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Achieving Accreditation in Echo, Nuclear and Vascular Robert Skotnicki, D.O., F.A.C.C. Achieving Accreditation in Echo, Nuclear and Vascular Robert Skotnicki,

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Presentation on theme: "Achieving Accreditation in Echo, Nuclear and Vascular Robert Skotnicki, D.O., F.A.C.C. Achieving Accreditation in Echo, Nuclear and Vascular Robert Skotnicki,"— Presentation transcript:

1 Achieving Accreditation in Echo, Nuclear and Vascular Robert Skotnicki, D.O., F.A.C.C. Achieving Accreditation in Echo, Nuclear and Vascular Robert Skotnicki, D.O., F.A.C.C.

2 Outline 1.What is the Intersocietal Accreditation Commission? 2.Why do we need Accreditation? 3.AC history 4.Where do we start? 5.Where do we find help? 6.How much does Accreditation cost? 7.What are the Application essentials? 8.Any Tips or Quips from AC experience?

3 Accreditation achieved through:  Intersocietal Commission for the Accreditation of Echocardiography Laboratories in Echo (ICAEL)  Intersocietal Commission for the Accreditation of Nuclear Medicine Laboratories in Nuclear Imaging (ICANL)  Intersocietal Commission for the Accreditation of Vascular Laboratories (ICAVL) Under the auspices of the Intersocietal Accreditation Commission Under the auspices of the Intersocietal Accreditation Commission

4 What is an Intersocietal Commission on Accreditation (IAC)? Accreditation (IAC)?  IAC founded on April 5, 1997  Seven years after the Intersocietal Commission for the Accreditation of Vascular Laboratories  Prompted by the incorporation of the  Intersocietal Commission for the Accreditation of Echocardiographic Laboratories  Followed later in the same year by Intersocietal Commission for the Accreditation of Nuclear Medicine Laboratories

5 The Intersocietal Accreditation Commission Is composed of:  The past president of all Commissions  The current president of all Commissions

6 The Intersocietal Accreditation Commission (IAC) provides oversight to:  Intersocietal Commission for the Accreditation of Echocardiography Laboratories  Intersocietal Commission for the Accreditation of Nuclear Medicine Laboratories  Intersocietal Commission for the Accreditation of Vascular Laboratories  Intersocietal Commission for the Accreditation of Computed Tomography Laboratories  Intersocietal Commission for the Accreditation of Magnetic Resonance Laboratories

7 Intersocietal Commission for the Accreditation of Echocardiography Labs  American College of Cardiology  American Society of Echocardiography  Society of Diagnostic Medical Sonographers  Society of Pediatric Echocardiography  Consultant  Technical Manager  CEO

8 Intersocietal Commission for the Accreditation of Nuclear Laboratories  Academy of Molecular Imaging  American College of Cardiology  American College of Nuclear Physicians  American Society of Nuclear Cardiology  Society of Nuclear Medicine - Technologist Section - Technologist SectionCEOPhysicist

9 Intersocietal Commission for the Accreditation of Vascular Laboratories  American Academy of Neurology & American Society of Neuroimaging  American College of Cardiology  American Institute of Ultrasound in Medicine  American Society of Echocardiography  Joint Section on Cerebrovascular Surgery/American Association of Neurologic Surgeons/Congress of Neurologic Surgeons  Society of Clinical Vascular Surgery  Society for Vascular Medicine  Society for Vascular Surgery  Society for Vascular Ultrasound  Society for Diagnostic Medical Sonography  Society of Interventional Radiologists  Society of Radiologists in Ultrasound  CEO  Technical Manager

10 Why should my practice/hospital become accredited?  Improve standard or quality of care by our facility facility  protocol review and organization  enhanced quality assurance and correlation  Confidential peer review  Recruiting gem for technologists and physicians  Marketing tool  patient confidence  referral physicians  Qualification for re-imbursement  Strongly recommended by ASNC and ACC  Litigation  Pros  Cons  Every one is doing it!

