IAC Cardiac Electrophysiology Accreditation: A Year in Review

Intersocietal Accreditation Commission (IAC) Cardiac Electrophysiology accreditation is designed to recognize facilities that perform cardiac electrophysiology procedures by ensuring that the facility meets quality benchmarks based on published clinical guidelines, best practices, and outcomes. Here we speak with John Beshai, MD, FHRS, FACC, President, IAC Cardiac Electrophysiology Board of Directors, and Frank Vermeiren, MS, RT (R)(CV), RDCS, IAC Director of Accreditation, Cardiac Electrophysiology.

Tell us about the IAC and how this voluntary accreditation program came about.  

Modeled after the success of the first IAC accreditation program created in 1990, IAC Cardiac Electrophysiology was created in 2014 to accredit facilities performing cardiac electrophysiology procedures, becoming the ninth division of the IAC. A nonprofit organization highly regarded for its accreditation programs, the IAC is committed to its mission of Improving health care through Accreditation^® through a rigorous peer review process. The IAC provides accreditation programs for vascular testing, echocardiography, nuclear/PET, MRI, diagnostic CT/dental CT, vein center, carotid stenting, and cardiac electrophysiology.  To date, the IAC accrediting divisions have granted accreditation to more than 14,000 sites throughout the United States, Canada, and Puerto Rico. IAC accreditation is widely respected within the medical community, as illustrated by the support of more than 40 national medical societies. 

How is the IAC Cardiac Electrophysiology program governed? 

IAC Cardiac Electrophysiology accreditation is developed by way of an intersocietal, multi-specialty approach that is the foundation of the accrediting divisions under the IAC umbrella. Through the IAC, the cardiac electrophysiology community has been provided with the unique opportunity to develop standards and establish an accreditation process to recognize quality benchmarks based on published clinical guidelines, best practices, and outcomes. Recognizing the relevancy of the mission of the IAC to the specialty of cardiac electrophysiology, the Heart Rhythm Society (HRS), Pediatric and Congenital Electrophysiology Society (PACES), and Alliance of Cardiovascular Professionals (ACVP) have each committed to participate as sponsoring organizations of the IAC Cardiac Electrophysiology program. As such, each organization provides representatives to the Board of Directors. Cardiologists and nurse members-at-large also have seats on the Cardiac Electrophysiology Board of Directors, for a total of eight board members. The involvement in the IAC as cardiac electrophysiology experts has enabled the specialties to have input in the accreditation process since its creation through the development of the standards and the corresponding online application. Now that the program is fully operational, the Board members will continue to participate in the program through periodic revisions to the Standards, the review of applications for accreditation/rendering of accreditation decisions, and overall steering of the accreditation program. 

Following the release of the program in early 2016, has the EP community embraced accreditation? 

The IAC and HRS recently celebrated another year of collaboration at Heart Rhythm 2017, held in Chicago, by honoring the inaugural group of facilities achieving IAC accreditation in Cardiac Electrophysiology. Each of the following facilities was recognized for leading the field of cardiac electrophysiology and demonstrating their commitment to quality:

• Baptist Health Care, Pensacola, Florida
• CentraCare Heart & Vascular Center, St. Cloud, Minnesota
• CHI Baylor St. Luke’s Medical Center, Houston, Texas
• C.S. Mott Children’s Hospital, Ann Arbor, Michigan
• Grandview Medical Center, Birmingham, Alabama
• Inova Heart and Vascular Institute, Fairfax, Falls Church, Virginia
• Mercy Medical Center, Des Moines, Iowa
• Mercy West Lakes, West Des Moines, Iowa
• Renown Regional Medical Center, Reno, Nevada
• St. Louis Children’s Hospital, St. Louis, Missouri
• The Valley Heart and Vascular Institute, Ridgewood, New Jersey
• University of Virginia Medical Center - Invasive Cardiology, Charlottesville, Virginia
• Valley Health - Winchester Medical Center, Winchester, Virginia
• Virginia Mason Medical Center, Seattle, Washington

What has the IAC learned during the first year of the release of the accreditation program? 

