This History of Radiology and Medicare

1. This History of Radiology and Medicare Julian Hardman, MD John H. StrogerHospital, Chicago

2. Rise of Medicare • In the 1940s, the idea of national hospital insurance seriously showed up on the congressional agenda in bills by Murray, Wagner and Dingell • All of the early congressional bills included radiology as a hospital based servicerather than a service provided by independent physicians • With the election of John Kennedy and Lyndon Johnson in the 1960s, Medicare seemed sure to be passed

3. Rise of Medicare • The American College of Radiology realized that it had to stop radiology from being perceived as a service provided by the hospital, and rather a service provided by physicians • In 1963 the ACR president Jack Carroll testified before a congressional committee that including radiology as a hospital service would destroy the field of radiology

4. Rise of Medicare • In 1964 it was apparent that Medicare was going to be pushed through Congress • The Medicare legislation in its current form was going to cover radiology in hospitals rather than in physician offices • In January 1965 the executive committee of the ACR met with Karl Mundt who was a conservative senator • He advised the committee to hire a lobbyist to get radiology written out of the bill as Medicare was sure to pass through Congress in 1965 • Who to Hire???

5. Lobbying Effort • One month later, the ACR hired a former Democratic congressman, J. T. Rutherford who taught the ACR how to lobby Congress in that era

6. Lobbying Effort • There were two targets of the lobbying effort: • Represenative Wilbur Mills of Arkansas who was the chairman of the house Ways and Means Committee • Senator Paul Douglas of Illinois who was the chair of the Senate Finance Committee • Rep. Mills supported the view of the ACR while Sen. Douglas and President Johnson did not • There was a letter writing campaign and visits to Washington DC from radiologists and patients all of which was orchestrated by the ACR

7. Legislation • The AMA proposed Eldercare which was renamed Medicare Part B by Rep. Mills • This greatly helped the cause of radiologists as it was more palatable to move radiology instead of exclude it from Medicare • Bill passed the House with radiology as a medical service (Medicare Part B) despite pressure from President Johnson • In the Senate however, Senator Douglas moved radiology back into a hospital service (Medicare Part A)

8. Legislation • In the conference committee, the ACR had to hope Rep. Mills could hold his ground and in addition, they had to change the mind of one senator • The hero was Dr. Wynton Carroll from Shreveport, LA who was treating the mother of Senator Russell Long for cancer • Dr. Carroll convinced Sen. Long that radiology should be treated as a medical service • Radiology officially became part of Medicare part B

9. Medicare Part A vs Part B • Medicare part A is hospital insurance that helps cover inpatient care in hospitals, skilled nursing facility, hospice, and home health care. • Most people don’t pay a Part A premium because they paid Medicare taxes while working.

10. Medicare Part A vs Part B • Medicare part B helps cover medically-necessary services like doctors' services, outpatient care, durable medical equipment, home health services, and other medical services. • If you have Part B, you pay a Part B premium each month. Most people will pay the standard premium amount.

11. Significance • If not for the efforts of the ACR, radiology would have been a part of Medicare part A. • Thus, radiology would only have been covered by Medicare via hospital payments and private insurers would have eventually followed Medicare’s lead, essentially making radiologists hospital employees. • Radiologists would have become salaried employees of the hospitals, and radiology would probably not be the same as it is today.