Managing Continuing Medical Education on the Local Level and Other Benefits of an Active Local Chapter
by Cliff Araki, PhD RVT
When compared to technologists in all other non-invasive diagnostic
specialties, Vascular Technologists are at considerable disadvantage in
terms of a lack of educational resources, level of technical expertise
demanded, and continual advances in technology that must be mastered at
the technologist level. Vascular Laboratories are in a position of
increasing government regulation, external competition and decreasing
reimbursement. The current environment places all vascular technologists
and laboratories in positions, which are increasingly difficult to
manage without external support. I believe this support is best and
possibly only available through the development of a strong local
organization such as a chapter of the Society for Vascular Ultrasound.
Vascular ultrasound is a difficult field of practice. Unlike most
non-invasive diagnostic modalities, it requires a skilled operator to
perform highly complex tasks. At its best this means that it requires a
person with good analytical skills capable of distinguishing subtle
hints of disease from an ultrasound image. At its worst it involves a
lengthy, labor-intensive diagnostic protocol that wears out both
technologist and patient. Diagnostic practices can be so specific in the
postoperative patient that protocols for evaluation often needs to be
developed impromptu, using reconfigured protocols to obtain as much
information as possible.
EDUCATION/CONTINUING EDUCATION
Vascular technologists rely upon the usual case of self-teaching and
on-the-job training. The educational foundation for Vascular Technology
is extremely weak. Within the United States, there are only seven
Vascular Technology Programs accredited by the Commission on
Accreditation of Allied Health Education Programs. This can be compared
to the 76 educational programs in Diagnostic Medical Sonography. The
typical general sonographer enters the workplace after graduating from
an accredited program. This gives the entry-level sonographer registry
eligibility after graduation and easy access to passing the registry
examination (RDMS for sonographers). On the other hand, educational
opportunities for Vascular Technology are extremely limited.
Realistically, they are nonexistent for the majority of personnel
entering the workforce.
Continuing education through national symposia is intended to provide a
forum for new applications in Vascular Technology, to facilitate the
introduction of new techniques and protocols. The educational conduit is
often restricted by travel dollars with only the senior staff usually
able to travel to national meetings. Other RVT staff must depend upon
other forms of CME accrual. Still, while local chapters of SVU can be
good sources of continuing education, they often suffer from low
membership and/or strong member participation. A significant number of
technologists do not participate in the local affiliate, making a strong
and vital chapter difficult to develop and maintain. There are many
working technologists that are not registered and have difficulty
gaining certification. Self-teaching combined with prolonged studying
proves to be a formidable challenge to those with busy work schedules.
For some, certification as a Registered Vascular Technologist (RVT) can
be delayed for years. For others it is on permanent hold.
NEW VASCULAR APPLICATIONS
New developments at the national level seldom reach the level of the
local laboratory. For the vascular laboratory, new noninvasive vascular
applications are slow to develop. If we look at the existing structure
in protocol development, there are few opportunities to convert new
vascular applications into practice. The traditional route for
developing expertise in vascular laboratories often involves Vascular
Surgeons and technologists working together in a laboratory often
working only with published literature to guide development. Limitations
in time and expertise often slow the progress, with many false starts
and mistakes rediscovered by one laboratory after another. Demands on
technologists can be extreme as they manage new applications on top of
the existing laboratory volume. The process is so daunting and
short-lived for most laboratories that many eventually venture little
beyond the basic forms of testing.
CHALLENGES TO THE VASCULAR LABORATORY
Despite day-to-day pressures, vascular laboratories are continually
being challenged to develop expertise beyond the basic procedures we
perform. Competition exists from General Ultrasound laboratories that
will only intensify as they perform and expand on basic carotid and
peripheral venous testing. Other forms of noninvasive assessment (e.g.
MR angiography, Spiral CT) are providing complementary competition to
ultrasound in certain applications, which may at some point lead to
replacement.
Positive challenges also arise from Vascular Surgery in seeking new
endovascular approaches to the treatment of vascular disease. As
vascular surgery makes new inroads to non-operative treatment, it is
vital that the vascular laboratory gain new skills pertinent to aiding
catheter-based treatment. This may take the form of screening,
post-catheterization assessment and even ultrasound guidance during the
performance of catheter-based procedures. Vascular laboratories should
be actively seeking these new applications to remain current and active.
