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10.14.2014

Study Suggests Vascular Testing Labs Lack Accreditation in Regions of U.S.

An interdisciplinary group of researchers from the University of Miami Miller School of Medicine recently published a study that found a lack of accredited outpatient vascular testing facilities in some regions throughout the U.S., including the southern stroke belt.

“These results are very significant for healthcare providers, patients and their families as well as for payers and policy makers,” said the study’s lead investigator, Tatjana Rundek, M.D., Ph.D., professor of neurology and Vice Chair for Clinical Translational Research. “A high number of unaccredited facilities gives the impression that no one is watching these labs.”

Lab accreditation, which is authorized by only a few organizations in the U.S., ensures quality standards at testing facilities, including lab work, personnel credentials and equipment. If labs are not accredited, patients are vulnerable to any number of medical issues and inaccurate test results and diagnosis, said Rundek, adding that results from non-accredited laboratories should be used with caution.

“At times test results have inaccurately suggested that patients need surgery and vice versa, so there’s a lot at stake.”

The study, “Accreditation status and geographic location of outpatient vascular testing facilities among Medicare beneficiaries: The VALUE (Vascular Accreditation, Location & Utilization Evaluation) Study,” was published in the September issue of Vascular Medicine. It’s one of the first of its kind providing actual statistics on accreditation of lab facilities by state.

As part of the year-long investigation, researchers examined a random sampling of about 13,500 vascular testing facilities that billed Medicare for vascular testing services in 2011. The sampling represented the study’s targeted 5 percent of outpatient vascular testing facilities in the U.S. The study assessed the number and percentage of facilities accredited by the Intersocietal Accreditation Commission, which certifies labs based on vascular testing, echocardiography, nuclear/PET, MRIs, diagnostic CT, dental CT, carotid stenting and vein treatment and management.

Among the research findings, about 13 percent of the labs in the sampling were IAC accredited. The rate of accreditation among vascular testing facilities also varied significantly by region.

States in the Northeast showed the largest number of accredited sites, at 26 percent. The South ranked second at 12 percent, followed by the Midwest at 11 percent and Western states at 7 percent.

Florida ranked 14th in the percentage of IAC accredited facilities. And other states within the Southeastern U.S. and Mississippi Valley, referred to as the “stroke belt,” had less than 10 percent IAC accredited facilities.

Researchers noted that non-accredited vascular testing facilities perform vascular ultrasound services of unknown volume and quality, while equally reimbursed by Medicare for their performance.

“Besides low IAC accredited vascular laboratories across the United States, we observed significant regional disparities in the utilization of IAC accredited laboratories, with a particularly low proportion of IAC accredited laboratories in the regions with greater mortality rates from vascular diseases,” said public health researcher Scott C. Brown, Ph.D., research assistant professor of public health sciences, who co-authored the study with Miller School biostatician Kefeng Wang, M.S., and Chuanhui Dong, Ph.D., research associate professor of neurology.

According to the study, prior evidence suggests that the accreditation of vascular testing facilities may be associated with better clinical outcomes. Among the shortcomings, non-accredited laboratories do not appear to be reliable in planning management of carotid atherosclerotic disease.

However, since the research was limited to IAC accreditation, Rundek noted that the study only offers a narrow glimpse of the accreditation rate of outpatient testing labs in the sampling.

IAC accreditation is widely respected within the medical community. Rundek was elected to the IAC’s Vascular Testing Board of Directors in 2012 and has set out to improve the quality of testing labs.

“Despite the limitation of including only one accreditation agency, the accreditation of vascular testing laboratories sets practice standards and assures quality performance of these laboratories,” said Rundek. “Increasing the number of accredited vascular testing facilities to improve performance quality is a hypothesis that we plan to test in our future research.”

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