Thank you for everyone for attending this afternoon's webinar, where we're going to talk about understanding sonography board eligibility requirements. My name is Jamie Warren. I am part of the CARE Transformation Team here with MedAxiom, and we're going to spend about an hour where we go over some specific information, but then also have a session where we can answer some questions. I have no disclosures. Just a couple of housekeeping items. At the bottom of your screen, you will see a button for the chat, and that's where you're able to download the slides that will be presented today. On the other side, you'll see a Q&A, and that is where if you would like to send a question that we can answer during our presentation, please enter that in at any moment during our talk today. If we get to the end and we're not able to get to your question due to time, we will email out the answers to those questions. Let's dig in. What is sonography? So, with this, we're talking about how science is built on simple sound waves, and it's about using those high-frequency sound waves into a body that bounces off the body's tissues and organs to create a diagnostic image, but the biggest piece here is that the performance of an ultrasound is considered a medical procedure, and this must be performed by an appropriately trained medical professional under the authority of a licensed physician. One thing about ultrasound that I'm not sure that our community has a full understanding of is that sonography really is one big umbrella that has multiple pieces that fit underneath it. So, I like to use the analogy of radiology in that you have CT and MRI and NUC-Med. It's kind of even more drilled down when we start talking about sonography. So, each one of these that's on this list is specific training, and a lot of these have a specific board exam that can be taken. For our purposes for today, we are going to talk about cardiac and vascular only. So one of the questions that I frequently get asked is, okay, there's all these terms and what do they mean and which one should I be using and how is this relevant to my sonographer, and so we're going to just take a few minutes to break down what the definition is for licensure, registry, certification, and credentialing. So our first one with licensure. So this is what you commonly think is legal permission that's granted by a designated authority to participate in a specific activity. And this is also what's going to help define the professional scope of the practice and more about the minimum requirements of what is allowed or required to practice. So we think about other common seen licenses in our healthcare, you can think about registered nurses, and you can also think about those that are operating radiation producing equipment, so your x-ray techs, your nuclear medicine technologist, your radiation therapy are just a few examples. This is also going to differ state by state and in what is required for each of these modalities. So now we're going to flip to registry, and you want to think about this as just a centralized database, and this is a list, and for our case here we're talking about a list of licensed healthcare professionals that's in a particular area. It's typically a list of individuals who can perform a very specific set of work, it can be maintained at a state or a national level, and a good example of this is our National Provider Identifier NPI Registry. Certification, so this is a really broad term, and this is talking about giving a certificate to an individual for certain situations. It can be legally applied to demonstrate those that have received the certificate can perform like a specific task, and where this falls in the sonography world is that several programs will offer a certificate of diagnostic medical imaging upon successful completion of an educational program. The term credential is really the one we're going to spend some time with, and when we are talking about a sonographer, this is really the bucket that we would need to talk about that's expressing how the sonographer is receiving the ability to work in this field. And this is going to involve them passing an exam that is very specific to a practice, and in our case we're going to talk about cardiac and vascular. These are offered by private agencies, which we will talk about those specifically here in a moment. And then to obtain this credential, the healthcare professional must meet the eligibility requirements for that specific exam, and one of those pathways is going to an accredited educational program. So now we're going to dive into sonography board exams. So again, each sonography specialty is going to have its own board exams, but there are three main organizations that offer these. That is the American Registration of Radiologic Technologists, or the ARRT, American Registry for Diagnostic Medical Sonography, the ARDMS, or Cardiovascular Credentialing International, CCI. We're going to hit pause here for just a moment and provide some definitions around two terms that you will see, didactic versus clinical. So didactic, think about this as the classroom, classroom work. So this can be where the student is learning the why, or in sonography, the physics of why they're doing the scan and how they're getting their results. Multiple different methods of being able to do this, whether it's in person or it is a virtual classroom, could even be videos, could be webinars, so on and so forth. Clinical is your practical piece. This is more your hands-on. This is where they're coming into your labs and doing their clinical rotations and learning from your existing team. Cardiac ultrasound. So in ECHO, we have two different board exams that could be taken, one or the other. We do see sometimes sonographers that do sit for both. This first one is the ARDMS. This is a two-part exam, and that means that they take this test on two separate days. And a lot of times there can be a gap in between taking the first part and then coming back and finishing up with the second. The first part of this exam is what you hear them refer to as a physics test. It is their principles and instrumentation, or SPI. And then the second part of this test is where they come in and take their specialty exam, and this is where it could be for adult, fetal, or pediatric ECHO. There is not an on-the-job pathway without having a prior allied health degree or bachelor's, and we will get