11 ICANL How many at present-607 labs  Private offices 77%  Freestanding Imaging Ctrs 4 %  Hospitals 10%  Mobile labs 3%  Other 6% Type of imaging  MPI 598  RNA 210  General Nuclear Med 45  PET 19

12  Associated Cardiologists has been accredited since:  2000 in Adult Echocardiography  2001 in Nuclear Cardiology  2001 in Vascular Ultrasound  Accreditation re-cycles every 3 years  Nine times!

13  First time around 6-8 months in Nuclear by Chief Technologist while supervising 2 sites, 5,000 case/yr while supervising 2 sites, 5,000 case/yr volume. volume. 4-6 months in Echocardiography by Chief Technologist while supervising 2 sites, Technologist while supervising 2 sites, 6,000+/yr volume. 6,000+/yr volume months in Vascular Ultrasound by Chief Technologist while supervising 2,000 exams/yr Technologist while supervising 2,000 exams/yr  Prior to present resources   consultants

14 Where/How to Start  Review the “Standards”        Each discipline has their own unique set with ultimately the same content albeit different order  List of specific requirements and regs  Document that is pages

15 Standards  General Summary  Definition  Personnel  Type of studies  Minimal Volume  Overall  Per physician  Per Technologist  Instrumentation  Protocols  Exam  Report  Safety  Imaging Energy Exposure  Emergency procedures/resuscitation equipment  QA  Multiple Site Requirements

16 Definitions:  Vascular: A Vascular laboratory is a unit performing noninvasive vascular diagnostic testing under the overall direction of a Medical Director. A Technical Director is appointed who is responsible for direct supervision of the technical staff and the daily operations of the laboratory.  Nuclear: A Nuclear Cardiology, Nuclear Medicine and/or Pet facility consists of at least one nuclear imaging camera, a qualified physician and a nuclear medicine technologist. Each facility must have a Medical Director and a Technical Director. It may be a single site or a conglomerate of sites, a mobile facility or a combination of the above, meeting the organizational structures defined in this document. There may be additional physicians, nuclear medicine technologists, and other professional and/or technical personnel. When more than one technical member is employed, a Technical Director (e.g. chief technologist) is responsible for supervision of the technical staff.  Echo: An Echocardiographic laboratory is defined as an entity located at one postal address, composed of at least one ultrasound instrument and a Medical Director and a Technical Director performing and/or interpreting transthoracic echocardiography. There may be additional physicians and sonographers. The laboratory may also perform transesophageal, stress or fetal echocardiography.

17  Personnel  Medical Director  Training  Experience  Technical Director qualifications  Qualifications  Medical Staff  Additional Technical staff  Patient care Personnel  CME requirements  Physicians  Technologists  Responsibilities and duties  Physicians  Technologists  Ancillary personnel  Clerical, administrative  Physicist  IT support

18 Medical Director Echocardiography Echocardiography The Medical Director must be a licensed physician. The Medical Director must meet one of the following criteria1: A) Level III training in echocardiography. B) Completion of a twelve-month formal training program in echocardiography. C) Level II training in echocardiography plus one year of experience that includes interpretation of at least 600 echo/Doppler examinations. D) Completion of a six-month formal training program in echocardiography plus one year of experience that includes interpretation of at least 600 Echo/Doppler examinations. E) Three years of echocardiography practice experience and at least 1800 echo/Doppler examination interpretations, preferably with Testamur status by the National Board of Echocardiography (NBE) in Echocardiography by 2010.

19 Medical Director Nuclear A. Certification in nuclear cardiology by the Certification Board of Nuclear Cardiology (CBNC). B. Board certified (or Board eligible but within two years of finishing training) in cardiology and completion of a minimum of a 4 month formal training program in nuclear cardiology [Level 2 as outlined in the ACC/ASNC COCATS Training Guidelines (2006 revision)]. This requirement applies only to cardiologists who began their cardiology training in July 1995 or later C. Board certified in cardiology and training equivalent to Level 2 training, or at least one year (full time equivalent) of nuclear cardiology practice experience with independent interpretation of at least 600 nuclear cardiology studies. This requirement applies only to cardiologists who began their cardiology training before July D. Board certified (or Board eligible but within two years of finishing training) in nuclear medicine. E. Board certified (or Board eligible but within two years of finishing training) in radiology with at least 4 months of nuclear cardiology training. F. Board certified (or Board eligible but within two years of finishing training) in radiology and at least one year (full time equivalent) of nuclear cardiology practice experience with independent interpretation of at least 600 nuclear cardiology studies.

