This History of Radiology and Medicare Julian Hardman, MD John H. Stroger Hospital, Chicago

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 service rather 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

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

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???

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

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

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)

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

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.

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.

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.