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UVMFLOWNET  March 2004

UVMFLOWNET March 2004

Subject:

Re: RVT Name Change by the ARDMS

From:

"Hodge, Megan D." <[log in to unmask]>

Reply-To:

UVM Flownet <[log in to unmask]>

Date:

Wed, 24 Mar 2004 11:40:59 -0600

Content-Type:

text/plain

Parts/Attachments:

Parts/Attachments

text/plain (153 lines)

  shall we really stir up the pot and go back to the argument that everyone
involved in the ultrasound field should have some kind of degree to prove
they have an education to back their qualifications?
    I see Frank's perspective because I have always used my RN, then RVT
certification as clarification. My salary was based on my RN licensure .
When I passed my RVT way back in 1983, the hospital never compensated me for
passing the certification. All merits were based on years of nursing
experience and tenure at the hospital. Even today, I have 2 RN's who need to
take their RVT certification because I wrote their job description to
include the RVT be mandatory; it was not the hospital's requirements. Their
salaries are based on their RN licensure not if they pass the RVT exam or
not.

-----Original Message-----
From: UVM Flownet [mailto:[log in to unmask]]On Behalf Of Johnson,
Bonnie
Sent: Wednesday, March 24, 2004 11:07 AM
To: [log in to unmask]
Subject: Re: RVT Name Change by the ARDMS


Frank,

I have missed our little talks! For once Frank, I do agree with you on most
points. However, the reason you and I do not have to worry about what we are
called as professionals is BECAUSE we have other options while the RVT
only's do not. I am not looking out for myself as I already have another
option. I am looking out for the future of the entire profession.
Sonographers have already been given a distinct classification separate from
technicians (ie;rvt,cvt,ekg techs etc) by DoL. This can and likely will lead
to further advancement. This is a problem for RVT's - especially where
hospital human resource departments and/or unions may be concerned. This
WILL and DOES impact pay scales and this WILL also impact IDTF's. In the
future it could lead to dictating job responsibilities or lack thereof. With
this in mind then, I think it was a lot easier to change the title of our
credential to sonographer to stay within our existing credentialing agency
than to ask everyone to go back to school, become a nurse, and sit for a
nursing board exam, or go find another credential somewhere, in order to NOT
be a 'tech'.  Perhaps we SHOULD rethink that concept now?

Your concerns about money are valid for the moment, but only for the moment.
In the BIG picture our (ie;RVT's of the future) status as professionals is
much more important. Especially after reading the front page of the San
Francisco Chronicle this morning: "Medicare will be broke in 15 years - new
study reports" When the money dries up we will have to find something else
of more value to argue about.

Bonnie L. Johnson RDMS, RVT, FSVU

Stanford University Medical Center

Director, Vascular Laboratory Services

Division of Vascular Surgery

-----Original Message-----
From: f_west [mailto:[log in to unmask]]
Sent: Tuesday, March 23, 2004 7:39 PM
To: [log in to unmask]
Subject: FW: RVT Name Change by the ARDMS

Bonnie,

With regard to your second point, thank you for your clarification.  You are
absolutely correct that the reference I cited (Federal Register:  Physician
Fee Schedule (PFS)) does not directly impact any RVT or sonographer working
in a hospital setting (this would be under the HOSPITAL Outpatient (or
Inpatient) Prospective Payment Systems).  You are further absolutely correct
that no direct relationship exists between wages and reimbursement, and any
relationship that does exist obviously more directly impacts owners than
non-owner employees.  Admittedly this is where we probably differ given you
are employed by a university hospital and I am employed by an employee-owned
(thus all employees are owners) Independent Diagnostic Testing Facility
(IDTF).  Thus, my income and that of any other RVT or sonographer owner of
an IDTF is very directly impacted by the PFS (under which we are reimbursed
when performing studies outside a Medicare Part A setting).  Additionally,
the 'few cents' you note actually translates to just shy of $5,000 per year
and, while other factors are probably of much greater significance in
determining employee wages (local supply & demand of RVTs or sonographers,
etc.), I suspect it na´ve to deny some relationship between wages and
revenue production, especially in smaller practices (e.g., office or clinic
settings) where the RVT or sonographer does not have the luxury of being as
insulated by other funding sources.

With regard to CMS or their contracted Carriers ever checking individuals
credentials, I suspect you may be mixing issues (or, at least, I may be
misreading your comments).  That is, CMS, by regulation, requires Carriers
obtain copies of credentials of all non-physician clinical staff that
perform tests for all IDTFs (they further require site visits, etc. - making
these the only sites where certification of personnel is assured).
Admittedly, this does not occur at the time of billing, but at the time of
Medicare application (or revision) for a provider number (see CMS 855B form
- Attachment 2).  CMS does not require credentialing of non-physician RVTs
or sonographers for any other provider type.  However, Medicare Carriers and
Fiscal Intermediaries (FI), in the form of Local Medical Review Policy
(LMRP), have the authority to require certification.  Given LMRP is
developed that includes such a requirement, it is then up to the developer
(Carrier or FI) to choose a mechanism to enforce the policy (i.e., LMRP is a
contractor issue, not a CMS issue).  From my personal point of view, it
would be obviously more desirable if CMS developed regulation to this end
but that is unlikely given absence of support from physician and hospital
associations.  Here I agree, it has everything to do with politics.

With regard to your first point, I hope it is not addressing anything I
suggested in the prior E-mail.  That is, at no point did I intend to suggest
there might be any problem with reimbursement if our moniker was altered
(and re-reading the E-mail, do not believe I did).  In fact, I doubt that
the contractors would have much in the way of a problem (some have not
revised their LMRPs in a very long time as it is) and CMS would be abhorrent
to recognize any 'smaller' 'independent' credential or credentialing
organization in regulation (they did not recognize "Registered Vascular
Technologist" but "Vascular Technologist").  However, CMS made the change
based on requests we made over roughly a decade, culminating in the
"coalition's" comments in the Proposed Rule, to which they finally responded
favorably in the Final Rule for 2001.  The remainder of my concerns still
exist as previously stated.

Obviously vascular technology is performed by individuals with a variety of
backgrounds and studies are interpreted by physicians with diverse
specialties (the interpreting physician specialties with which I work
include vascular surgery, general surgery, cardiothoracic surgery,
cardiology, radiology, neurology, nephrology and internal medicine - in no
specific order).  Taking you & I as examples, your 'primary' credential is
as a RDMS whereas mine is RN - naturally this is going to result in some
variation in points of view.  While we both have worked in vascular
technology for more years than either of us would probably care to admit,
you are probably going to be comfortable thinking of your role as an
extension of the "sonographer" moniker while I tend to see it as an
extension of my role as a nurse.  At the end of the day, maybe we should
leave it up to the folks that have limited their practices to vascular
technology to decide what to call themselves - unless, of course, the entire
field is consumed by a single specialty.

Enough of this - I'm out of here ... have to try out my new electronic
stethoscope (Andromed) with Stethographics bruit analysis software ... now
where is that patient with the bruit?

Franklin W. West (& in the interest of disclosure) BSN, RN, RVT, RVT, RVS,
(ex-CVN - let that one lapse), CCP
[log in to unmask]
425.398.7774 (voice)

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****CONFIDENTIALITY NOTICE****
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