With apologies for the following stream of consciousness ...
Against my better judgment and at the danger of offending many, I will
attempt to keep this semi-brief ... also, with apologies if my comments
raise anyone's blood pressure ...
First, I have no great desire to be called a technologist, technician,
sonographer, stenographer, etc., simply because I do not believe these terms
remotely describe 'our' role. That is, IMHO, our role is to provide patient
care, and these terms, at least to me, suggest that our fundamental role is
to work with technology, this inferring that the patients are incidental.
The expertise/technologies we employ, whether they be in performing patient
histories, physical examinations, using stethoscopes, any of the various
forms of plethysmography, various forms ultrasound can take, etc. are all
simple tools that can be utilized to provide patient care. At the end of
the day, it is not the technology that is of significance, but the human
impact of our actions, without which the technologies are meaningless.
Thus, at the risk of being viewed as a radical revolutionary, my suggestion
is that we discard all the current suggestions and begin a search for
terminology that actually describes our fundamental focus. On the other
hand, if our job is simply to 'do studies' we can adopt whatever terminology
best describes those studies (I have read a definition of 'sonographer' that
read 'ultrasound technician', both of which I found offensive). But I will
leave that to others ...
With re to reimbursement: this is a complex issue, all the impacts of which
(and history) I will not attempt to completely discuss here. I invite any
interested in a primer to read the 11/1/2001 Federal Register (Physician Fee
Schedule; Final Rule for 2002 - pages 55246 through 55503 inclusive). This
contains (on page 55261) a table of the 'revised' wage rates for CPEP staff
types. For any that are confused after reading this FR, I recommend review
of each years FR starting with 10/31/97 (at least) to current - and for any
obsessive/compulsive enough to do this, I recommend talking with your
psychiatrist regarding a medication change - it's obviously not working
'Short' version: for "Vascular Technologist," the wage rate of $0.35/min
was changed to $0.54/min based on the nVision Survey that was done (funded
by SVT is memory serves). In comparison, for categories of "Diagnostic
Medical Sonographer" and "Cardiac Sonographer," the wage rate of $0.39/min
was changed to $0.50/min based on BLS data. Consequently, assuming that CMS
has or ever gets the formula straightened out (debatable), the non-physician
clinical staff time (probably the single most significant) inputs will
result in vascular procedures having inputs that are 8% higher than
echocardiography and diagnostic ultrasound procedure codes (this I do not
worry about). While CMS has noted that the "cardiac sonographer" inputs
were simply crosswalked from "sonographer," CMS did note that they would be
willing to reconsider pricing given valid salary data was submitted (here
lies an example of the lumping that can occur simply on the basis of a
name). Given the cardiac sonographers and cardiology associations have not
addressed this issue in the interim, it is my assumption that the input is
viewed as adequate. However, in the case of deletion of "Vascular
Technologist" as a category, a very real danger exists that the sonographer
rate could be applied, this representing an 8% decrease (this I would worry
about). While this probably could be avoided, it would require a
coordinated effort (SVU Govt. Relations, attorneys, etc., & money). Also,
given removal of the vascular codes from the ZWP, and the rather ill-logical
current determination of the -TC based on the simple difference of the
global minus the -26, I doubt that any of this has any applicability in the
current calculation (it is interesting the true PE seems to have been lost
somewhere along the way - plus 10 points for pragmatism, minus 100 for
failing to follow anything that can be defended as remotely rational - may
bite us big time in the long run).
I also fear that from a CMS viewpoint, we may well not be viewed kindly.
That is, in 2001, after roughly a decade of regular visits to HCFA/CMS, CMS
altered our recognized descriptions based on input from a "Coalition"
including AAVS, ASN, SDMS, SVS & SVT - from 'cardiovascular technologists &
technicians' to "Vascular Technologist," - they also maintained 'cardiac
sonographer' (eliminating the description 'ultrasound technician') and
changing 'sonographer' to "Diagnostic Medical Sonographer". Now here we are
a couple of years later suggesting that "Vascular Technologist" does not in
fact describe the clinical staff type? It would be all to easy to conclude
that we do not know who or what we are ... but then, that might be accurate.
Personally, having shed enough blood on this field of battle, I'll be happy
to sit and observe from the sidelines, and am erecting a "Somebody Else's
Problem Field" around this issue (10 points to anyone that can provide a
description of, and cite for, this very useful piece of technology) ...
Franklin W. West
From: [log in to unmask] [mailto:[log in to unmask]]
On Behalf Of Nancy Hohn
Sent: Monday, March 22, 2004 7:43 AM
To: [log in to unmask]
Subject: Re: RVT Name Change by the ARDMS
I agree with the RDVS for consistency among sonography professions. How
about echo/vasc cross trained? Can we be RDCVS? This would shorten the
alphabet soup chain a bit.
I also thought as far as government categorizing we wanted to get
vascular technology moved from CV Tech category to the diagnostic
sonography category. This would group our pay ranges with other
sonographers instead of ekg/TM techs. Then when medicare was looking at
the cost of vascular exams the "average" salary would be more accurate
than it is now, thus increasing reinbursement (someday) for vascular
exams. Is this correct Frank?
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