Presentation on theme: "Outline What is the Intersocietal Accreditation Commission? Why do we need Accreditation? AC history Where do we start? Where do we find help? How much."— Presentation transcript:
1 Achieving Accreditation in Echo, Nuclear and Vascular Robert Skotnicki, D.O., F.A.C.C.
2 OutlineWhat is the Intersocietal Accreditation Commission?Why do we need Accreditation?AC historyWhere do we start?Where do we find help?How much does Accreditation cost?What are the Application essentials?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
4 What is an Intersocietal Commission on Accreditation (IAC)?IAC founded on April 5, 1997Seven years after the Intersocietal Commission for the Accreditation of Vascular LaboratoriesPrompted by the incorporation of theIntersocietal Commission for the Accreditation of Echocardiographic LaboratoriesFollowed later in the same year by Intersocietal Commission for the Accreditation of Nuclear Medicine LaboratoriesPrimarily because ICAVL wanted to maintain its identity from ICAEL and serves as managerial oversight of the various disciplines
5 The Intersocietal Accreditation Commission Is composed of:The past president of all CommissionsThe current president of all Commissions
6 provides oversight to: The Intersocietal Accreditation Commission (IAC)provides oversight to:Intersocietal Commission for the Accreditation of Echocardiography LaboratoriesIntersocietal Commission for the Accreditation of Nuclear Medicine LaboratoriesIntersocietal Commission for the Accreditation of Vascular LaboratoriesIntersocietal Commission for the Accreditation of Computed Tomography LaboratoriesIntersocietal Commission for the Accreditation of Magnetic Resonance Laboratories
7 Intersocietal Commission for the Accreditation of Echocardiography LabsAmerican College of CardiologyAmerican Society of EchocardiographySociety of Diagnostic Medical SonographersSociety of Pediatric EchocardiographyConsultantTechnical ManagerCEO
8 Intersocietal Commission for the Accreditation of Nuclear Laboratories Academy of Molecular ImagingAmerican College of CardiologyAmerican College of Nuclear PhysiciansAmerican Society of Nuclear CardiologySociety of Nuclear Medicine- Technologist SectionCEOPhysicist
9 Intersocietal Commission for the Accreditation of Vascular LaboratoriesAmerican Academy of Neurology & American Society of NeuroimagingAmerican College of CardiologyAmerican Institute of Ultrasound in MedicineAmerican Society of EchocardiographyJoint Section on Cerebrovascular Surgery/American Association of Neurologic Surgeons/Congress of Neurologic SurgeonsSociety of Clinical Vascular SurgerySociety for Vascular MedicineSociety for Vascular SurgerySociety for Vascular UltrasoundSociety for Diagnostic Medical SonographySociety of Interventional RadiologistsSociety of Radiologists in UltrasoundCEOTechnical Manager
10 Why should my practice/hospital become accredited? Improve standard or quality of care by ourfacilityprotocol review and organizationenhanced quality assurance and correlationConfidential peer reviewRecruiting gem for technologists and physiciansMarketing toolpatient confidencereferral physiciansQualification for re-imbursementStrongly recommended by ASNC and ACCLitigationProsConsEvery one is doing it!Discuss highmark of Western Pa already requires Accreditation and ours in south central Pa is following suit.
11 How many at present-607 labs ICANLHow many at present-607 labsPrivate offices %Freestanding Imaging Ctrs %Hospitals %Mobile labs %Other %Type of imagingMPIRNAGeneral Nuclear MedPET
12 Associated Cardiologists has been accredited since: 2000 in Adult Echocardiography2001 in Nuclear Cardiology2001 in Vascular UltrasoundAccreditation re-cycles every 3 yearsNine times!After we received the third Accreditation, we searched the IAC web site and believe we were the first private practice in Pa to achieve all three.Reaccreditation is by no means a “rubber” stamp of the prior application.I will show our most recent Nuclear attempt with the return letter from the ICANL.
13 Prior to present resources First time around6-8 months in Nuclear by Chief Technologistwhile supervising 2 sites, 5,000 case/yrvolume.4-6 months in Echocardiography by ChiefTechnologist while supervising 2 sites,6,000+/yr volume.8-10 months in Vascular Ultrasound by ChiefTechnologist while supervising 2,000 exams/yrPrior to present resourcesconsultantsAs director of Nuclear Cardiology at our practice, I can tell you that this was an extensive and intensive effort from my chief technologists. I am a bit biased towards nuclear, thinking that this credentialing is more difficult than echo or vascular due to the radiation factor.We will exam what resources are available to you in 2007 and 2008.
14 Review the “Standards” Where/How to StartReview the “Standards”Each discipline has their own unique set with ultimately the same content albeit different orderList of specific requirements and regsDocument that is pages
15 Standards General Summary Definition Personnel Type of studies Minimal VolumeOverallPer physicianPer TechnologistInstrumentationProtocolsExamReportSafetyImaging Energy ExposureEmergency procedures/resuscitation equipmentQAMultiple 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 Technical Director qualifications TrainingExperienceTechnical Director qualificationsQualificationsMedical StaffAdditional Technical staffPatient care PersonnelCME requirementsPhysiciansTechnologistsResponsibilities and dutiesAncillary personnelClerical, administrativePhysicistIT support
18 Medical Director 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 inechocardiography.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 NuclearCardiology (CBNC).B. Board certified (or Board eligible but within two years of finishingtraining) in cardiology and completion of a minimum of a 4 month formaltraining program in nuclear cardiology [Level 2 as outlined in theACC/ASNC COCATS Training Guidelines (2006 revision)]. Thisrequirement applies only to cardiologists who began their cardiologytraining in July 1995 or laterC. Board certified in cardiology and training equivalent to Level 2 training,or at least one year (full time equivalent) of nuclear cardiology practiceexperience with independent interpretation of at least 600 nuclearcardiology studies. This requirement applies only to cardiologists whobegan their cardiology training before July 1995.D. Board certified (or Board eligible but within two years of finishingtraining) in nuclear medicine.E. Board certified (or Board eligible but within two years of finishingtraining) in radiology with at least 4 months of nuclear cardiology training.F. Board certified (or Board eligible but within two years of finishingtraining) in radiology and at least one year (full time equivalent) of nuclearcardiology practice experience with independent interpretation of at least600 nuclear cardiology studies.
