1. What is the Echocardiography Quality Improvement (EQI) Program?

The IQMH Echocardiography Quality Improvement (EQI) Program is a quality improvement initiative for all facilities providing echocardiography services in Ontario. The EQI Program reviews all registered echocardiography facilities according to the Standards for Provision of Echocardiography in Ontario.

Please note that the EQI Program only evaluates the practice of complete echocardiographic examinations on adult patients and currently does not review any of the following echocardiography services:

• Pediatric echocardiography, inclusive of fetal echocardiography
• Intraoperative transesophageal echocardiography
• ICU transesophageal echocardiography

If you have questions pertaining to the billing of any of the above echocardiography services, please direct your questions to the Ontario Ministry of Health (MOH):

Service Support Contact Centre
1-800-262-6524
IncidentSupport@ontario.ca

2. How does the EQI Program effect billing for echocardiography?

As described in the Ontario MOH bulletin #4664 published on January 26, 2016 , facilities must be actively engaged in the EQI Program to qualify for  billing practices for echocardiography services.

The EQI Program and the Ontario MOH require a valid OHIP group number or numbers, as a unique identifier for your facility. If you have not already done so, please submit all valid OHIP group billing numbers associated with your facility to the EQI Program.

If your facility does not have a group billing number, one can be obtained here.

3. How do I continue to bill for fetal echocardiographic examinations?

If you are a provider who performs fetal echocardiography on pregnant mothers and your facility is not registered to the EQI Program (i.e. it is a pediatric institution), please contact the EQI team for further instructions on how to continue normal billing practices for fetal echocardiographic examinations. 

EQI Team
416-3239540
eqi@acdiagnostics.ca

4. What should my facility do with our new OHIP group billing number(s)?

All facilities should exclusively use the valid OHIP group billing number(s) they submitted to the EQI Program to bill for echocardiography services. If you have received a new group number, you may also use this number to bill for other services. Group billing numbers submitted to the EQI Program for your facility have been approved and activated by the Ontario MOH.

The use of any additional billing numbers (e.g. solo billing numbers, “0000”) or group billing numbers not submitted to the EQI Program will result in the receipt of an error message (EG1) on your error report.

If your facility receives an error message or experiences difficulties with claim submissions that you are unable to resolve, please contact:

Service Support Contact Centre 
1-800-262-6524 
IncidentSupport@ontario.ca

5. What should I do if my facility receives an OHIP error message “EG1”?

Please ensure your facility is only submitting billing claims for echocardiography services using a valid OHIP group number that was provided to the EQI Program. You may resubmit claims with a group number that has been submitted to the EQI program and activated by the Ontario MOH.

To resolve any issues with OHIP billings, please contact:

Service Support Contact Centre 
1-800-262-6524 
IncidentSupport@ontario.ca

6. Why do I need a valid OHIP group billing number?

Valid OHIP group billing numbers allow IQMH to update the MOH with a list of active EQI Program participants. If your facility has a group billing number(s) you can submit them to the EQI program to have them activated for billing claims for echocardiography.

If you have not already done so, please make sure to submit all valid OHIP group billing numbers associated with your facility and practicing physicians to the EQI Program.

If your facility does not have a valid OHIP group billing number, one can be obtained here.

Please note that only physicians can bill and be paid for echocardiography technical and professional fees. Physicians are reminded that the Schedule of Benefits for Physician Services has requirements for billing technical fees and those requirements must be met for the technical fee to be eligible for payment.

7. Can I use my Independent Health Facility (IHF) group billing number for echocardiography services?

No. Please note that only physicians can bill and be paid for echocardiography technical and professional fees. If echocardiography services are provided in the same location as an Independent Health Facility (IHF), the IHF group number is not valid for payment. A physician group will require a new OHIP group billing number for the purposes of billing for echocardiography if services are provided in the same location as an IHF.

If your facility does not have a valid OHIP group billing number, one can be obtained here.

Physicians are reminded that the Schedule of Benefits for Physician Services has requirements for billing technical fees and those requirements must be met for the technical fee to be eligible for payment.

8. I am a physician providing echocardiography services out of my own clinic. Do I still require a valid OHIP group billing number?

Yes. Sole physician clinics require a valid OHIP group billing number.

If you currently do not have a group billing number, one can be obtained here.

9. Our echocardiography facility did not register every affiliated site. Is it necessary to register our other sites?

Yes. All sites affiliated with your facility must be documented and reviewed by the EQI Program. Please ensure that all sites, where echocardiography services are performed have been registered to the EQI Program.

10. After registration, how long does it take for a site visit to be scheduled?

Once registered, a facility will need to ensure the documents listed below are submitted to the EQI Program in order to arrange a site visit date. Please visit the IQMH website, specifically Step 2 of the EQI Process, for information on how to submit required documents electronically via the website’s file manager.

a) A signed Facility Agreement is required from the signing authority at each site location listed under your facility. 

b) Signed Physician Attestation Forms are required from all practicing physicians within a facility. 

c) A full policy and procedure manual is required to be available for review at every site. To ensure an efficient and accurate review of your facility, we require a few key documents to be submitted three weeks in advance of the site visit. The documents allow us to make an accurate assessment of your facilities and are a useful resource when we work with you to develop a meaningful quality improvement plan. Failure to submit these documents in advance, may result in the site visit being cancelled.

11. What facility staff, material and equipment are required to be present for the site visit?

a. The Medical Director or their physician delegate must be available to meet with the on-site reviewer(s) to answer questions.

b. The Technical Director must be available to coordinate the site review, provide a tour of the facility and to answer questions.

c. It is expected that other members of the facility staff are available to answer questions pertaining to their role and the facility operations.

d. The policy and procedure manual must be available on site for review.

e. The on-site reviewer must be able to observe each type of examination on the day of the visit (patient consent required). Site visits will be collaboratively scheduled, so that each modality performed at the site, has scheduled patients on the day of the site visit.

f. Case studies (images and accompanying reports) must be available on location for each modality performed at your facility for the on-site reviewer.

