Background

In a March 2005 Report to Congress, the Medicare Payment Advisory Commission (MedPAC) recommended that Congress require mandatory accreditation for all imaging services performed on Medicare beneficiaries to address rapid utilization growth and ensure patient safety. When Congress acted on this recommendation through the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA), it mandated accreditation only for suppliers of advanced diagnostic imaging services (MRI, CT, nuclear medicine, and PET), leaving echocardiography excluded. As a result, any Medicare provider can perform and bill for echocardiograms without meeting standardized equipment requirements, personnel qualifications, or quality assurance procedures. While some state-level Medicare carriers require facility accreditation or sonographer credentialing for reimbursement, there is no uniform national standard.

The Utilization and Quality Problem

Without mandatory accreditation, echocardiography faces significant quality control challenges. The absence of accreditation requirements allows facilities to operate without standardized protocols, trained sonographers, or quality improvement processes, resulting in poor image quality, incorrect diagnoses, unnecessary repeat testing, and inappropriate Medicare spending. Accredited laboratories, by contrast, must meet rigorous standards for staff training and experience, equipment maintenance, examination protocols, report completeness, and ongoing quality assurance, as outlined in the Intersocietal Accreditation Commission (IAC) Standards and Guidelines for Adult Echocardiography.

ASE Recommendations

ASE urges Congress to mandate accreditation for all facilities performing echocardiography on Medicare beneficiaries, consistent with MedPAC's 2005 recommendation and the existing accreditation framework for other advanced imaging modalities. This would:

• Establish uniform national quality standards for echocardiography, including requirements for qualified personnel, standardized equipment, and proper examination protocols
• Reduce unnecessary testing and Medicare costs by improving diagnostic accuracy and eliminating substandard studies that lead to repeat examinations
• Ensure that the quality protections Congress intended when it passed MIPPA apply equally to echocardiography, one of the highest-volume cardiac imaging tests in Medicare

ASE Accreditation Policy Statement

ASE is committed to advocating for an environment of excellence in the quality and practice of cardiovascular ultrasound. As such, the Society supports pediatric, vascular and adult lab accreditation as an established method of achieving these goals. ASE recommends that in every laboratory minimum standards be maintained in terms of equipment, quality improvement activities, and lab protocols. An environment of excellence also requires that the entire cardiovascular team engages in continuing education to maintain and improve their skills over time. To address both the quality and appropriateness of cardiac and vascular care, ASE believes that all labs serving adult, vascular or pediatric patients should utilize clear, consistent processes to ensure establishment and continued reassessment of methods for achieving and maintaining standards and excellence. (ASE Policy)