20 Medical Director Vascular A.) Formal Training Program – Completion of a residency or fellowship that includes appropriate didactic and clinical vascular laboratory experience as an integral part of the program. For those testing areas in which training is provided, the physician should have experience in interpreting the following minimum number of studies while under supervision: Vascular Laboratory Examination Minimum Number of Cases carotid duplex ultrasound 100 cases transcranial Doppler 100 cases peripheral arterial physiologic tests (e.g. extremity pressures, Doppler waveforms, exercise testing, reactive hyperemia) 100 cases peripheral arterial duplex 100 cases ultrasound venous duplex ultrasound 100 cases visceral vascular duplex 75 cases ultrasound The formal training experience must be documented by a letter from the director of the training program verifying the areas of testing and the extent of the training and experience B.) Informal (or self-study) training - Appropriate training and experience for proper qualifications to interpret noninvasive vascular laboratory studies can be achieved through formal accredited post-graduate education A minimum of 40 hours of relevant Category I CME credit must be acquired within a three-year period. At least one half of these hours must be met with courses specifically designed to provide knowledge of the techniques, limitations, accuracies and methods of interpretation of the noninvasive vascular laboratory test the physician will interpret. The remaining hours may be dedicated to appropriate clinical topics relevant to vascular laboratory testing. Documentation of the CME courses with a listing of the content must be submitted Comment: At least eight (8) of these hours

21 Choices  Nuclear  Myocardial perfusion imaging *  Equilibrium radionuclide Angiography  General Nuclear Medicine  PET  Echocardiography  Adult Transthoracic*  Adult Transesophageal  Adult Stress Echo  Pediatric Transthoracic  Pediatric Transesophageal  Fetal Echo  Vascular  Carotid Duplex Ultrasound *  Transcranial Doppler  Peripheral Arterial *  Peripheral Venous *  Visceral Vascular *  Screening (exercise testing, extremity pressures, reactive hyperemia)

22 Volume  600 cases  Training minimum in Echo and Nuclear  Overall laboratory volume/year in Echo and Nuclear  300 cases  Minimum/year for Medical Staff in Echo  Minimum/year for Sonographers  Minimum Vascular studies (of each 5 types) performed in established practice for training  100 cases  Overall laboratory volume/year Stress Echo  Minimum/year for Medical Staff in Stress Echo  Minimum/year for Sonographers in Stress Echo  Minimum Vascular (5) studies in formal training program  Minimum/year (5) for Vascular Sonographers  Minimum/year (5) for Medical Staff in Vascular

23 Lower Volumes than those recommended here, however, should not dissuade a laboratory that is otherwise compliant with the ICAEL/ICANL/ICAVL Standards from applying for Accreditation.

24 Standards  General Summary  Definition  Personnel  Type of studies  Minimal Volume  Overall  Per physician  Per Technologist  Instrumentation  Protocols  Exam  Report  Safety  Imaging Energy Exposure  Emergency procedures/resuscitation equipment  QA  Multiple Site Requirements

25  Decision  Proceed without any changes necessary  Proceed with minor changes necessary  Re-writing protocols  Patient confidentiality concerns  Archiving issues  Delay for 6 months to a year with major changes  Bldg additions  Staff certification  HELP!

26 Where to get HELP Web sites of each Commission with hyperlink to Accreditation OnDemand Free webcasts of minute duration each on 5- 7 topics 1.Preparing your staff and facility for accreditation 2.Do your protocols meet the minimum requirements? 3.Documenting your laboratories accuracy 4.Are all of your final reports complete and accurate? 5.Case studies: documenting your accuracy 6.What to expect at the site visit

27 Where to get HELP  Web sites of each Commission with hyperlink to Accreditation OnDemand  Software assistance available for all 5 disciplines from private vendors at a cost!  JR associates offers protocol support for Echo and Vascular at a cost of $ 900 for 33 protocols at a cost of $ 900 for 33 protocols  Echo ToolBox from the ASE is offered at a very reasonable price.  The American Society of Echocardiography developed Echo ToolBox™ as a web-based, interactive program that facilitates the accreditation process and promotes excellence in cardiovascular ultrasound laboratories.  Not only is Echo ToolBox™ a user-friendly and comprehensive tool that walks participants step by step, screen by screen, through the application process itself, but it is also an affordable and time-saving option for labs of all sizes.  Prices start at $ 75/yr for ASE members and $ 150/yr non ASE members, with reduction for high numbers of staff members. This is a yearly subscription.

