Abstract
The letter is in reply to the article by Having, Barwick, and Collins, titled “Lab Accreditation and Credentials in Sonography: A Demographic Assessment of Facilities Receiving Federal Reimbursement,” published in the November/December 2011 edition (27(6): 243–251).
First, I would like to thank and applaud the authors and their supporting institution for developing, administering, and analyzing the survey. Finishing my dissertation a few months ago let me appreciate the amount of work put into this project. These types of endeavors are greatly needed to inform all of us about the state of the profession (as diagnostic medical sonography as a whole and in each specialty) today as well as what may need to be done or addressed for the future. I also thank the Journal of Diagnostic Medical Sonography (JDMS) and editorial staff for choosing this study for publication. The timing was very appropriate because of the changes in regulations awaiting the profession, and because as 2011 has ended, it may give many of us the opportunity to start 2012 with new motivations to be involved in professional organizations.
Personally, the publication of this article is also important because I have been preparing a manuscript about the utilization of diagnostic sonography in today’s health care system in an attempt to address needs, demand, and supply for the future. As such, I would like to present some additional information to the article.
In 2007, the Center for Medicare and Medicaid reported that 18 million claims were presented and paid through Medicare Part B for sonography services to its beneficiaries. 1 In 2008, the US Census Bureau reported that the use of diagnostic sonography during hospital short stays dropped to 900,000 procedures, or 3.0 procedures per 1000 people, from 1.6 million procedures in 1990. 2 Although the authors reported that the 300 million imaging procedures cited included all types of diagnostic imaging, I believe it is important to emphasize that the utilization of sonography is only a small portion of the services provided and is declining (in some areas of services).
The Bureau of Labor Statistics reported that in 2009, 51,630 people stated employment as sonographers. This number does not equate to positions available but to what people reported in the census questionnaire. I realized that it is almost impossible to estimate the actual number of people working as sonographers or the number of vacant positions. In September 2011, the number of sonographers (all specialties) credentialed through the American Registry for Diagnostic Medical Sonographers (ARDMS), Cardiovascular Credentialing International (CCI), and American Registry of Radiologic Technologists (ARRT) was 68,297 (with a few more since, as some of my graduates passed their tests—congratulations!). This number represents all active sonographers as reported by these organizations at that point in time. These include sonographers credentialed in one or several specialties, physicians holding a registry but not practicing as sonographers, and sonographers working in academia or research. Finally, and again as of September 2011, there were 10,517 accredited laboratories in the United States through the Intersocietal Accreditation Commission (IAC; Intersocietal Commission for the Accreditation of Vascular Laboratories [ICAVL]: 2164 and Intersocietal Commission for the Accreditation of Echocardiography Laboratories [ICAEL]: 4346), American College of Radiology (ACR; 3941), and American Institute of Ultrasound in Medicine (AIUM; 66). The same trend, more labs accredited through the IAC than the ACR (taking into account that the trend may be led by specialized services), is seen regionally and at the state level (for example, Florida has 96 ICAVL labs, 391 ICAEL labs, 319 ACR labs, and 8 AIUM labs; New York has 220, 491, 427, and 15 respectively; Ohio has 130, 217, 173, and 0; California has 59, 216, 194, and 17).
Comparing these data with the results of the survey presented in the article shows that overall, hospitals or medical centers appear to favor ACR accreditation (83% of the respondents of the survey were hospitals and therefore Figure 3 shows a higher percentage of ACR-accredited facilities when the IAC overall accredits more labs for two specialties only) over the IAC, but the IAC has a largest presence for office-based labs and independent diagnostic testing facilities (probably because more of these offer specialized vascular and cardiac imaging services). With regard to the number of sonographers not credentialed but working in that capacity, the percentage reported in the article seems low (which would be a good thing!), but estimating that number globally is almost impossible. Previous publications reported potentially 50,000 sonographers working without credentials. This may also be overestimated and may have changed (hopefully recently) with more stringent regulations for reimbursement of services.
I would also like to end by addressing a confusing statement in the article. The Commission on Accreditation of Allied Health Education Programs (CAAHEP) is one of the accrediting organizations for schools or education programs. The other accrediting organization is ABHES (Accrediting Bureau of Health Education Schools). The Joint Review Committee on Education in Diagnostic Medical Sonography (JRC-DMS) and the Joint Review Committee on Education in Cardiovascular Technology (JRC-CVT) are commissions under CAAHEP, for education programs and schools with curriculum in diagnostic sonography. The JRC-DMS and JRC-CVT (or Joint Review Committee on Education in Radiologic Technology [JRC-ERT] as cited in the article) do not accredit programs; they review applications, materials, and schedule site visits and then make recommendations for accreditation to CAAHEP. The JRC-ERT does not review diagnostic sonography.
In conclusion, I am again very appreciative of the effort of these authors in undertaking this study, and I hope it will inspire others to tackle other projects needed to provide information about our profession.