Mandatory Cardiac Imaging Accreditation Looms on the Horizon

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The federal government is following the path of some private payors by crafting legislation that ties payment for advanced imaging services to accreditation.

In the past two decades, non-invasive diagnostic imaging has become a first-line protocol in the evaluation process of the estimated 61 million people in the U.S. with known or suspected heart disease. Because of the prevalence of the disease, quality cardiovascular imaging and interpretation are critical components in the diagnostic armamentarium. In response to this need, professional medical societies have formed accreditation bodies to ensure those performing diagnostic cardiac imaging procedures demonstrate a commitment to quality and accepted standards of practice.

There are two nationally accepted accrediting bodies in the U.S. for the medical imaging modalities of noninvasive vascular technology, nuclear medicine (including SPECT and PET), MR and CT: the Intersocietal Accreditation Commission (IAC), which has five divisions dedicated to cardiac imaging accreditation, and the accreditation programs offered by the American College of Radiology (ACR).

“Laboratory accreditation offers the means necessary to demonstrate a commitment to quality in patient care, quality in imaging, quality in interpretation, quality in reporting and, most of all, the overall quality of the facility,” says Gary V. Heller, MD, PhD, director of nuclear cardiology and the cardiovascular fellowship program at Hartford Hospital in Hartford, Conn., and co-author of a recent article on cardiovascular accreditation (J Am Coll Cardiol Img 2008;1:390-397).

Historically, cardiac imaging accreditation has been a voluntary effort by facilities electing to participate in the process. By many indications, mandatory compliance with accreditation may soon be compulsory.

The American College of Cardiology (ACC) Statement on Accreditation/Certification, adopted by the ACC Board of Trustees on March 5, 2005, delivered emphatic support for cardiac imaging accreditation. The ACC emphasized that it “encourages governments and payors to make accreditation/certification programs mandatory conditions of participation.”

Though the ACC supports accreditation solely as a mechanism to improve quality, not as a growth- or cost-containment mechanism, “the inference is clear: unaccredited facilities risk losing business as well as public confidence,” notes Wayne Schellhammer, executive vice president of Kardia Health Systems, a Rochester, Minn.-based provider of echocardiography information management systems and cardiac accreditation consulting.

Applications for Accreditation on the Rise
The number of applications for echo and nuclear lab accreditation has grown exponentially since the accrediting bodies were initiated more than a decade ago. Source: Gary V. Heller et al, J Am Coll Cardiol Img 2008;1;390-397

Imaging societies get onboard

On April 27, 2005, the American Society of Echocardiography (ASE) released a statement, in the form of a proposed local coverage determination which clearly indicates its position on accreditation.

“The accuracy of a transthoracic echocardiogram depends on the knowledge, skill, and experience of both the individual performing the study and the physician interpreting the study. For this reason, a transthoracic echocardiogram must be performed in a laboratory that is accredited in transthoracic echocardiography by the Intersocietal Commission for the Accreditation of Echocardiography Laboratories (ICAEL) and interpreted by a physician who is subject to the quality assurance program established by that laboratory,” the ASE wrote.

The American Society of Nuclear Cardiology (ASNC) also came out strongly in favor of facility and personnel accreditation in 2005, stating that it “supports the mandatory accreditation of nuclear cardiology laboratories and mandatory certification of physicians practicing nuclear cardiology by January 1, 2008.”

As chair of the ACR board of chancellors in 2005, James Borgstede, MD, testified before Congress that the use of “accreditation standards is one mechanism to help attain the goal of increasing quality and safety, while at the same time reducing utilization costs to Medicare.”

These unequivocal statements endorsing mandatory accreditation did not sit well with all members of these professional societies. “Our organizations got to be a little unpopular with some of the membership,” observes Kim A. Williams, MD, director of nuclear cardiology at the