12. Does IQMH provide a pre-evaluation assessment for site visits?

IQMH does not provide a pre-evaluation assessment.

13. Who will conduct the facility site visit?

Two EQI Program echocardiography sonographers will conduct the site Visit. Site visits to secondary facilities may require only one reviewer.

14. How long is a facility site visit?

The length of a site visit will depend on the size of the facility and the number of modalities to be reviewed. Smaller facilities may take one day, whereas a large academic facility may take several days.

15. Can my mobile echocardiography facilities practice in long-term care homes, nursing homes or retirement residences?

All echocardiographic examinations must occur in a physical space dedicated to the practice of echocardiography. This may be present in some long-term care homes, nursing homes or retirement residences.

Echocardiographic examinations that occur in private patient rooms or residences where the physical environment is changing, do not align to the Standards and will not be reviewed by the EQI Program.

Please note that EQI facility agreements will need to be submitted by the signing authority at long-term care homes, nursing homes or retirement residences  before the EQI Program will be able to conduct a site visit.

16. What if the rooms at a facility do not meet the size requirements as stated in the Standards?

The site reviewer will assess if the room is adequate to perform echocardiography procedures and determine if the environment is safe for patients and the echocardiography facility staff.

No single element of the EQI Program will result in the need for an EQI quality improvement plan to be actioned. Specific elements of your facility site review may be highlighted in the final report as areas that require improvements and room size could be one of those elements.

17. Will IQMH provide translation services for sites in Ontario that are primarily French speaking?

No. The EQI program is provided in English only.

18. We do not have a Medical Director for our mobile echocardiography services. Must we have a Medical Director in order to meet the Standards?

Yes. A Medical Director is a required position for all echocardiography facilities in Ontario. Several facilities have partnered with Medical Directors from external facilities to meet this requirement of the Standards. If your facility would like help in partnering with an external Medical Director, please contact the EQI team at eqi-program@accreditation.ca.

19. I have a facility where echocardiography is one of the services provided, and we do approximately 250 echocardiography exams per year. Does that mean that we will not meet the Standards?

No. Minimum volume requirements are in place for the Medical Director and medical staff performing echocardiographic examinations. There are no required volumes for the facility.

In addition, the minimum volume requirements for the Medical Director and medical staff are cumulative across all locations where individuals practice and count towards a practitioner’s total annual volume.

20. If the requisition form does not have an indication documented for the echocardiogram, is it ok to ask the patient why they need the echocardiography exam?

For referrals without a standard indication (see Appendix B of the Standards), facilities must have mechanisms in place whereby the referring physician is contacted and provides the indication prior to the study being performed.

21. My facility equipment records echocardiography cases on VHS Tape, not a digital imaging system. Are we required to purchase a new machine in order to register to the EQI program?

Please refer to Standard F2, which outlines the criteria required of echocardiography imaging systems. If not in place at the time of the site visit, this will likely be a suggested area for improvement.

22. What are the potential outcomes of the EQI review process?

The goal of the EQI Program is quality improvement of echocardiography services in Ontario. Quality improvement is ongoing and it should not begin, nor end, with an EQI review.

There are four potential outcomes, all of which highlight areas for quality improvement as follows:

a. Full accreditation
b. Minor Concerns
c. Significant Concerns
d. Critical Concerns

23. What happens if my facility is found to be compliant with the Standards?

Facilities found to be compliant with the Standards will receive a detailed report and certificate. Notice of this status will also be shared with the Ontario MOH.

24. What happens if my facility is not found to be compliant with the Standards?

The goal of the EQI Program is quality improvement of echocardiography services in Ontario. Quality improvement is ongoing and it should not begin, nor end, with an EQI site visit. Any site that does not meet the Standards upon initial review will be given a detailed report indicating key areas of required improvements. 

Facilities may be asked to submit an EQI quality improvement plan within a defined time frame to address these key areas. EQI Program staff will also work with facilities to determine if any further assessments are required.

25. Do I need to notify the EQI Program of facility changes (e.g. change the business name or add physicians to the group)?

Yes. Facilities are required to notify us prior to any of the following: 

a. Change of ownership and/or facility name
b. Change of Medical Director
c. Any addition or deletion of services and/or modality offered (e.g. stress echocardiography)
d. Any addition or change of site locations to the facility/practice
e. Any addition or removal of Medical Staff to the echocardiography facility group
f. Any addition or removal of Technical Staff to the echocardiography facility group

26. How are case studies submitted to IQMH when required?

If your facility is requested to submit case studies, this is done electronically through a secure FTP server. Please refer to the EQI Program Information and your facility agreement on details regarding the step(s) taken to protect Personal Health Information. The EQI team will contact your facility with additional instructions. IQMH requires that all cases be submitted in digital imaging and communications in medicine (DICOM) format.

27. If required, how many case studies should my facility submit?

Case study submission is not required from all facilities, as case study review will occur on location whenever possible. If the EQI team requests case study submission, the number of studies required will depend on the number of modalities in use at your facility.

28. What if I have to reschedule or cancel my on-site review appointment?

Rescheduling/cancellation or not being present and available at the on-site review, particularly on short notice, makes it impossible for EQI Program staff to offer that date to another site, and the site review date can go unfilled. Understanding that there are a range of valid reasons for rescheduling or cancelling an on-site review, the full rescheduling guidelines are available in the EQI Program Information.