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Nuclear Medicine: Introduction to U.S. & International Regulations and Clinical Practice Resources: Accreditation

Accreditation Overview

Accreditation is a process through which an organization is recognized for its ability to meet standards promoted by an accrediting body. During an accreditation survey, the accrediting body compares the applicant's performance with the standards established by the accrediting body. This may be done through an assessment of responses to written questions, a review of documentation, interviews with patients and staff, review of procedures (including protocols, images, and reports), as well as an inspection of the healthcare organization's facilities.  Healthcare accreditation attempts to assure an adequate minimum level of competence. Accreditation standards are evidence of the community standard of care.

In the United States, the Centers for Medicare and Medicaid Services (CMS) permit hospitals to be exempt from routine state surveys if the hospital is accredited by an organization approved by CMS.  The vast majority of hospitals choose to be accredited through one of these accrediting bodies. The Joint Commission, the largest of these, accredits over 18,000 organizations and programs in the United States.  Joint Commission International is a separate, but related, organization that accredits non-U.S. healthcare facilities. 

U.S. Nuclear Medicine Accreditation

As of January 1, 2012, the Centers for Medicare & Medicaid Services (CMS) require that all non-hospital providers of nuclear medicine, nuclear cardiology, and PET imaging services obtain accreditation as a condition of reimbursement.   CMS has designated three bodies as approved accrediting organizations for these services: the IAC (Intersocietal Accreditation Commission), the ACR (American College of Radiology) and The Joint Commission.  If a facility bills the U.S. government under Medicare Part B for nuclear medicine, nuclear cardiology, or PET imaging services, that facility will not be reimbursed for services after January 1, 2012 if the facility is not accredited.  The facility may still bill the patient or third party payers (insurance companies); however, many insurers also require accreditation, as some do so already.  A lack of accreditation does not affect the legal status of the facility or the physician's state licensure.

The IAC and ACR have accreditation programs for several different areas of medical imaging and therapy.  Included in these is accreditation for nuclear imaging and therapy.  While the IAC and ACR have long-standing and well-recognized standards for nuclear medicine accreditation, the Joint Commission is a late-comer in this area of specialty accreditation.  The IAC division for nuclear imaging and therapy is the ICANL, the Intersocietal Commission for the Accreditation of Nuclear Medicine Laboratories. 

The IAC Nuclear Medicine/Nuclear Cardiology/PET standards are freely downloadable as are the ACR Nuclear Medicine/PET program requirements.

The Joint Commission Standards for Diagnositic Imaging Services are available for purchase from their web site or from Amazon.com.  Details of their Nuclear Medicine-specific standards are not openly available, however the Joint Commission does provide a free, downloadable Accreditation Handbook for Diagnositc Imaging Centers that explains their program in general.

         ISBN 978-1-59940-564-3. 

 

Further information on these programs is available through the links below. 

IAC

American College of Radiology

  

Non-U.S. Nuclear Medicine Accreditation

The European Union of Medical Specialists (UEMS) provides political representation for medical specialists in the EU and nearby countries. The European Board of Nuclear Medicine is a section of this organization.  The EBNM along with the European Association of Nuclear Medicine (EANM) sponsors an accrediting organization for nuclear medicine facilities in Europe as well as providing accreditation for nuclear medicine training facilities in Europe.

The Accreditation Board of the Australia and New Zealand Society of Nuclear Medicine sets the standards and conducts accreditation activities for those nations.

Other Nuclear Medicine Accreditation programs have been reported:

The Intercollegiate Standing Committee on Nuclear Medicine establishes standards for Nuclear Medicine Services including PET imaging and radionuclide therapy.  Their efforts have been reviewed and reported.

The Radioisotope Metrology Laboratory of the Argentina National Atomic Energy Commission has reported a program for nuclear medicine instrumentation commission.

National Program for Quality Control of Nuclear Medicine Instrumentation is reported to be an active program in Cuba.

The Pan American Health Organization has developed a basic diagnostic imaging accreditation program for developing countries.

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