20 Medical Director Vascular A.) Formal Training Program – Completion of a residency or fellowship thatincludes appropriate didactic and clinical vascular laboratory experience asan integral part of the program. For those testing areas in which training isprovided, the physician should have experience in interpreting the followingminimum 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 ultrasoundThe formal training experience must be documented by a letter from thedirector of the training program verifying the areas of testing and the extentof the training and experienceB.) Informal (or self-study) training - Appropriate training and experience forproper qualifications to interpret noninvasive vascular laboratory studies canbe achieved through formal accredited post-graduate educationA minimum of 40 hours of relevant Category I CME credit must be acquiredwithin a three-year period. At least one half of these hours must be met withcourses specifically designed to provide knowledge of the techniques,limitations, accuracies and methods of interpretation of the noninvasivevascular laboratory test the physician will interpret. The remaining hoursmay be dedicated to appropriate clinical topics relevant to vascularlaboratory testing. Documentation of the CME courses with a listing of thecontent must be submittedComment: At least eight (8) of these hours
22 Volume 600 cases 300 cases 100 cases Training minimum in Echo and NuclearOverall laboratory volume/year in Echo and Nuclear300 casesMinimum/year for Medical Staff in EchoMinimum/year for SonographersMinimum Vascular studies (of each 5 types) performed in established practice for training100 casesOverall laboratory volume/year Stress EchoMinimum/year for Medical Staff in Stress EchoMinimum/year for Sonographers in Stress EchoMinimum Vascular (5) studies in formal training programMinimum/year (5) for Vascular SonographersMinimum/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 VolumeOverallPer physicianPer TechnologistInstrumentationProtocolsExamReportSafetyImaging Energy ExposureEmergency procedures/resuscitation equipmentQAMultiple Site Requirements
25 Decision HELP! Proceed without any changes necessary Proceed with minor changes necessaryRe-writing protocolsPatient confidentiality concernsArchiving issuesDelay for 6 months to a year with major changesBldg additionsStaff certificationHELP!
26 Where to get HELPWeb sites of each Commission with hyperlink to Accreditation OnDemandFree webcasts of minute duration each on 5-7 topicsPreparing your staff and facility for accreditationDo your protocols meet the minimum requirements?Documenting your laboratories accuracyAre all of your final reports complete and accurate?Case studies: documenting your accuracyWhat to expect at the site visit
27 Where to get HELPWeb sites of each Commission with hyperlink to Accreditation OnDemandSoftware assistance available for all 5 disciplines from private vendors at a cost!JR associates offers protocol support for Echo and Vascularat a cost of $ 900 for 33 protocolsEcho 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 HELPWeb sites of each Commission with hyperlink to Accreditation OnDemandSoftware assistance available for all 5 disciplines from private vendors at a cost!ConsultantsVascular has about +/- 30Echo has about +/- 34Nuclear has about +/- 40Cost $ 4,000-$ 10,000Location may add thousands of dollarsExtent of servicesFill in the blanks-software integration with DiCOM networkingACCREDITATION 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 All start with The Standards at $ 200 Cost of AccreditationTechnologist hoursOutside assistanceSoftware only $ 400 e.g.Echo Toolbox$ 900 software protocolIn House Consultants $ 4,000-15,000consider locationconsider networkingconsider supportphoneonsite (extra cost?)All start with The Standards at $ 200
30 Individual Disciplines ICAVL Base Fee $ 1,000300 for each area750 each siteICAEL Base Fee $ 1,500 Adult TT250 Adult TE250 Adult Stress1,500 Pediatric TT250 Pediatric TE250 Fetal200 per staff (7-25)50 per staff over 25750 per site500 mobileICANL Base Fee $ 3,800 ComprehensiveNuclear StressPETNuclear Medicine3,300 any one of the three1,000 each site
31 Application Essentials Use online applicationMust purchase a copy of the StandardsInclude Random Audit ConsentInclude Accreditation AgreementTwo sets of case studiesComplete mobile or multiple site supplemental applicationReview web site often for changes and updates in all of the above before submission
33 Case StudiesPrepare case studies based on lab volumes and staff (both Technologists and Medical)Submit two copiesDo not delete namesDo not send originalsSend best quality imagesSend entire examinationRepresentative cases from as many staff members as possibleActual typed reports must be unified
37 Insufficient CMEs will hold up acceptance Incomplete QA policies MiscellaneousInsufficient CMEs will hold up acceptanceIncomplete QA policiesQA documentationCases must be done to current GuidelinesAppropriatenessASE Report StandardsASNCReport must be standardizedNo typographical errorsRapidity of report productionPrepare for site visitReady access to all documents and facilitiesIncluding CME certificatesNuclear will want to watch physician interpret nuclear studies!Not reading from hard copyReview of all data systematic orderThey like colors
38 ConclusionThe Intersocietal Accreditation Commission is the governing body providing oversight to Accreditation Commissions.Yes, we need Accreditation.AC history was provided as example.We have direction regarding initiation of the credentialing process.Help is available through multiple resources.A list of the Accreditation cost was provided.The Application essentials were presented.Brief list of Tips and Quips from AC experience.