Imaging at a Crossroads: CT scan providers urged to initiate accreditation

“Imaging is at an interesting crossroads,” Dr. Setzen said. “As more physicians perform advanced imaging services as part of their office practices, there are concerns about radiation dose exposure and safety, cost and utilization. Accreditation is the route to address these concerns. It takes unqualified personnel and poor quality out of the picture, and provides a more standardized mechanism for performance and interpretation, for reimbursement and, most importantly, for safety of the patient.”

Michael Sillers, MD, past president of the American Rhinologic Society and owner-operator of Alabama Nasal and Sinus Center in Birmingham, Ala., didn’t wait for Medicare’s deadline. As a solo practitioner who uses a limited cone beam CT scanner for diagnosis and treatment planning, he started his accreditation process in 2009. “You could see the writing on the wall,” he said. “We knew [accreditation] was coming.” In fact, United Healthcare (UHC) was the first payer in Alabama to announce accreditation as a requirement for reimbursement. (UHC later suspended its 2008 deadline in deference to the impending CMS/MIPPA rule.)

“As more physicians perform advanced imaging services as part of their office practices, there are concerns about radiation dose exposure and safety, cost and utilization.”

—Gavin Setzen, MD, FACS, FAAOA

Which Accrediting Organization?

In January 2010, CMS/Medicare, as mandated by Congress, designated the ACR, The Joint Commission and the IAC as the three accrediting organizations (AOs). Each has developed and maintains its own program standards and protocols, and although Medicare does not dictate those programs, the agency did outline parameters that any standards used should address, such as:

• qualifications for personnel who furnish the technical component of imaging services;
• qualifications of facilities’ medical directors and supervising physicians, which can be the same person, depending on the AO;
• equipment specifications and procedures; the assurance of operator and patient safety; and
• ongoing quality assurance programs.

Although each AO has a three-year accreditation cycle, there are program differences that will determine which organization providers choose.

Since 1963, the ACR has provided accreditation for diagnostic imaging and radiation oncology. The supervising physician for the ACR accreditation program can be a board-certified radiologist or diagnostic radiologist, or another physician who has completed continuing medical education units and has interpreted and reported on 500 cases within the last 36 months. A distinctive feature of the ACR process is the requirement to submit phantom images. The ACR does not accredit the cone beam scanners. If a practice uses a full-body scanner, physicians “can visit the ACR website to see whether their images will meet our requirements,” Wilcox said. For a summary of the ACR’s CT Accreditation Program Requirements, go to acr.org/accreditation/computed/ct_reqs.aspx.