The Need for Vascular Laboratory Accreditation Within the Veterans Administration

“To care for those that shall have borne the battle.” ¹

President Abraham Lincoln delivered these renowned words to a divided nation with thousands of causalities after the Civil War; compelling words for veterans past and present. The Department of Veterans Affairs (VA) embraced these words, undertaking that same mission for modern-day veterans. Building upon that calling, Robert A. McDonald stated, “Our commitment to serving veterans must be unquestioned. Veterans must know that we are ‘all-in’ when it comes to accomplishing our mission and living by our values.” ² He reinforced that mission, highlighting the core values of integrity, commitment, advocacy, respect, and excellence.

Vascular sonography is the creation of imagery using ultrasound, providing clinically diagnostic evaluations of vascular anatomy through noninvasive methods for significant pathophysiological diagnoses. Vascular sonographers provide services with increased levels of responsibility, and quality imaging is essential. Under the scope of a vascular surgeon or radiologist, exemplary imaging skills with a strong understanding of peripheral vascular hemodynamics are of utmost importance. Playing a major role in the acquisition of a preliminary diagnosis, sonographers and physicians must consistently emphasize quality and accuracy.

The VA vascular sonography service must exem-plify these principles in daily practices to continue the important task established in 1865. The most important step in that mission is using an accreditation organization. “Accreditation,” according to the Oxford Learner’s Dictionaries, is “the approval given by an organization stating that someone or somebody has achieved a required standard.” ³ Few VA imaging laboratories acquire national accreditation, instead preferring to use standard VA patient safety policies. To obtain vascular laboratory accreditation, you must have credentialed vascular technologists (RVT or RVS). This specific skill set provides patients the assurance that their vascular care is vital. Without accreditation, many patients are unlikely to pursue vascular imaging with a facility that does not meet that higher bar of excellence. Patients have access to online medical forums that promote high expectations for medical care. These sites can also provide guidance to patients as to how and where they can use their medical benefits. Many insurance providers seek more qualified personnel, and as such, accreditation is becoming the requirement for reimbursement eligibility. It has become an integral part of the perception and expectation of the vascular sonographer’s competency and capability to provide detailed and reliable imaging for a veteran vascular patient.

Many medical facilities seek and maintain their accreditation with the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), but vascular imaging laboratories are specifically reviewed for higher standards of care. The Intersocietal Accreditation Commission (IAC) and the American College of Radiology (ACR) are the primary accrediting bodies for vascular imaging. The achievement of facility accreditation benefits the veteran community, ensuring that the vascular evaluations performed are comprehensive and executed by credentialed individuals. A vascular team that confidently provides a correlation of patient evaluation to symptoms allows the patient and surgeon to make difficult but appropriate medical decisions. Veterans and the health facility benefit from promoting accreditation of the vascular lab as it reflects a commitment to being “actively engaged in the care of patients through their pursuit of accreditation.” ⁴ Vascular accreditation requires continual evaluation of functional practices, ensuring superior image quality and thereby making patient safety a top priority. These same principles are represented in the VA’s core values. Implementation of accreditation also promotes a more self-fulfilling environment for sonographers who advocate patient care and integrity in their work. This also increases the patient’s ability to use additional insurance benefits.

Currently, the VA is reimbursed for medical services based on a veteran’s income verification and establishing copays. Medicare benefits and private insurance are then used for repayment. Medicare is the established benefit carrier for veterans 65 years and older as well providing the largest form of reimbursement. This is relevant due to Medicare’s increased demand for vascular laboratories to become accredited in order to provide reimbursement. Private insurance vendors are following that same line of action. ⁵ Examinations must be performed by a sonographer adequately credentialed and provides an elevated standard of care, as determined by the accrediting body. Failure to achieve accreditation will result in unpaid imaging services and a reluctance for veterans to seek vascular care at the VA. Recruiting health care professionals, who provide high-quality services, and retaining experienced staff help to meet Medicare’s newly established directives.

However, challenges to recruiting appropriately trained personnel and achieving laboratory accreditation, within the VA system, are due to discrepancies in the job description. The job requirements for federal imaging personnel are often different from those for private-sector personnel. Community vascular facilities have specific job descriptions and qualifications that serve to uphold laboratory accreditation, as well as JCAHO mandates. These are included as a term of employment. Very often, failure of staff to provide the expectation of high-quality patient care can be grounds for termination. Currently, the VA Health Administration requires that sonographers be credentialed in their prospective imaging field but does not require imaging laboratories to be accredited. Maintenance of laboratory accreditation is not a condition for continued employment. This could be easily remedied by having the vascular laboratory become accredited as this will mandate specific personnel requirements, motivating current sonographers to maintain their basic skills, and current technology. The sonography staff also benefits by progressing professionally and reflecting core health care values, which translates to veterans who prefer medical care, within the VA.

Our nation’s veterans have sacrificed years of service to promote our safety and protection. It is for this reason that they deserve excellent medical care. These former military men and women were held to high standards of professionalism, and they share the VA’s core values. Promoting vascular laboratory accreditation demonstrates to veterans a commitment to high-quality vascular assessment. Sonographers can advocate for patients by presenting high-quality, in-depth imaging and clear preliminary reporting. When highly trained and experienced vascular personnel are providing patient care, there is an unquestionable commitment to excellence. When the vascular laboratory commits to the ongoing process of accreditation, it promotes respect, integrity, and workplace ethics that are core values of the VA. Veterans value integrity and are conditioned to expect higher levels of performance through their own military experience. Vascular physicians have confidence in initial imaging completed by an accredited laboratory staff, and this translates to expediting secondary imaging and treatment decisions, which positively affects veterans and their families. Veterans will have more confidence in a medical system built specifically to support their health care needs and vascular concerns. This makes veterans more at ease with the decision to seek care with the VA and fulfill the organization’s mission, “To care for those who shall have borne the battle.” ¹