28 Where to get HELP  Web sites of each Commission with hyperlink to Accreditation OnDemand  Software assistance available for all 5 disciplines from private vendors at a cost!  Consultants  Vascular has about +/- 30  Echo has about +/- 34  Nuclear has about +/- 40  Cost $ 4,000-$ 10,000  Location may add thousands of dollars  Extent of services Fill in the blanks-software integration with DiCOM networking Fill in the blanks-software integration with DiCOM networking  ACCREDITATION IMAGING ASSOCIATES NORTH AMERICA, INC. Nuclear consulting. Contact: April A. Adams, RN, CNMT, RT(N) San Jose Blvd, #310, Jacksonville, FL Phone: , Fax:  ACCREDITATION CONSULTING GROUP Vascular, Echocardiography, and Nuclear consulting. Contact: Ken Suhr, 71 Heritage Drive, Shrewsbury, NJ Phone: , Fax:

29 Cost of Accreditation  Technologist hours  Outside assistance Software only $ 400 e.g.Echo Toolbox Software only $ 400 e.g.Echo Toolbox $ 900 software protocol $ 900 software protocol In House Consultants $ 4,000-15,000 In House Consultants $ 4,000-15,000 consider location consider location consider networking consider networking consider support consider support phone phone onsite (extra cost?) onsite (extra cost?)  All start with The Standards at $ 200

30 Individual Disciplines  ICAVL Base Fee $ 1, for each area 300 for each area 750 each site 750 each site  ICAEL Base Fee $ 1,500 Adult TT 250 Adult TE 250 Adult TE 250 Adult Stress 250 Adult Stress 1,500 Pediatric TT 1,500 Pediatric TT 250 Pediatric TE 250 Pediatric TE 250 Fetal 250 Fetal 200 per staff (7-25) 200 per staff (7-25) 50 per staff over per staff over per site 750 per site 500 mobile 500 mobile  ICANL Base Fee $ 3,800 Comprehensive Nuclear Stress Nuclear Stress PET PET Nuclear Medicine Nuclear Medicine 3,300 any one of the three 3,300 any one of the three 1,000 each site 1,000 each site

31 Application Essentials  Use online application  Must purchase a copy of the Standards  Include Random Audit Consent  Include Accreditation Agreement  Two sets of case studies  Complete mobile or multiple site supplemental application  Review web site often for changes and updates in all of the above before submission

32 Tips and Quips

33 Case Studies  Prepare case studies based on lab volumes and staff (both Technologists and Medical)  Submit two copies  Do not delete names  Do not send originals  Send best quality images  Send entire examination  Representative cases from as many staff members as possible  Actual typed reports must be unified

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37 Miscellaneous  Insufficient CMEs will hold up acceptance  Incomplete QA policies  QA documentation  Cases must be done to current Guidelines  Appropriateness  ASE Report Standards  ASNC  Report must be standardized  No typographical errors  Rapidity of report production  Prepare for site visit  Ready access to all documents and facilities  Including CME certificates  Nuclear will want to watch physician interpret nuclear studies!  Not reading from hard copy  Review of all data systematic order  They like colors

38 Conclusion 1.The Intersocietal Accreditation Commission is the governing body providing oversight to Accreditation Commissions. 2.Yes, we need Accreditation. 3.AC history was provided as example. 4.We have direction regarding initiation of the credentialing process. 5.Help is available through multiple resources. 6.A list of the Accreditation cost was provided. 7.The Application essentials were presented. 8.Brief list of Tips and Quips from AC experience.


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