Elizabeth F. McIlwain, MHS, RDCS, RCS, FASE, Chair, Council on Cardiovascular Sonography

When advocacy is mentioned we tend to think of all the various acronyms, regulations, and governmental agencies that are confusing and overwhelming to most of us. As sonographers, we often do not want to be bothered with all those activities we perceive as “advocacy”. We would much rather be left alone in our labs to perform studies and take care of our patients. After all, we are sonographers! Performing cardiovascular ultrasound procedures is what we are trained to do. That is what we love. This is our passion!

However, advocacy is a part of our sonography life. Governmental regulation affects our profession in many ways. Being educated on the issues and being involved is vital. As we embark on a new year I would like to use this communication to educate and encourage you on the world of advocacy as it relates to cardiovascular ultrasound and ASE.

According to the Merriam-Webster Dictionary, advocacy is a noun meaning “the act or process of supporting a cause or proposal.” Our cause is cardiovascular ultrasound. Our activities can be found at the local, state, and federal levels of government, as well as in the private world through work with various payors. The activities that ASE finds itself involved in are typically related to policies, politics, and payors.

Sonographers are usually well educated on policy issues that relate to training or qualification. Should a credential be required for an individual to perform cardiovascular ultrasound and therefore be hired as a sonographer? Should a person be required to have formal training from an accredited program before entering the profession? Should a sonographer be held to ethical and professional standards? These are some of the questions that are addressed through advocacy activities.

In the absence of state or federal regulations, each institution can set its own minimum requirements for positions at the local (or institutional/corporate) level. Some facilities require a sonographer to be credentialed. Other places feel that training and experience are more important than credentials. A “local” requirement cannot be set at a lower standard than a state or federal requirement. For example, if a state requires sonographers to be licensed and has credentialing as one of the necessary elements for licensure, then the “local” standard would have to be a licensed, and therefore a credentialed, sonographer. If the federal government were to enact legislation (such as the CARE Bill) requiring sonographer credentialing and minimum education, states and local entities could not set a standard lower than that.

ASE is very active in these types of advocacy concerns, and works closely with other imaging organizations to ensure that proposed legislation properly addresses needs that are unique to cardiovascular ultrasound. ASE supports formal sonography education through accredited programs and is on record stating that sonographers should be credentialed.

It is the issues relating to payors (public and private) that often cause us to cringe. Just identifying all of the various agencies involved in developing healthcare policy and comprehending the various roles they play makes ultrasound physics look easy! The president’s message, “The Alphabet Soup of Federal Healthcare Agencies” by Dr. Byrd in the July 2013 issue of JASE is a great review of the federal agencies and committees involved in healthcare policy. I encourage you to read that communication if you have not done so already.

It is in the areas of payors and politics that ASE spends a large portion of its advocacy resources. A great deal of time is spent attending meetings, participating in conference calls, coordinating with other imaging organizations, and contacting individuals to ensure our voice is heard and the best interests of our patients and profession are considered.

Echocardiography reimbursement is currently a major target of proposed cuts from both private payors and Medicare. The updating and revaluation of Current Procedural Terminology (CPT) codes is an ongoing process. In recent years, echocardiography codes have been negatively impacted by this process. We have seen reimbursement for echocardiographic procedures steadily (and often dramatically) decline. Along with this reduction in reimbursement, we are experiencing an increase in payors requiring pre-authorization and other approval procedures.

Whether the issue is policy, payor, or politics related, ASE is actively involved. Our mission is to represent the interests of our members while advocating to create an environment for excellence in the quality and practice of cardiovascular ultrasound. The ASE advocacy team is comprised of staff and volunteers devoted to our cause. The Advocacy Committee is chaired by Dr. David Wiener, with Sue Maisey serving as the sonographer co-chair. The committee also includes a legislative counsel (Diane Millman), coding expert (Judy Rosenbloom), CMS consultant (Denise Garris) and our Health Policy Manager (Irene Butler). Over the years, ASE has been very effective using the resources we have. At the same time we have seen the need to expand our efforts while taking steps to ensure that we stay focused on the mission. In response to the need for a more focused voice on Capitol Hill, the Board of Directors voted in June to retain a lobbyist to act on our behalf, specifically with regards to reimbursement issues.

The Advocacy section of the ASE Website ( http://www.asecho.org/advocacy/ ) and Connect@ASE provide a wealth of information on all topics related to advocacy, including “breaking news” and information on advocacy “hot” topics, coding and reimbursement, quality improvement initiatives, sonographer licensing and credentialing, and how to get involved.

Like it or not, all of the areas of advocacy affect sonographers. It is easy to see how policies on licensure, credentialing, and education relate to us, but we must not overlook payors and politics. As sonographers on the front line we are often the first to be impacted by policy and payment changes. ASE is committed to advocating for our profession. It is both an organizational effort and a personal one.

As sonographers we are always advocating for something related to our profession, from our patients and co-workers to our own well-being. Advocating, supporting a cause, is something we do every day. It is important that we apply our “advocating” nature to our profession as a whole.

To effectively advocate one must have a working knowledge of the payors, policies, and politics that are involved. I hope these paragraphs will encourage you to stay updated on what is going on in the advocacy world and that you will be ready to step up and support the cause when you see the need or are asked.