Frequently Asked Questions / Licensure

1. Why should I support licensure and how does licensing reduce risk and liability for the hospital and surgeons?

Liability for untracked, inadequately trained Neurodiagnostic Technologists places the reputation and financial solvency of healthcare facilities and associated professionals at risk. State licensure will require those performing Neurodiagnostic testing and monitoring to acquire pertinent, standardized basic and continuing education, resulting in accurate data collection, reduced additional testing, and decreased risk of patient harm. State licensure provides protection for employers with an accessible database of sanctions imposed on individual technologists. The Neurodiagnostic profession aids assessment of neurological systems regulating cardiac, respiratory, sensory, motor, and cognitive functions, and is vital to the practice of medicine.  Therefore, training should not consist of a four hour add-on for diverse hospital staff. All medical specialties, especially those under shared administration, must uphold published practice standards for their particular fields. A major, publicized malpractice case for the Neuro department reflects poorly on the rest of the organization, as well. Health Care Administrators, Medical Clinical Professionals, and Hospital Medical Boards can collaborate to understand and ensure effectiveness and safety protections for both business and clinical interests.  
2. How does licensing Neurodiagnostic Technologists save my facility money?
Diagnostic tests may need to be repeated if not performed properly. Patients have choices and may request to have testing done elsewhere if the technologist is obviously not professionally prepared. The NDT specialist is an integral part of the diagnostic and monitoring team in the operating room, helping to prevent sentinel events. The medical/legal implications can be costly to your facility. Insurance companies currently are moving toward value-based reimbursement for medical services. Services that can prove quality including use of credentialed licensed technologists, may be reimbursed at higher rates.   

5. I perform neurodiagnostic procedures but I am a licensed medical professional in another field, how does this impact me? 
The ASET Model Bill has an exemption clause provides that the following persons performing ND procedures do not require licensure under this act:

(1) A licensed physician.
(2) A person recording ND testing for research purposes provided the results are not used in treatment and diagnosis.
(3) Appropriately licensed health care professionals working within their scope of practice. (Source: ASET Model Bill, Section 6)  (Note: Scope of practice may be legally outlined and designated for various professions in each state.)   

6. Are Neurodiagnostic Technologists trying to encroach upon my scope of practice?    
No. NDT professionals practice within the extent and limits of their own scope of practice. Outlined standards were/are established by select boards of leading neurology and neurophysiology physicians, technology professional associations and  credentialing organizations. Skills and knowledge are related to neurology, neuroanatomy, and neurophysiology and test the functioning of these systems.

FAQs: Legislators

1. Why should I support licensure?

Licensure will assure an appropriately educated workforce of technologists, rather than having so-called “techs” who are briefly trained in methods and means that do not meet the neurodiagnostic practice standards established by boards of physician leaders in the appropriate fields.

Mandatory state licensure for healthcare practitioners is initiated to:

a. Protect the public from harm caused by inadequately trained practitioners. State Licensure
    Practice Acts may limit the practice of the Neurodiagnostic Technologist profession to
    those who have met requirements for licensing including:
          i. Attaining minimum initial levels of appropriate education, experience, and
             supervision, and submitting the required number of earned units of continuing
             education on a timely basis.
          ii. Passing appropriate competency testing from organizations accredited by certified
              accrediting agencies.
b. Enable intrastate and interstate tracking and monitoring of individuals, to include:
          i. documented incidences of serious incompetency; those who are impaired by mental
             disturbances or substance abuse, or involved in professional ethical infractions or
             criminal convictions, and listing of any sanctions imposed by state governing boards.
c. Providing clearly defined scopes of practice for each occupation and defining who is
    qualified to be a professional in each field. The public benefits as a result of the
    professional scope of practice. {Source: White Paper on Occupational Regulation. }

3. How many technologists will be covered by this license?

The question will need to be answered on a state by state basis. A starting point is to determine how many credentialed technologists there are and then determining how many technologists are not credentialed.

7. What groups would oppose or have an interest in the proposed legislation?

Some Audiologists are qualified to do intraoperative monitoring, and Brainstem Auditory Evoked Potentials Hearing Threshold Testing. Chiropractors in a couple states may be qualified to place needles and perform Electromyography (EMG). Respiratory Therapists have an interest in adding neurodiagnostics to their skill set, but their education is in cardiopulmonary and respiratory functioning, not neurophysiological functioning or disorders. Some facility administrators have respiratory personnel very briefly “trained” to run the equipment in an attempt to save money; not recognizing what the collected wave patterns signify and most often not trained in recording strategies to recognize and eliminate artefact, and best clarify abnormalities.

9. What is the nature and severity of the harm?

Document the physical, social, intellectual, financial or other consequences to the consumer resulting from incompetent practice. Currently, competency testing of personnel assigned to perform neurodiagnostic testing is not legally required.

a. An article published in the American Journal of Electroneurodiagnostic Technology in 1997
    documented occult blood detected on surface EEG electrodes. Without continuing
    education, and knowledge of subsequently increasing infection control standards,
    techs could spread blood borne diseases such as hepatitis or HIV/AIDS. Article about
    hepatitis spread to 75 patients from an infected tech not wearing gloves and using
    subdermal electrodes.

b. Briefly trained techs may not be aware of limits to their scope of practice regarding
    providing final decisions about the normality or abnormality of recorded data in a
    written report. Specialist physicians, after years of advanced medical education,
    have the knowledge required for clinical correlation, determining diagnosis.
    Technologist basic education includes personal/professional relations and scope
    of practice limits.

10. Are there other states in which this occupation is regulated?

No. (As of May 2019)

11. What impact will the requested regulation have upon the authority and scope of practice of currently regulated groups?

According to the ASET Model Bill, persons who currently are practicing in neurodiagnostics at the time of enactment of a state licensing bill may obtain a license to practice, but will be required to obtain 15 approved education units biennially in the appropriate diagnostic modalities. Those not practicing yet at the time of bill enactment will have to meet standards outlined in their state licensure bill, which may include obtaining the national credential or minimum levels of neurodiagnostic education, among other possible requirements. (Source: ASET Model Bill, Section 11)

FAQs: Patients and the General Public
1. Why should I support licensure?

Mandatory state licensure for healthcare practitioners provides:

a) Protection for the public from harm caused by inadequately trained practitioners.
    Licensure enables intrastate and interstate tracking and monitoring of medical
    professionals to document incidences of serious incompetency and of those
    who have been ruled to be impaired by mental disturbances or substance abuse.

b) A Licensure Practice Act limits the practice of the neurodiagnostic profession to those
    who have met requirements for licensing including:
        1) Minimum levels of appropriate education and maintenance of continuing education.
        2) Passing appropriate competency testing from organizations accredited by certified
            accrediting agencies.
        3) Regulation gives clearly defined scopes of practice for each occupation and defines
            who is qualified to be a professional in each field. The public benefits as a result of the
            professionals being able to concentrate on clearly established guidelines and
            requirements within their scope of practice. {Source: White Paper on Occupational
. }

2. How much will this increase the cost of my care as a patient?

Mandatory licensure would not directly increase the cost of patient care. On the contrary, poor quality data, collected by incompetent technicians, leading to incorrect or delayed diagnosis, can increase costs for patients, facilities and insurance companies due to need to repeat or additional testing.


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