more in depth with that in a few more slides. For your sonographer that have sat and passed this board, their credential will be an RDCS. The second exam that they can take is the CCI exam, and this is a single exam. This includes the physics and the adult cardiac sonography specialty all in one exam. So they go one time, take it, pass it, and they receive their credential. This particular board also offers two specialty exams that can be taken on congenital or advanced cardiac sonographer. And then there was a change just recently with the CCI back in June that they no longer offer an on-the-job pathway without a prior allied health degree, and once your sonographer sits and passes this board, they will have the credential of RCS. Now we're really going to kind of dive down into the onion here and talk about those two boards. So the first one with the ARDMS has several different pathways that would deem someone eligible to sit for the boards. The first one is that they have completed a two-year allied health educational program that is related to patient care. So this may be that they've gone to a sonography program, but maybe they did general sonography, or they went to a radiology program, or occupational therapy, physical therapy, nursing. These are just a few examples. With this, they will have to show, document it, that they have full 12 months of full-time clinical cardiac ultrasound experience. That means that they are working full-time hours within that echo space to be able to then show that they've done their practical piece, and then they would be eligible to sit for their boards. The next pathway is that they have graduated from a programmatically accredited cardiac sonography program. Now I'm going to pause here just for a moment because the word programmatically accredited can sometimes be a bit confusing. So while a school may hold an accreditation, or if they're even doing a long distance, they may have that long distance accreditation. There is an accreditation that is specific to sonography and specific to the programs. If they have attended one of these programs that has received that type of accreditation, no additional clinical experience is needed outside of this program because they have done both their didactic and their clinical during that time that they were in school. Our last pathway here is if you have someone that has a bachelor's degree in any major, but they will be expected to do 12 months of full-time clinical cardiac ultrasound experience. And just one last note, if the bachelor's degree is in sonography, no additional work experience is required. Let's switch over to CCI. With this one, the first pathway, very similar to what we saw with the ARDMS, is with someone who has completed a two-year allied health educational program that is patient-related. They also will be expected to show documentation of 12 months of full-time clinical cardiac ultrasound experience. And then one last piece with CCI, they do set a minimum amount of procedures that will need to be shown as done during that clinical space. Our next pathway is that they have graduated from a programmatically accredited sonography program, very similar to the ARDMS, and no additional clinical experience is needed because they've done both their didactic and clinicals during their program. This last pathway is for those that are attending non-programmatically accredited programs. It has to be a minimum of a one-year of specialty training. So if you see a program in ECHO that's only six months, that will not meet this requirement. It does have to show for 12 months. They have to have a minimum of 800 documented clinical hours. And one note is, is those 800 hours have to be completed while they're considered a student in the program. And hours completed after graduation would not count towards this. We have one more. This is our last pathway with CCI. So if you have someone that is already an active ultrasound credential holder, and they've had this within six months, they are able to then participate and take this for their ECHO boards. They do have to show a minimum of 100 cardiac ultrasound studies at the time of their application. So if you have somebody that's in vascular, they are going to have to show that they've done full-time six months or full-time work within the ultrasound, the ECHO department, and that they've done 100 minimum, but then they would be eligible to sit for the boards. So let's switch over to vascular. So in vascular, there's three exams that can be taken. Very similar to what we saw with ECHO with the ARDMS and CCI, but this time we're going to add the ARRT. So very similar with the first two, you will see the same that the ARDMS is a two-part exam. Those two parts are not done on the same day. A sonographer candidate will come in and do their physics test and then return at a later date to do their specialty exam in vascular. Once they sit in past this board for the ARDMS, they will have the credential of an RVT. With CCI, this is a single exam, includes both physics and vascular sonography. And once they pass their boards, they will have the RVS credential. And then this last one here, this again is a single exam that includes both physics and vascular sonography. There is no on-the-job pathway. We will talk about the pathways with this one. And then their credential will be the ARRT with VS in parentheses. So we're going to just step through each one of these also pathways. So with the ARDMS, you're going to see very similar to what was in place for the ECHO is also in place for the vascular. So if you have a student that has a minimum of completing two-year allied health education program that is related to patient care, and they have 12 months of full-time clinical vascular ultrasound experience, then they would be eligible to sit for the ARDMS vascular study test. The second pathway is if they've graduated from a programmatically accredited vascular sonography program. And there are accreditations for cardiac programmatically and also for vascular programmatically. If this is the case, no additional clinical experience is needing outside of this program as they have completed both their didactic and clinical all while they were a student. Our next pathway is that they have a bachelor's degree, it could be any major. They will need 12 months of full-time clinical vascular ultrasound experience. With CCI, they can also have a minimum of completing