The Academy was invited by American Society of Neurophysiological Monitoring (ASNM) to comment on their draft professional practice guidelines. President Deb Carlson compiled comments from the Academy members she had asked to review it (Paul Kileny, Douglas Beck, and Michael Dennis) and submitted on behalf of the Academy.
Practice Guidelines for the Supervising Professional: Intraoperative Neurophysiological Monitoring
Overall, it was agreed that the document seems to be well written and addresses its purpose.
What Information, If Any, Did You Find to Be Unclear or Inconsistent in this Draft Document?
The document was comprehensive and acknowledges that there are differences in in IONM-P care as related to state licensure and scope of practice.
Section 2.0 The role of the Qualified Healthcare Professional (QHP) was unclear to some reviewers and consideration of the term Qualified Healthcare Professional Provider (QHPP) is suggested to clarify the active role of the non-physician professional in their partnership with the physician in the provision of IONM services. This term would then follow through the document. Likewise, the term "proceduralist" was felt to be confusing and unnecessary and that surgeon or interventionalist is adequate and promotes clarity.
Section 5 provides an appropriate definition of the Intraoperative Neurophysiological Monitoring Supervising Professional (IONM-P) as: A" Physician or Qualified Healthcare Professional insert [Provider] (QHPP) is an individual qualified by education, training, licensure…who performs a professional services within his/her scope of practice and independently reports that professional service". Consideration of this definition should be used consistently throughout the document.
Section 6.3 describes the IONM-P responsibility for formulating an individualized IONM patient care plan. In some situations this may be a matter of approving an IONM patient care plan. Recommend the terms "… formulating or approving…". In the last sentence of the section, clarity is enhanced if parentheses and the word "great" be removed. How would one quantify "great"? "Whenever possible, and when case complexity dictates, the IONM-P: …."
Section 7.2.1 number 1 "Proceduralist activity" – what is proceduralist activity - enhances clarity to state this as surgical or interventional activity…
Section 7.2.2 Does terminology such as "convey/recommend" anesthetic strategies to the anesthesiologist suggest the practice of medicine? This is better stated as discuss the IONM plan and impact of anesthetics on IONM modalities to assist the anesthesiologist in establishing anesthetic strategies for successful monitoring during the procedure.
Section 7.4 lacks clarity with the use of the term "Proceduralist" (see above comment in 2.0) and represents coding concerns. The AMA CPT codes and the CNS do not allow billing of IONM services by the surgeon or the anesthesiologist performing the procedure. We recommend the addition of a statement clarifying the coding requirements specific to this section.
Do You Have Other Comments on this Draft Practice Guideline?
Concern was raised about the patient safety aspect of the IONM-P monitoring concurrent cases. Cases are best handled when the fully qualified professional remains through the entire case in both the technological and interpretive roles.
Thank you for your extensive work on this document and for the opportunity to comment on this draft guideline.