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Is medical technology accreditation really necessary?

Some startling data have appeared concerning the initial impact of prospective payment on allied health clinical education programs. At the beginning of this year, the American Medical Association's Committee on Allied Health Education and Accreditation sent a survey form on this subject to 2,850 directors of the group's accredited programs. Excluded were programs sponsored by the military, the Veterans Administration, and proprietary agencies.

A resounding 74 per cent responded to CAHEA--proof of strong concern among educators. Their observations raised serious questions about the prognosis for our system of program accreditation for laboratory scientists.

The survey results indicate that the DRG payment revolution has had a profound impact on some areas of allied health education, with further changes anticipated across the board. And the overall outlook for medical technology programs is far from rosy.

To understand what is happening, we must appreciate the basic difference between institutional versus program accreditation. In the former case, a college or univeristy--including all its programs--is accredited by nationally accepted regional agencies.

Program accreditation, on the other hand, is an approval process--such as those offered by the National Accrediting Agency for clinical Laboratory Sciences and the Accrediting Bureau of Health Education Schools--for individual curricula or sets of courses. It applies to programs run by academic institutions, hospitals, and proprietary or vocational/technical schools. These accrediting agencies are sanctioned by the U.S. Office of Education, a Federal standard-setting body.

This two-tiered system subjects universities to a costly dual survey process when they seek allied health program accreditation. So far, attempts to reform the process have been unsuccessful. The biggest impetus for change comes from hospitals--those with either academic affiliations or freesanding programs.

The bottom line is cost. Prospective payment still allows hospitals cost-based reimbursement for accredited medical and allied health education programs, but all signals out of Washington indicate that this allowance won't last. However it is altered, the flow of dollars will dwindle.

Respondents to the CAHEA survey are at the front lines of the embattled system. Here are some of the casualties they report already: smaller class size, loss of clinical affiliations, actual and anticipated program closing, temporary suspension of classes, less time for hospital-based educators and bench personnel to devote to teaching, and a diminished quality of supervision due to an increase in lower-level staff members.

The allied health educators also made some revealing comments on how DRGs have affected their programs so far --comments, I believe, that indicate what all such programs may encounter in the next few years. The most significant changes were predicted for these occupational categories:

MLT (medical laboraotry technician, associate degree and certificate)--affiliates unable to provide as many reagents and supplies for students; possibility of charging students supply fees; less student experience with a smaller variety of tests; more work responsibilities and less teaching time for clinical instructors; more use of simulated labs; substitution of ambulatory sites for hospital labs; and heavy cost cutting by clinical affiliates.

MT (medical technologist or clinical laboratory scientist)--fewer students accepted into programs; stipends eliminated; budget cuts and strong pressure to contain and justify costs; reduced or changed staffing; tighter job market; greater use of reference labs and fewer in-house procedures; need for diversified teaching to include more administration, education, and computer skills.

Nuclear medicine technologist--job market static or contracting; less testing; stipends cut and tuition increased; smaller classes; less new equipment.

Blood bnak specialist--decrease in test volume; cost pressures to justify programs; job shortage for graduates; hospitals unwilling to grant a year's leave of absence.

In general, program directors anticipate many changes in academic and clinical laboratory education programs, including these:

* Future graduates will have to be more competitive in the job market. They will need multiple skills and greater competence. More emphasis will be needed on business, management, computer, and interpersonal skills.

* As clinical affiliates and hospital-based programs dwindle, we will need more university or college-based programs offering didactic instruction and simulated labs--with less hands-on clinical experience.

* The Medicare system's pass-through for education costs will be eliminated by 1986 or 1987. Most programs will then have to find practical alternative sources of funding or close.

* Technicians will perform the bulk of laboratory testing, and medical technology graduates will need greater sophistication.

* Evolving technology in nuclear medicine will require graduates with multidisciplinary training in related fields. Jobs will be fewer but more complex.

* The demand for blood bank specialists will decrease even though blood bank practice is growing blood bank practice is growing more complex. Those with master's degrees will have the edge on entering administration and teaching.

What should we be doing to accommodate these changes? First, we must face the fact that change is inevitable. We won't see yesterday again; all we can do is reach for a role in shaping tomorrow. It is completely unrealistic to believe that the number of hospital-based technologist and technician programs won't shrink by 1987. In fact, we will be lucky if any are left.

Hospital administrators are already scrutinizing the cost-benefit ratios of their programs, and academia is taking a serious look at the direct and indirect costs of multiple program accreditation. Meanwhile, a job market in transition may make today's students obsolete before they start to work.

The first place to make changes of our own is in accrediting agency standards. Rigid or outdated curriculum requirements must go. Cumbersome and bureaucratic approval processes must be streamlined and made less costly. The agencies must consult with employer groups, particularly laboratory managers, to determine what kind of individuals are needed in the workplace. And curricula must meet job demands, not educators' desires.

Finally, the profession itself must reevaluate its traditional must reevaluate its traditional must reevaluate its traditional method of preparing practitioners. Is the present accreditation process really necessary? Are there viable alternatives that will meet future needs? Do we hang onto the existing process because of vested organizational interests?

if we are unwilling to answer these questions with an open mind, then someone else will make the decisions for us. The end result may be no program accreditation and few if any hospital-based programs. The ball is in our court, and how we play it will determine the future of medical technology.
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Copyright 1985 Gale, Cengage Learning. All rights reserved.

Article Details
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Author:Barros, Annamarie
Publication:Medical Laboratory Observer
Article Type:column
Date:Jun 1, 1985
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Next Article:Lab director issue pivotal in CAP's deemed status bid.

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