Accreditation - Nonstandard Standards

September 13, 2010
Melissa Young, MD

Some payers are now requiring that non-radiologists get certified or accredited to perform ultrasounds. Otherwise, guess what - they won’t pay.

As an endocrinologist, the ultrasound is a very valuable tool. It helps me not only to determine the size of a thyroid nodule, but to monitor it over time, and to look for certain characteristics that would make me more suspicious of thyroid cancer. Not to mention that, quite honestly, it is one of the few reimbursable procedures I can do.

Some payers are now requiring that non-radiologists get certified or accredited. Otherwise, guess what - they won’t pay. Fortunately (or unfortunately, depending on your point of view), the American Association of Clinical Endocrinologists anticipated this, and developed a program so that endocrinologists can get accredited. For a fee, of course.

It entails taking a written exam, providing documentation of the volume of ultrasounds and ultrasound guided biopsies performed, and submitting samples of studies and reports. The reports have very specific requirements. The manual spells out exactly what needs to be in the report - size, character, location, degree of vascularity. And not just thyroid nodules, but also abnormal lymph nodes and parathyroids.

I understand, you don’t want every Tom, Dick, and Harriet performing ultrasounds after taking a one-day course. You want someone to have enough experience and expertise to make sure the studies are reliable. Having said that, I receive plenty of ultrasound reports from radiologists - you know the people who spent four years of residency learning this and who do this every day - that would not meet the exacting standards that I am being asked to meet.

Hello? Where is the third dimension of the nodule? I can’t tell from their descriptions whether or not the nodules have suspicious characteristics. Microcalcifications? Increased vascularity? Hypoechoic? If these radiologists, who are, of course, certified or accredited or whatever the proper term is, are getting paid to read these studies (which by the way are performed by techs, not by the good docs themselves), then why am I being held to a higher standard?

And did I mention I get to recertify again in 10 years? Maybe by then I’ll retire, or hit the lottery. Hey, I can dream, can’t I?