I have reviewed with interest messages which have appeared on the
UVMFLOWNET regarding CCI and the Vascular Registry Examination offered
which awards the credential RVS (Registered Vascular Specialist).

I would first like to clarify information regarding the allied health
fields in medicine and the credentialing agencies role in what is
considered the professional "triad".

The professional triad exists to serve a specific allied health field. This
triad has three components:

1.  Educational Programs
2.  Professional Associations
3.  Credentialing Agency

For Example:
The allied health field known as Cardiovascular Technology is represented
by the Joint Review Committee in Cardiovscular Technology (JRC-CVT), a
committee of the Commission on the Accreditation of Allied Health
Educational Programs (CAAHEP). This committee establishes the educational
standards for programmatic accreditation through a document called
the "Educational Guidelines and Essientials" .There are many other
educational programs however, but, they are not programmatically accredited
and are most likely, institionally accredited (this may include programs in
university or community college systems, as well as, proprietary schools)
or State approved.

Cardiovascular Technology has several professional organizations which
serve members of the profession this includes the American Society of
Echocardiography (ASE), the Alliance of Cardiovascular Professionals (ACP),
the Society of Invasive Cardiovascular Profesionals (SICP) and the American
College of Chest Physicians ect.

The identified credentialing agency for Cardiovascular Technology is CCI.

The allied health field known as Diagnostic Medical Sonography is
represented by the Joint Review Committee in Diagnostic Medical Sonography
(JRC-DMS).

Diagnostic Medical Sonography is served by many professional organizations
such as the Society of Diagnostic Medical Sonographers, The Society of
Vascular Technology ect.

The identified credentialing agency for Diagnostic Medical Sonography is
the American Registry of Diagnostic Medical Sonography (ARDMS).

This professional "triad" is also found in the Field of Radiology (JRC-ERT,
ARRT, ASRT) or in most professions found in the United States (legal,
accountants, physicians, nurses).

Having stated these differences I wish to address the question in relation
to CCI's Vascular Exam. In review of messages I have seen both testimonial
to CCI and it's exam, testimonial to the ARDMS and varied requests or
underlying comments related to current national politics or accreditation
pathways through the ICAEL or ICAVL. I would first address what CCI
currently administers in regards to the examination process. I will make
reference to the ARDMS, this is to allow individuals who currently have
this registry credential to be assured that there are no underlying
processes or politics involved between these two agencies except for those
generated from within the professional community. In addition, I will
address the ARRT crendentialing process to the best of my ability, and my
historical knowledge on the development of it's credentialing program.
Finally, I wish to make an attempt at demonstrating the value of any
credential to the care and safety of the patient, who appears to have been
left out of this controversy.

CCI is the credentialing agency for Cardiovascular Technology and as such
develops and administers examinations in Vascular Ultrasound,
Echocardiography and Cardiac Catheterization. Registry exams in these
specialities require the completion of a two-part exam process. The Board
of CCI however, realizes that many educational programs leading to the
completion of a specific degree or certificate in allied health fields may
teach similar core science courses. Therefore, an exemption may be granted
for the first part of the registry process if an applicant can demonstrate
a "current" active status for their original credential as issued by the
ARDMS, ARRT, NBRC or other agencies which have been identified as providing
a valid and acceptable credential for entry level practice.

In addition, CCI offers certification as a one part exam for EKG, Stress
Testing and Holter monitors.

The vascular regisry examination of CCI has been reviewed by the American
College of Cardiology (ACC) and has been endorsed as an exam of choice in
Invasive (Cardiac Catheterization-RCIS), Non-invasive (Echocardiography-
RCS) and Vascular Technology (RVS). In addition, the ARDMS vascular
registry was also reviewed and endorsed for the RVT and RDCS credential.

