Chapters

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 a reluctance in 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 individuals 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.

• 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.
• Promote greater standardization of laboratory protocols among local laboratories
• 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.