Advances in ultrasound technology add additional challenges to
technologists and laboratories. Many of these advances are uniquely
suited to improving vascular investigation. Significant enhancement of
imaging harmonics, color energy, color flow Doppler, and the greater
computing power have allowed greater real-time scanning with better
noise filtration. All have added greater capability to diagnostic
testing. Vascular laboratories have not yet recognized how best utilize
the new sophistication in equipment. While these factors have the
capability to expand the application base of the vascular laboratory,
they will not truly help a laboratory until it decides to move beyond
the basic forms of vascular laboratory testing.
THE CHANGING REIMBURSEMENT ENVIRONMENT
HCFA requirements ICAVL accreditation
In June of 1995, the Health Care Finance Administration (HCFA)
recommended to its carrier medical directors that “… effective January
1, 1997 all non-invasive vascular diagnostic studies must be performed
by, or under the supervision of persons that have demonstrated minimum
entry level competency by obtaining credentials in Vascular Technology.
Examples of appropriate verification includes the (RVT) and (RCVT) in
Vascular Technology. Direct supervision requires the certified
individual's physical presence in the laboratory”.
The policy, directed toward Medicare Part B reimbursements, was not a
strict mandate from HCFA. Local carriers, contracted by HCFA to manage
regional Medicare reimbursement, have been able to determine the
implementation of this policy within the states and regions they
oversee. States currently affected include Louisiana (1/1997), Alabama,
Ohio, and West Virginia (1/1998), Kansas, Nebraska, and Western Missouri
(7/1998), New Jersey, Pennsylvania, and South Carolina (1/1999).
Delaware, greater District of Columbia, and Texas (2/2000). The form of
implementation has varied with carrier. Some require direct supervision
by an RVT or RVS (AL, LA). The others allow either RVT/RVS supervision
or ICAVL accreditation.
Laboratories have to be concerned about maintaining and building
laboratory volume but managers of private laboratories know that billing
and reimbursement drive the business. HCFA continually proposes
limitations on reimbursement to stem potential abuses. Because abuses in
the field tarnish all providers in the field, many restrictions are
applauded by the industry. However, restrictions may also threaten good
diagnostic practices. State and HCFA proposals should be monitored by
the local vascular community and the local chapters are the ideal means
for laboratories to impact upon statewide legislative actions, network
on ICAVL accreditation, and pooling resources to register technologists.
PARTICIPATING IN THE LOCAL CHAPTER
I have mentioned above the problems faced by vascular laboratories to
maintain current and viable and to face problems in advancing the
laboratory to meet future goals. Laboratory managers have not recognized
how the local chapter may be utilized to provide many of the
educational and developmental needs of the individual laboratory.
Local chapters have instead been designed to address the needs of
individual technologists: 1) to keep up with the latest vascular
applications and technology, 2) to earn Continuing Education credits,
and 3) to network when searching for a new position.
Strong local SVU chapters should be developed with the active support
of vascular laboratories and managers within the chapter area. Chapters
should be focused on overcoming challenges faced by technologists and
affiliate laboratories and to advance new applications in the field.
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Facilitate the adaptation of new vascular applications by providing a
collaborative environment for the development of new techniques. Local
Organizations should serve as information transfer centers between newly
developing techniques discussed in national meetings and actual
practice.
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Promote greater standardization of laboratory protocols among local laboratories
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Facilitate the formation of study groups to aid technologists in passing the RVT examination.
SUMMARY
Vascular Laboratories and technologists should not be complacent.
Unable to grow, we may become antiquated and overwhelmed as we sink into
obsolescence. Laboratories within a locality should be more interactive
to achieve common goals. I do not believe that competition, outside of
bragging rights, really exists among laboratories but neither does the
level of cooperation that is becoming increasingly important. We should
be in a cooperative environment to grow as a strong specialty field.
Local chapters should be looked at as important links to rejuvenating
and advancing the field of vascular technology.