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AAOS Now

Published 3/1/2010
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Terry Stanton

CMS approves three imaging accreditors

Medicare requirement takes effect in 2012

Orthopaedic surgeons have options for complying with upcoming accreditation requirements for advanced imaging after the Centers for Medicare and Medicaid Services (CMS) named three organizations, one of which has ties to the AAOS, as designated accrediting bodies.

CMS announced that the Intersocietal Accreditation Commission (IAC), the Joint Commission, and the American College of Radiology (ACR) are approved to accredit Medicare suppliers who furnish the technical component of advanced diagnostic imaging—magnetic resonance imaging (MRI), computed tomography (CT), and positron emission tomography (PET). Under the Medicare Improvement for Patients and Providers Act, beginning Jan. 1, 2012, suppliers of those services must be accredited to receive Medicare reimbursement.

The IAC unit for MRI is the Intersocietal Commission for the Accreditation of Magnetic Resonance Laboratories (ICAMRL). The current president of ICAMRL, Robert W. Westergan, MD, is an orthopaedic surgeon, as is another of its board members, A. Louis Mariorenzi, MD.

A victory for AAOS
The AAOS had sought to have more than one accrediting agency, and the CMS decision is viewed as welcome news for orthopaedic surgeons. In comments submitted to CMS last year, 2009–2010 AAOS President Joseph D. Zuckerman, MD, urged CMS “to ensure that multiple accreditation organizations participate in the process so as to guarantee that no single organization maintains a monopoly on the imaging accreditation process and criteria.”

The perception was that under sole ACR administration, medical practices without a radiologist on staff would find it difficult to obtain accreditation. According to Matthew Twetten, AAOS senior policy analyst, about 30 percent of orthopaedic groups provide advanced imaging services.

Because “orthopaedic surgeons experienced in diagnostic radiologic methods are fully competent to supervise the performance of and interpret imaging studies in their office for the evaluation and management of their relevant conditions,” the AAOS argued that measures to ensure high quality of care in the use of imaging should focus on transparency of ownership interests, disclosure of alternative providers, development of appropriateness criteria for imaging services, and liability reform to address the practice of defensive medicine.

The accreditation initiative was pushed by the rapid rise in the use of advanced imaging modalities across medicine. Between 1999 and 2003, diagnostic imaging services paid under Medicare’s physician fee schedule grew more rapidly than any other type of physician service, at approximately double the rate of all other physician services.

Meeting the ICAMRL standards
It is expected that most orthopaedic practices seeking accreditation will do so through ICAMRL, both because of the involvement of orthopaedic surgeons in its governance and because it provides the option of obtaining accreditation for MRI only.

“Orthopaedic surgeons have been extremely involved in writing the standards,” said Tamara Sloper, marketing director for the IAC. They can look at ICAMRL as “a program that is steered and governed by their peers,” she added.

The standards for the musculoskeletal component of ICAMRL are available online and identify key elements of both technical and interpretive quality. These include indications, technique, and components of examination performance, procedure volumes, and quality assurance. Standards also cover the background and training of medical and technical personnel, physical facilities, and patient confidentiality.

To meet the Jan. 1, 2012, accreditation deadline, ICAMRL recommends that practices submit their applications no later than July 2011. Generally, the time between submission of an application and a decision from the Board is about 12 weeks, but most applicants are not approved on the first try, so allocating enough time to resubmit is crucial. Furthermore, the time required to assemble information prior to submitting the application can vary widely depending on a practice’s readiness.

Cost to obtain and submit an application is $200, and the cost for review of the first unit is $2,400, with discounts for additional units and multiple sites.

“Because our process meets the needs of the orthopaedic surgeons, we look forward to working with them to achieve accreditation for their facilities,” Ms. Sloper said. “AAOS members need to know about this process so that they can comply.”

ICAMRL and its MRI standards can be accessed at www.icamrl.org

Terry Stanton is senior science writer for AAOS Now. He can be reached at tstanton@aaos.org

Imaging accreditation by The Joint Commission
The Joint Commission has accredited ambulatory care facilities since 1975; it has also surveyed imaging practices for more than 10 years. An orthopaedic practice engaging or continuing with the Joint Commission can elect to have its imaging facility included as part of its ambulatory care accreditation.

According to Michael Kulczycki, executive director, Ambulatory Care, for the Joint Commission, “We wanted to make sure that we could offer our significant base of current customers this additional designation that CMS is requiring so that they wouldn’t have to weigh a decision about switching to another organization.”

The accreditation philosophy of the Joint Commission takes an organization-wide approach. “It’s systems-oriented and process-oriented. And it is also, overall, concerned with both patient and staff safety and the processes for doing the right things right,” said Mr. Kulczycki.

The cost of accreditation through the Joint Commission for a moderately sized practice is about $10,000, which includes the ambulatory care evaluation and as many modalities as the practice may have. The process takes an average of 3 to 6 months and typically involves a 2-day site visit.