Accreditation of your office-based vascular lab: A must

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Drusilla Sparks
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1 Accreditation of your office-based vascular lab: A must Jose I. Almeida, MD, FACS, RPVI, RVT Director, Miami Vein Center Voluntary Associate Professor of Surgery University of Miami School of Medicine

2 Faculty Disclosure Jose I. Almeida, MD, FACS, RPVI, RVT 1. Research grant support AngioDynamics, Covidien, Sapheon, Vascular Insights 2. Managing Partner Vascular Device Partners, LLC

3 Why Become Accredited? Process clearly organizes Vascular Laboratory testing and improves quality of patient care. Increase physician & patient referrals. Will be required for reimbursement in the future?

4 Accrediting Organizations Organization Year Founded Accredited Organizations Joint Commission on Accreditation of Healthcare Organization (JACHO) Accreditation Association for Ambulatory Health Care (AAAHC) , ,600 Intersocietal Commission for the Accreditation of Vascular Laboratories (ICAVL) (913 Venous) Florida: (33%) Hospital Based

6 Outpatient Surgery Safety Committee & Florida Board of Medicine Basic standards for Level I surgical procedures. Rules for Level II and III anesthesia are more stringent. All offices using IV sedation or general anesthesia must be accredited by the JCAHO, AAAASF, AAAHC, and adverse incidents must be reported to the Medical Board of Florida. Risk management program with detailed logs. Balkrishnan R. Dermatol. Surg. 2003

7 AAAHC

8 ICAVL $200 Application Kit $1,000 Base Fee $500 Supplies $300 per Area of Accreditation Arterial 1, Venous 2, Extracranial 3, Intracranial 4, Visceral 5, and Screening 6.

11 Contractor Name: First Coast Service Options, Inc. LCD Title: Non-Invasive Evaluation of Extremity Vein Contractor Number: & Contractor Type:

12 Training Requirements The accuracy of non-invasive vascular diagnostic studies depends on the knowledge, skill and experience of the technologist and the physician performing the interpretation of the study. Consequently, the technologist and the physician must maintain proof of training and experience. All non-invasive vascular diagnostic studies must be: (1) performed by a qualified physician, or (2) performed under the general supervision of a qualified physician by a technologist credentialed in vascular technology, and/or (3) performed in a laboratory accredited in vascular technology.

13 A qualified physician for this service is defined as follows: Training and expertise must have been acquired within the framework of an accredited residency and/or fellowship program in the applicable specialty/subspecialty or must reflect extensive continued medical education (CME) activities. If these skills acquired by CME, the courses must be comprehensive, offered or sponsored or endorsed by an academic institution in the United States and/or by the applicable specialty/subspecialty society in the United States, and designated by the American Medical Association (AMA) as Category 1 Credit.

14 Examples of certification in vascular technology for nonphysician personnel include: Registered Vascular Technologist (RVT) credential Registered Vascular Specialist (RVS) credential These credentials must be provided by nationally recognized credentialing organizations such as: The American Registry of Diagnostic Medical Sonographers (ARDMS) which provides RDMS and RVT credentials The Cardiovascular Credentialing International (CCI) which provides RVS credential

15 Appropriate nationally recognized laboratory accreditation bodies include: Intersocietal Commission for the Accreditation of Vascular Laboratories (ICAVL) American College of Radiology (ACR) However, if the facility has a documented process for grand-fathering experienced technicians who have performed the services referenced in this LCD (a process addressing years of service and experience with number of supervised cases), this documentation should be available to Medicare upon request; otherwise the provider must have documentation available to Medicare upon request which indicates that the technician meets the credentialing requirements as stated above or is in the process of obtaining this credentialing.

16 Administrative Part Practice Demographics Practice History Annual Volume Staff (Medical Director, Technical Director, Technologists, and Medical Staff) Credentials Policies QA Instrumentation

18 Venous Part Indications Technical Protocols Diagnostic Criteria Correlation Analysis (Vascular Laboratory vs. Various Modalities) Logs Example Cases

19 STANDARD Medical Director 1. must be designated for the facility. Medical Director qualifications: Supervises the entire operation; may delegate specific duties to appropriate staff Maintaining and assuring compliance to the standards as outlined in this document Comment: If the Medical Director is off site, he/she must have a physical presence in the lab to participate in regular QA meetings, case study review conferences, personnel interviews and other laboratory operations.

20 STANDARD Technical Director 1.must be designated for the facility. 2.generally a full-time position. If the Technical Director is not onsite full time, he/she must work a minimum of 20% of normal business hours each month AND An appropriately credentialed technologist must be appointed in the Technical Director s absence and report to the Technical Director. Comment: The Medical Director or a member of the medical staff must satisfy the qualifications of the Technical Director to serve in that capacity.

21 Jose I. Almeida, MD, FACS, RPVI, RVT

22 THE ICAVL DOES: Attempt to stay abreast of payment policies as a service to the vascular community. Communicate information to vascular laboratories about payment policies (through the ICAVL website, newsletter articles) THE ICAVL DOES NOT: Establish rules or regulations for the insurance carriers.

24 Conclusion: Credentials, credentials, credentials Thank you!

CLINICAL PRIVILEGE WHITE PAPER

Practice area 191 CLINICAL PRIVILEGE WHITE PAPER Cardiovascular technologist Background Cardiovascular technologists are allied health professionals who are concerned with the diagnosis and treatment of