In regards to policies of Medicare Part B, the carrier medical directors
for each state have accepted both the credentials of CCI and the ARDMS for
reimbursement practices. This includes all regions that have adopted this
policy. CCI and the ARDMS are independent non-profit credentialing agencies
and serve different allied health fields. The choice of who professionals
credential through is their own. Policies, regulations and decisions of
these credentialing agencies are normally made to ensure the longevity,
reliability and validity of the examination offered within a given field of
practice. Upon successful completion of the credentialing exam, it is a
consideration that the individual has demonstrated the entry level
knowledge to perform. This is true of CCI, the ARDMS or ARRT credentialing.

In regards to the ARRT. In the late 80's the ARRT introduced the CIT
examination. This was following a classification of their registrants into
job skills (Specials, cardiac cath, ultrasound ect.) This exam was
developed as a specialty exam to cover procedures in cardiac
catheterization and special procedures. The introduction of an abdominal
and vascular ultrasound examination currently is considered by this agency
to be a continuing need of their registrants as they assume a broader range
of specialty areas in which they work in the field of radiology.

At the time the CIT exam was developed many individuals believed that it
would effect the cardiovascular technologist in cardiac catheterization and
that it would reduce the status of this credential or dilute it. However,
this did not occur. What did occur was the radiographer now had a choice as
to the credentialing pathway they could choose. The practice of special
procedures (a skill associated within radiology labs nationwide) was more
appropriately addressed by the ARRT and this created greater safety for the
patient. However, in cardiac catheterization labs (CCL)professionals who
were RT's and solely worked in that area began credentialing through CCI to
obtain their invasive registry.

The ARRT feels that adding to their examinations by specialty will better
serve their registrants. This is not something that CCI or the ARDMS would
support, however, it is an independent decision of this Board and the
responsibility of this Board to then seek approval of their exams and their
processes through the agencies or organizations who develop healthcare
policy, standards, or laws.

The Professional Society involved in other allied health fields can then
comment on these additions to policy by providing appropriate information
on scope of practice, qualifications employers may wish to look for, and
ultimately how the the best patient care will be provided. They may also
object to the inclusion. In addition, Societies provide continuing
educational opportunities for the profession, which meet the contact hours
determined by the credentialing body to ensure the current knowledge and
practice of professonals within the field. Professional membership within a
Society is an important decision and ensures that your occupation is
recognized and that your concerns are heard.

Accreditation through the ICAVL or ICAEL is not contingent upon all
individuals within your laboratory being credentialed at this time. This
however, could change as laws or policies change, this is a result of
professional growth, advancement of technology or additional regulation of
the field through state or federal law. The Board decisions to accept CCI
or ARDMS credentials is not to ensure the ARDMS does not obtain a monopoly.
The decision of this agency is based upon the acceptance of CCI as the
credentialing agency for Cardiovascular Technology and it's relationship to
the standards developed and the validation that the examinations offered
are a reliable assessment which ensures both safe and accurate imaging
procedures, ensuring patient safety and accurate diagnosis. CCI and the
ARDMS have been identified because these agencies have demonstarted the
ability to provide valid and reliable registry examinations of individuals
in the fields of Cardiovascular Technology and Diagnostic Medical
Ultrasound. This is a benefit to individuals credentialed by these agencies
and should be viewed professionally by individuals as an acknowledgement of
their credential and it's recognition within the national healthcare
community, regardless of the agency source for the credential.

Finally, I wish to state in reference to other comments that CCI has not
changed exam requirements or qualifications and at no time required
registrants to retest after successful exam completion. Exam requirements
or qualifications are changed when indicated by a Job/Task analysis survey.
In order for requirements to be changed this analysis would have to
demonstrate that practice within the fields requires a higher level of
education. This would very basically be determined by analysis of the
educational level of indviduals completing the survey and their report of
the frequency and importance of the duties they perform daily.

CCI does maintain a requiremnt for continuing education of 36 contact hours
every three years for registry credentials to be maintained. Registrants
may recertify through testing every three years to maintain these 36
credits.

I will be glad to address any questions related to CCI's examination
process or to assist any individual in obtaining accurate information
sources-I may be contacted by e-mail [log in to unmask] or by phone at 1-
800-326-0268.

Thank you

Julia Hillier
Executive Director, CCI