's Issue: resources for Sepsis Awareness Month; commonly missed chances for early sepsis diagnosis; test of pediatric sepsis screening tool; antibiotic stewardship in sepsis treatment

September: A Month for Increasing Awareness About Sepsis

Sepsis is one of the leading causes of death in U.S. hospitals.  This September, AHRQ is offering provider resources and data on the seriousness of sepsis during Sepsis Awareness Month.  Sepsis is a medical emergency.  Learning the signs of sepsis for early detection and treatment is crucial.  The free AHRQ Toolkit for Improving Antibiotic Use in Acute Care Hospitals offers best practices for diagnosing and treating sepsis.  This tool reviews approaches for diagnosing and treating sepsis and discusses when to stop antibiotics for patients who may have sepsis.  AHRQ data sources demonstrate both the problem and prevalence of sepsis.  Data from the Healthcare Cost and Utilization Project (HCUP) were used to create a report to Congress that provides an assessment of hospital care for sepsis in the United States.  AHRQ also created an interactive data resource on trends in sepsis hospital care and recently updated the following Statistical Briefs on sepsis with 2022 data:

Finally, the AHRQ Quality Indicators measure performance over time and include a Patient Safety Indicator (PSI 13) for determining postoperative sepsis rates.  Join AHRQ and other partners across the country in supporting Sepsis Awareness Month.  Infection Prevention is Sepsis Prevention™!

Opportunities for Diagnosis and Treatment of Sepsis

Among patients with sepsis, potential missed opportunities for earlier recognition of sepsis are relatively common, according to research published in the journal Critical Care Explorations.  A comparison of nearly 650,000 sepsis cases recorded between 2016 and 2019 with records from prior visits revealed potential missed diagnostic opportunities in over 16 percent of hospital admissions where sepsis was the diagnosis.  Most of these potential missed opportunities occurred in outpatient settings.  Many of these patients reported symptoms an average of 2 days before their diagnosis.  Younger age and receipt of antibiotic, inhaler, and opioid prescriptions—which can mask symptoms of infections that can contribute to developing sepsis—were associated with potential delayed diagnoses.  These findings stress that making a diagnosis and not just treating symptoms could lead to faster sepsis identification.  Access the article.

Timely Shock Treatment in Suspected Pediatric Sepsis Not Improved by Predictive Clinical Decision Support

An AHRQ-funded study in Pediatrics found that a clinical decision support (CDS) tool did not increase the proportion of patients treated for septic shock before shock developed in pediatric emergency departments.  In 1,331 encounters with pediatric patients across four emergency departments, researchers tested the ability of a CDS tool based on machine learning predictive models to shorten the time between suspected sepsis and shock treatment.  While screening tools for pediatric sepsis have been implemented in emergency departments, this was the first prospective study with a control group.  Providers receiving CDS alerts administered standard treatment for sepsis in 39 percent of cases, while providers in the control group gave treatment in 38.9 percent of cases without the assistance of the CDS.  However, all four participating units chose to continue using the CDS tool, citing the reliability and infrequency of its alerts, as well as its value as a backup support for a priority area of patient safety.  Access the abstract.

Case-Based Vignettes Help Advance Antibiotic Stewardship in NICUs

There is both widespread variation in antibiotics use and antibiotics overuse in neonatal intensive care units (NICUs).  However, case-based vignettes that demonstrate safe antibiotics prescribing practices in specific patient scenarios can help promote more antibiotic stewardship–friendly practices in NICU settings, according to an AHRQ-funded study published in the Journal of Perinatology.  The authors surveyed clinicians at 31 NICUs participating in the Optimizing Antibiotic Stewardship in California NICUs (OASCN) collaborative to learn how they would evaluate and manage early-onset sepsis in newborns before and after a 12-month collaborative intervention.  The study found that clinicians in NICUs were less likely to order laboratory testing and more likely to follow stewardship-friendly practices after the intervention.  For example, when given test results for a well-appearing infant that could be associated with a bacterial infection at 12 hours of life, 26 percent of clinicians were likely or very likely at baseline to start antibiotics; this decreased to 14 percent at follow-up.  In addition to validating the use of case-based vignettes to optimize prescribing practices, the study suggested targeting specific antibiotic use practices in the NICU setting.  Review the study.

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AHRQ Stats: Trends in Sepsis-Related In-Hospital Stays

Among adults aged 65 and older, the total number of sepsis nonmaternal inpatient stays steadily increased by 44.2 percent between 2016 and 2022 (from 1,007,000 to 1,452,000 discharges).  The number of stays among those aged 18 to 64 increased in the same time frame, peaking at 1,024,000 in 2021, then dropping to 895,000 in 2022.  (Source: AHRQ Healthcare Cost and Utilization Project Statistical Brief #306, Overview of Outcomes for Inpatient Stays Involving Sepsis, 2016–2021 and Addendum with 2022 Data.)

New Research and Evidence

AHRQ in the Professional Literature

Allergy alerting and overrides for opioid analogues across two health systems.  Wasserman RL, Goss FR, Seger DL, et al. BMJ Health Care Inform. 2025 May 25;32(1):e101259.  Access the abstract on PubMed®.

Association between the sequence of β-lactam and vancomycin administration and mortality in patients with suspected sepsis.  Kondo Y, Klompas M, McKenna CS, et al. Clin Infect Dis. 2025 Apr 30;80(4):761-9.  Access the abstract on PubMed®.

Using interpersonal continuity of care in home health physical therapy to reduce hospital readmissions.  Engel P, Vorensky M, Squires A, et al. Home Health Care Manag Pract. 2025 Feb;37(1):54-63. Epub 2024 Jul 28.  Access the abstract on PubMed®.

MRI adoption in pediatric appendicitis: trends and outcomes.  Mangus CW, Janke AT, Mahajan P, et al. Hosp Pediatr. 2025 May;15(5):416-22.  Access the abstract on PubMed®.

An objective method to determine nurse staffing for an acute care for elders (ACE) hospital unit: discrete event simulation.  Simmons SF, Hollingsworth EK, Slagle JM, et al. J Am Geriatr Soc. 2025 Jul;73(7):2146-54. Epub 2025 May 9.  Access the abstract on PubMed®.

Integrating a risk prediction score in a clinical decision support to identify patients with health-related social needs in the emergency department.  Mazurenko O, Harle CA, Musey PI, Jr., et al. JAMIA Open. 2025 Aug;8(4):ooaf060. Epub 2025 Jul 4.  Access the abstract on PubMed®.

Machine learning for predicting waitlist mortality in pediatric heart transplantation.  Haregu F, Dixon RJ, McCulloch M, et al. Pediatr Transplant. 2025 Jun;29(4):e70095.  Access the abstract on PubMed®.

Type II diabetes mellitus and COVID-19: exploring insulin management in patients from family medicine clinics.  Opara C, White A, Fulda KG, et al. Pharmacy. 2025 Jul 4;13(4):93.  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