a two-year allied health educational program that's patient care, and then 12 months of full-time clinical vascular ultrasound experience. And the only piece that's added on this, they do have a minimum requirement of 600 vascular ultrasound studies that were completed during that 12 months. With the pathways here, you could also graduate from a programmatically accredited sonography program, and no additional clinical experience is needed outside of that. You could also have graduated from a non-programmatic accredited program, again, this will need to be one year of training, so if you have a program that's less than 12 months, it will not qualify for this particular pathway. They do have to have a minimum of 800 documented clinical hours, and any hours that are completed outside of that 12-month educational program will not count towards their 800 hours. And then if you have, again, if you have somebody that already has an ultrasound credential, they are eligible to take this board, but they will have to show that they've done 100 vascular ultrasound studies at the time of their application. This last exam is very specific to vascular, and with this, there's two different pathways. One is if this is their primary, this is their first time taking a board exam in sonography. This will require the completion of minimum of an associate's degree from an educational institution that's been accredited by the agency that the ARRT recognizes. But this degree does not have to be specifically in allied health. They also have to complete an educational program in vascular sonography that has both didactic and clinical pieces to it, and then they must meet the standards and ethics requirement for ARRT. If you have somebody that this is where they're going to go back for a secondary or what we call a post-primary to be able to get into vascular, this is also an option that could be done if they've been registered with ARRT, or this pathway can also be used if you have ARDMS. They must show the documented performance of a minimum of 1,120 repetitions of vascular studies, and then they must also have the completion of a structured program. This can also be through CMEs or CE opportunities, a combination of those, and this information is provided on the ARRT website, and then also meeting the standards and ethics requirements. State licensure. At the time of us doing this presentation, and I will say it that way, so if you're watching this a year from now, it's important to go and check to see if any additional states have been added, but there are four states that have approved legislation mandating the licensure of medical sonographers, along with many other allied health professionals. So these four states as of today are New Hampshire, New Mexico, North Dakota, and Oregon, and this is going to have a requirement that the sonographer have credentials or have sat for their boards. There is some provisions in place to grandfather in, but that's going to vary based on those four different states. IAC requirements. So for those that are accredited through the interstitial accreditation commission for cardiac and vascular, there are requirements that are needed when it comes to your technical staff. And so with this, you will see in both categories that they will have to sit for one of their board exams. And then there is a provision in here for new graduates that they have 12 months to be able to sit for their boards and show that they've obtained their appropriate credential, but during that 12 months, they're going to be listed as provisional staff and they must work under the supervision of a credentialed sonographer. So very specific in cardiac and very specific in vascular. Billing requirements. This is like one of the questions that comes up a lot about, does my sonographer need to be credentialed in one of these to meet my billing requirements? So I often send people to the IAC website if they have a great resource to provide a state by state requirements for CMS and then third party payments. This is for both cardiac and vascular are going to vary based on state plans. And the technical requirements are going to vary from none, zero requirements to having the ability to show your sonographer's credentials. So just a couple of examples to walk through here. The first one's a Medicare example, and this has to do with the technical portion. So who is actually doing the exam? There's a couple of levels that can be to meet this. One is that the service was performed by a physician. So your vascular study or your echo study was performed by a physician. The technical service was performed by someone who was credentialed either in the cardiac or the vascular, or the service was performed at a lab that was credentialed by IAC, and this is for your outpatient labs. And an example, and again, for your outpatient labs, for the technical portion, an acceptable level of competency is considered a lab accreditation, so your IAC or ACR, and then the lab accreditation will have requirements for sonographers to be credentialed. So we went through that really quick. So I hope that we have some good Q&A, but I do just want to put a plug in for an upcoming webinar that we will have in September, where we will be walking through our program that we have partnered with Washburn University to be able to offer an online sonography program for both cardiac and vascular. So watch for more news coming on how to register for that, that is going to be mid-September. So let's see what questions we have today. I think you did a fantastic job, Jeannie. We are clear on the questions on this end, so just a reminder, if you do have any questions at all, there's that little Q&A button down on your banner screen, if we want to give another minute or two to see if there's any last-minute questions. And I will also say that my email is on the screen, but, you know, please feel free, if you'd like to email me directly, we'll also be able to answer questions that way. All right, nothing coming through, no last-minute questions, like I said, you did a great job, Jeannie. All right. Well, thank you, everyone. I know that was a lot of technical information. I do encourage you to download the slides and be able to use that as a resource. And if you all have any questions for us, please let us know.

sonography

board eligible

high-frequency sound waves

diagnostic images

medical procedure

trained professional