title: Intersocietal Accreditation Commission Accreditation Status of Outpatient Cerebrovascular Testing Facilities Among Medicare Beneficiaries: The VALUE Study.
abstract: OBJECTIVE
  Accreditation of cerebrovascular ultrasound laboratories by the Intersocietal Accreditation Commission (IAC) and equivalent organizations is supported by the Joint Commission certification of stroke centers. Limited information exists on the accreditation status and geographic distribution of cerebrovascular testing facilities in the United States. Our study objectives were to identify the proportion of IAC-accredited outpatient cerebrovascular testing facilities used by Medicare beneficiaries, describe their geographic distribution, and identify variations in cerebrovascular testing procedure types and volumes by accreditation status.
  
  
  METHODS
  As part of the VALUE (Vascular Accreditation, Location, and Utilization Evaluation) Study, we examined the proportion of IAC-accredited facilities that conducted cerebrovascular testing in a 5% Centers for Medicare and Medicaid Services random Outpatient Limited Data Set in 2011 and investigated their geographic distribution using geocoding.
  
  
  RESULTS
  Among 7327 outpatient facilities billing Medicare for cerebrovascular testing, only 22% (1640) were IAC accredited. The proportion of IAC-accredited cerebrovascular testing facilities varied by region (χ(2)[3] = 177.1; P < .0001), with 29%, 15%, 13%, and 10% located in the Northeast, South, Midwest, and West, respectively. However, of the total number of cerebrovascular outpatient procedures conducted in 2011 (38,555), 40% (15,410) were conducted in IAC-accredited facilities. Most cerebrovascular testing procedures were carotid duplex, with 40% of them conducted in IAC-accredited facilities.
  
  
  CONCLUSIONS
  The proportion of facilities conducting outpatient cerebrovascular testing accredited by the IAC is low and varies by region. The growing number of certified stroke centers should be accompanied by more accredited outpatient vascular testing facilities, which could potentially improve the quality of stroke care.
authors.affiliation: Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida USA sbrown@med.miami.edu.
authors.forename: Scott C
authors.initials: SC
authors.lastname: Brown
authors.affiliation: Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida USA, Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida USA.
authors.forename: Kefeng
authors.initials: K
authors.lastname: Wang
authors.affiliation: Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida USA.
authors.forename: Chuanhui
authors.initials: C
authors.lastname: Dong
authors.affiliation: Intersocietal Accreditation Commission, Ellicott City, Maryland USA.
authors.forename: Mary Beth
authors.initials: MB
authors.lastname: Farrell
authors.affiliation: Intersocietal Accreditation Commission, Ellicott City, Maryland USA.
authors.forename: Gary V
authors.initials: GV
authors.lastname: Heller
authors.affiliation: Department of Vascular Medicine, Cleveland Clinic, Cleveland, Ohio USA.
authors.forename: Heather L
authors.initials: HL
authors.lastname: Gornik
authors.affiliation: Intersocietal Accreditation Commission, Ellicott City, Maryland USA.
authors.forename: Marge
authors.initials: M
authors.lastname: Hutchisson
authors.affiliation: Department of Radiology, Thomas Jefferson University, Jefferson Medical College, Philadelphia, Pennsylvania USA.
authors.forename: Laurence
authors.initials: L
authors.lastname: Needleman
authors.affiliation: Baptist Cardiac and Vascular Institute, Baptist Hospital of Miami, Miami, Florida USA.
authors.forename: James F
authors.initials: JF
authors.lastname: Benenati
authors.affiliation: Department of Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts USA.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Jaff
authors.affiliation: Department of Vascular Surgery, University of Cincinnati Academic Health Center, Cincinnati, Ohio USA.
authors.forename: George H
authors.initials: GH
authors.lastname: Meier
authors.affiliation: Department of Vascular Surgery, University of Southern California, Keck School of Medicine, Los Angeles, California USA.
authors.forename: Susana
authors.initials: S
authors.lastname: Perese
authors.affiliation: Vascular Laboratory, William Beaumont Hospital, Royal Oak, Michigan USA.
authors.forename: Phillip
authors.initials: P
authors.lastname: Bendick
authors.affiliation: Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, Massachusetts.
authors.forename: Naomi M
authors.initials: NM
authors.lastname: Hamburg
authors.affiliation: Good Samaritan Outpatient Center, Cincinnati, Ohio USA.
authors.forename: Joann M
authors.initials: JM
authors.lastname: Lohr
authors.affiliation: Riverside Radiology Associates, Columbus, Ohio USA.
authors.forename: Lucy
authors.initials: L
authors.lastname: LaPerna
authors.affiliation: University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania USA.
authors.forename: Steven A
authors.initials: SA
authors.lastname: Leers
authors.affiliation: Vascular Laboratory, University of Maryland School of Medicine, Baltimore, Maryland USA.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Lilly
authors.affiliation: Wake Forest Baptist Health, Winston-Salem, North Carolina USA.
authors.forename: Charles
authors.initials: C
authors.lastname: Tegeler
authors.affiliation: Intersocietal Accreditation Commission, Ellicott City, Maryland USA.
authors.forename: Sandra L
authors.initials: SL
authors.lastname: Katanick
authors.affiliation: University of Tennessee Health Science Center, Memphis, Tennessee USA.
authors.forename: Andrei V
authors.initials: AV
authors.lastname: Alexandrov
authors.affiliation: Department of Neurosurgery, University at Buffalo, State University of New York, Buffalo, New York USA.
authors.forename: Adnan H
authors.initials: AH
authors.lastname: Siddiqui
authors.affiliation: Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida USA, Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida USA.
authors.forename: Tatjana
authors.initials: T
authors.lastname: Rundek
mesh_terms: D000068:Accreditation / Q000379:methods*; D000554:Ambulatory Care Facilities / Q000592:standards*; D002561:Cerebrovascular Disorders / Q000175:diagnosis / Q000000981:diagnostic imaging*; D006801:Humans; D006278:Medicare; D012955:Societies, Medical; D014463:Ultrasonography / Q000592:standards*; D014481:United States
keywords: Intersocietal Accreditation Commission; Medicare beneficiaries; carotid duplex ultrasound; cerebrovascular disorders; cerebrovascular testing; geographic disparities; health services research; public policy; sonography; transcranial Doppler ultrasound; ultrasound; vascular laboratory testing accreditation