CLINICAL LAB SCIENEC

46
ESSENTIALS OF CLINICAL LABORATORY SCIENCE
The federal government’s first attempt to improve the situation centered on
the Clinical Laboratory Improvement Act of 1967 (CLIA 67). Those who were
qualified under previous regulations were “grandfathered” on a permanent basis.
But then ways were sought to credential laboratory workers who were supposedly
already deemed qualified to work in a medical laboratory through a hodgepodge
of on-the-job training, various obscure registries, and sometimes on a
self-regulating basis. Problems continued to erupt, and the Health Care Financing
Administration (HCFA) developed the final regulations called CLIA 88. This
act attempted to deal with the competence and credentials of medical laboratory
workers but it has done nothing if not worsened the scene. HCFA, under CLIA
88, now states that all personnel performing high complexity testing must have
had a minimum of 2 years of college by 1997. Critics of this provision, on both
sides, argue that it places an undue burden on those who were previously qualified,
while other interest groups say that at least a baccalaureate degree is necessary
to be a supervisor. HCFA claims that personnel standards are so intertwined
with complexity models and other sections of the law that modifying one aspect
could lead to other complex adjustments and would give various interest groups,
including private registering agencies, more grounds for appeal.
Those who were deemed qualified and worked before March 14, 1967, were
permanently “grandfathered” in the first version of CLIA. But the final rule of
CLIA 88 states that those with only a 1-year program of training must not perform
high-complexity testing without supervision. And to keep their jobs, they
must have completed an associate’s degree by 1997. This requirement has sometimes
been conveniently overlooked by individuals, institutions, and governing
bodies. Debate still rages from those who say the personnel requirements are too
strict. And there are those who say that the educational requirements have been
gutted by all of the interest groups. Some of these groups have much to gain by
maintaining their status quo. These groups often resist efforts requiring that their
members expend more educational effort but may insist that their constituents
maintain the same level of employment as their peers who have 4-year college
degrees and should earn the same salary with essentially on-the-job training and
no advanced formal education.
These final regulations have done nothing to enhance the profession from the
personal viewpoint of most medical laboratory workers. It has also not served as
a means of added protection to the consumer. The medical laboratory profession
would do well to adopt the stance of the various nurses’ and pharmacist’s associations.
In an informal show of unity by the various licensing boards and professional
associations, nurses and pharmacists have greatly advanced the stature
of their respective professions. State licensure even includes specialty boards for
various nurse practice acts; for example, for a certified nurse anesthetist (CRNA),
the nurse with this specialty education is licensed separately from those practicing
basic nursing care. The nursing and pharmaceutical professions also appear
to have achieved somewhat consistent standards from state to state, with standardized
tests that are the same, regardless of the state issuing the license. And
for medical technology workers, CLIA 88 was a classic example of a movement
that started out with extremely lofty goals and then was gradually weakened by
the attempts of special interest groups or by ignoring the provisions by many.
Copyright 2010 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s).
Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.