Achieving Vascular Laboratory Accreditation through the Intersocietal Accreditation Commission (IAC) or American College of Cardiology (ACR) is rewarding and demonstrates to patients and referring physicians that your facility or practice is dedicated to quality. Accreditation may also help you meet reimbursement requirements of some insurers, especially for IAC Vein Center accreditation which requires Vascular Lab accreditation in Venous Ultrasound.
However, even if you’ve been through it before, preparing the vascular lab accreditation application can still be a daunting task. It seems that every year the Standards and Guidelines are updated to improve the process; however, this leaves the Technical and Medical Directors clamoring in many cases to comply with the new Standards.
My colleagues and I have been through the process too many times to count. We have been involved in accrediting hospitals, physician practices, and imaging centers, and despite our experience, there are still issues that arise that make the accreditation process challenging. So we put together the “Top 3” challenges that our clients have encountered during the IAC and ACR accreditation processes, whether it was a brand new accreditation or going through the reaccreditation process.
Challenge #1 Time
The initial accreditation process takes quite a bit of time. We estimate that we need 100+ hours per each Medical and Technical staff member to complete the process. The time needed includes, but is not limited to, the following tasks:
- Documenting and referencing testing protocols and diagnostic criteria;
- Operational evaluation including gathering and entering testing volumes, creating or finding required policies, and reviewing the requirements with the staff to assure compliance;
- Gathering and documenting the necessary Quality Assurance information, which includes reviewing cases, reports, turnaround time, and adherence to testing protocols and diagnostic criteria (see Challenge 2);
- Assuring that the Medical and Technical Staff satisfy an appropriate experience pathway and that they have the proper Continuing Medical Education (CME) experience (see Challenge 3).
Typically it’s the responsibility of the Technical Director to complete the Accreditation process, taking time away from direct patient care. The Technical Director still needs to successfully carry out the responsibility of “technically directing” the other technologists, or in the case of smaller labs where only the Technical Director is performing studies, the application must be completed between patients or outside of normal lab hours. The bigger the lab, the more time it takes to complete the process. If accreditation is taking you away from these daily tasks, your lab is increasing expenses and losing revenue.
Challenge #2 Quality Assurance
The accrediting bodies give us the opportunity to submit our best work, and in a perfect world, we would be able to take any study that we’ve done and submit it. However, we all know that there are circumstances that keep us from being “perfect”, including difficult patients and performing studies under less than ideal conditions. While a case might meet the definition of “positive” and is diagnostic, it might not strictly adhere to the testing protocols or it might have an interpretation that is vague when it comes to the diagnostic criteria. Cases that don’t adhere to the Standards may cause a delay or even a denial of accreditation, which makes picking cases for submission one of the most challenging tasks.
Another challenge is defining a process for gathering correlative studies, analyzing and documenting correlation findings, and putting together and sharing the correlation findings. Some labs have difficulty getting comparative reports or films from other departments or facilities, while other labs have trouble actually finding an “adequate” gold standard to which to compare. The IAC has other pathways for comparing quality, like peer review; however, finding the time (see Challenge 1) to review and report these findings can be daunting.
Then there is the time needed to have Quality Assurance Meetings to review the cases and correlation findings. We all know how frustrating it can be to schedule a regular meeting with the Medical and Technical staff without disrupting patient care (see Challenge 1 again).
It’s not that this Challenge cannot be overcome; it takes planning and dedication of all of the staff to make sure that there is adherence to the quality standards. Some labs are able to review cases and have meetings remotely, while other labs have the full buy-in from their staff to make this happen.
Challenge #3 Documentation
As stated above, it can be difficult to get all of the Medical and Technical Staff together to review QA results, but try gathering all of the educational, experiential, and credential information from the Staff, especially during the initial application process; it’s like herding cats. During the initial process gathering curriculum vitae, sonographer and physician credentialing documentation, and continuing medical education (CME) credit related directly to Vascular Technology is one of the most challenging tasks you will encounter.
Getting documentation from the technical staff proving that they are credentialed is difficult. For the well-organized technologist, producing the appropriate documentation is not difficult, but this creature can be as elusive as a unicorn. Credentialing of ALL technical staff became a requirement for accreditation as of January 1, 2017. In some states, credentialing and accreditation are linked to reimbursement, so if someone doesn’t have their credential within this calendar year, your lab may run the risk of losing accreditation, and ultimately revenue.
Most staff do not know the CME requirements prior to beginning the process and may have to go conferences and seminars or find another way of getting appropriate CME. The lab should set up a process for getting CME on a regular basis; this is a must if you don’t want to be scrambling for CME at the accreditation submission deadline. If a lab is in a hospital or facility that is ACCME-accredited they can offer Category I AMA Physician Recognition Award credit for the QA meetings. Subscriptions to publications or websites that provide physician and sonographer CME is another alternative. Applying to professional organizations that offer technologist CME credits for your meetings is also a viable pathway for assuring that appropriate CME requirement are met for technical staff.
So whether you are starting out with a new application or you’re an old pro at IAC Vascular or ACR Accreditation, the process will never run as smooth as you’d like. But having a plan in place and knowing what challenges lay ahead will help make the process as painless as possible.