The experience of working with those seeking accreditation has allowed the IAC to not only streamline the application process, but to also develop value-added services for currently accredited facilities, facilities seeking accreditation, or those simply looking for Quality Improvement (QI) support tools. Prior to the release of the cardiac electrophysiology accreditation program, the EP community was offered an opportunity to review all program standards as part of a 60-day public comment period. As a result, requirements for the IAC Standards and Guidelines for Cardiac Electrophysiology Accreditation are truly a reflection of not only established guidelines, but best practices of the cardiac electrophysiology community. The IAC has also improved the post application process of submitting procedural documentation. Facilities are now able to access a user-friendly documentation upload tool within their IAC portal account. It is very important for the IAC to solicit feedback from professionals within the diagnostic imaging, therapeutic, and interventional communities. As the practice of medicine evolves, so do the requirements to improve the quality of patient care and clinical outcomes. The IAC is committed to providing excellent customer service and streamlined accreditation processes through feedback from accredited facilities as well as the community at large.    

How can IAC Cardiac Electrophysiology accreditation address the demands of QI initiatives, reimbursement, and physician certification requirements? 

In the era of value-based reimbursement, facilities are asked to demonstrate how they measure quality and employ methods to improve patient outcomes. The IAC has developed several tools and activities to assist providers in managing payer and other governing agency requirements. Accredited facilities are required to perform quarterly QI measures in four areas. The objective of these measures is to standardize quality metrics to evaluate processes of care, identify areas for improvement, and implement corrective actions to improve patient outcomes. The four areas of measure include: test appropriateness, safety and procedural outcomes, interpretive quality review, and report completeness and timeliness. The following value-added tools and activities are provided to facilities seeking accreditation, accredited facilities, and/or interpreting physicians of accredited facilities.   

The IAC Quality Improvement (QI) Self-Assessment Tool is available for use by all members of the cardiac electrophysiology community, whether they are accredited, working on their applications for accreditation, or they simply wish to engage with IAC solely by using the tool at this point in time. Facilities may use this online self-assessment tool to complete a comprehensive list of QI measures and receive reports, on demand, that document their overall quality scores and provide trending analyses. Use of the IAC QI tool:

• Allows facilities to self-assess their procedural documentation;
• Provides a data-driven, objective measure of QI progress for use in complying with the IAC Standards and Guidelines for Cardiac Electrophysiology Accreditation and fulfilling a variety of facility quality initiatives;
• Gives facilities the ability, over time, to benchmark their findings both internally and with the cardiac electrophysiology community as a whole;
• Creates a quantitative report that targets opportunities for improvements, leading to enhanced patient care;
• Incorporates HRS-developed Merit-Based Incentive Payment System (MIPS) Quality Specialty-Specific Measure Sets (#392, #393, #348) and National Quality Forum (NQF) measure (#2474).

The IAC also offers a Maintenance of Certification (MOC) activity for interpreting physicians within accredited facilities. Successful completion of this activity enables the participant to earn 20 Practice

Assessment points and patient safety credits in the American Board of Internal Medicine’s (ABIM) MOC program, 25 credits from the American Board of Pediatrics (ABP), and/or to satisfy the “Part IV: Participatory Quality Improvement (PQI)” Activity requirement from the American Board of Radiology (ABR) for a three-year period.   

For those concerned with the MACRA requirements established in 2015 as part of the Medicare Accessibility and CHIP Reauthorization Act (MACRA), physicians participating in MIPS will earn a Medicare payment adjustment based on practice-specific quality data for providing high-quality, efficient care through success in four performance categories. The IAC Quality Improvement Self-Assessment (QI) Tool and IAC Maintenance of Certification (MOC) activity are both options that may be used to satisfy the Improvement Activity component under MIPS.

Who should consider accreditation, and why? 

The IAC Cardiac Electrophysiology Board of Directors has designed the accreditation program to be inclusive rather than exclusive. The objective is to recognize those facilities who demonstrate compliance with standard requirements and to provide those facilities who may not with a pathway that provides detailed feedback for how to meet the requirements.

Explain the accreditation process and the IAC Standards and Guidelines for Cardiac Electrophysiology Accreditation. In what areas does this program provide accreditation? 

IAC Cardiac Electrophysiology accreditation is offered in the following areas: testing and ablation, device implantation, and chronic lead extraction. 

Serving as the basis for the accreditation program, the IAC Standards and Guidelines for Cardiac Electrophysiology Accreditation is an extensive document defining the minimal requirements for cardiac electrophysiology facilities to provide high-quality care. Sections within the published Standards include Personnel and Supervision, Facility (inclusive of examination and interpretation areas, storage space, equipment and instrumentation, and equipment and instrumentation quality control), Administrative, Procedures, and Protocols and Quality Improvement. Facilities may visit https://intersocietal.org/ep/main/about_standards.htm to download and review the comprehensive document. The Standards are used by facilities as both a guideline and the foundation to create and achieve realistic quality care goals. 

What initial steps need to be taken prior to application submission? 

Completion of the application requires detailed information on all aspects of facility operation as well as the submission of actual procedural documentation for review. The procedural documentation is crucial in determining the facility’s compliance with the Standards, and is the basis for judgment of the quality of work that the facility performs. Once the self-evaluation is completed and the application is submitted to the IAC, the facility and procedural documentation is reviewed by the Board of Directors. All aspects of the review are confidential. In addition, facilities undergo a comprehensive site visit of their program as part of the accreditation process. 

IAC offers a convenient online application format accessible from any computer, by multiple users. As a first step, creation of an account is necessary to gain access and begin the application process: https://intersocietal.org/ep/seeking/your_account.htm. Facilities preparing their applications for accreditation are encouraged to explore the IAC Cardiac Electrophysiology website to view and utilize the many tools and resources made available, including report templates and sample quality improvement reports and facility policies, access to recorded webcasts, CME resources, and links and references.

In addition to basic information about the facility and staff, the application requires detailed information related to procedural and complication documentation, policies, and quality improvement measures. Helpful resources, including several policy examples and a procedure checklist, may be found at https://www.intersocietal.org/ep/seeking/sample_documents.htm. 

Discuss the procedure selection process.

In addition to completing an online application questionnaire and providing documentation of the QI program, each facility is asked to provide documentation of their most recent procedures performed. Specifically, a list of a minimum of 30 consecutive cases from each of the areas of accreditation in which the facility is applying for accreditation is required. From this list, a small sample is randomly selected for review.

Required procedural documentation includes the following: 

• Clinical diagnosis leading to the cardiac electrophysiology procedure  
• Patient history and physical documentation
• Consent for the procedure performed
• Cardiac electrophysiology procedure report  
• Nurse monitoring / Technical report during the procedure
• Anesthesia monitoring report during the procedure
• Cardiovascular assessment documentation pre- and post-procedure
• Documentation of the pre- and post-procedural rhythm
• Most recent reports from prior cardiac electrophysiology testing 
• Complication information (if appropriate)

Are there any plans for future accreditation programs? 

Understanding that many facilities share resources between cardiac electrophysiology, cardiac catheterization, and other interventional programs, the IAC has developed a new complementary program for cardiovascular catheterization that is slated for release in the Fall of 2017. The program will provide facility accreditation specific to cardiovascular catheterization procedures in the following areas: adult diagnostic catheterization, percutaneous coronary intervention (PCI), valve interventions, structural heart interventions, complex adult congenital heart disease (ACHD), pediatric diagnostic catheterization, and pediatric interventions. 

Is there anything else you’d like to add? 

With a long history and reputation for offering friendly and responsive customer service, the IAC is fully staffed with both clinical and administrative personnel to guide participating facilities through the process. The IAC looks forward to working with the cardiac electrophysiology community as they begin the accreditation process.

Disclosures: The authors have no conflicts of interest to report regarding the content herein.