Impact of Medicare For All on Radiology

Medicare for all is either the best idea of all time that will save trillions of dollars and millions of lives, or it is a step into socialism that will shove the country off the abyss and into its demise. The truth must lie on this spectrum, but where on the spectrum is now being discussed ad infinitum by those in Congress, the American Medical Association (AMA), individual health care providers, insurance companies, and consumers.

Polls show that increasing numbers of consumers want the country to adopt a single-payer health plan. Employers who currently have the responsibility for providing employees health care benefits would like to be relieved of that burden.

One major problem is that legislators who are for Medicare for all cannot agree about how it will work, and insurance companies are opposed to a single-payer plan which would mean insurance companies would be essentially out of business. The AMA, which has been adamantly opposed to such a concept for years, recently came close to withdrawing its opposition.

Very little publicity is given to how, if implemented, Medicare for all will affect health care providers in general, and even less attention to how it will affect specialty practitioners such as radiologists. The first step in understanding how such a plan will likely affect radiology is to understand the basic premise of what Medicare for all means and its impact in general.

How Medicare For All Is Expected to Work for the Consumer

The non-profit Urban Institute pointed out in its March 2019 publication that Medicare for all is not a single-payer plan. “It is a multi-payer program that includes a government-run plan, enrollee premiums, an array of private insurance options, and significant beneficiary cost-sharing requirements.”

The legislative bills currently pending in Congress are not really Medicare for all, but single-payer systems. Even those plans can be designed in different ways.

University of Illinois professor emeritus of community health and expert on health policy analysis, Thomas W. O’Rourke, explained in a recent news interview how a true single-payer program like Medicare for all should work.

• Every U.S. resident will be covered from birth to death.
• Health care will be a public service and be funded through taxes, like the way public schools, fire departments, and the military are funded.
• Health care benefits will no longer be attached to employment. A person may move from one employer to another, or be unemployed, and they will still receive health care benefits.
• All medically necessary health care will be provided including drugs, vision, dental, hearing, and long-term care. There will be no copays, no deductibles, and no premiums paid.
• Every resident will have the same coverage and same opportunity for health care diagnostic tests and treatment.
• Every health care provider is in the system. There are no separate contracts because there is only one payer.
• There is no role for private insurance except for possibly supplemental plans that will cover electives like cosmetic surgery.

The General Benefit Health Care Providers are Expected to Reap Under a Medicare For All Plan

Under the present system, according to O’Rourke, providers have high administrative costs since they must deal with many different insurance carriers. Patients are billed individually depending on their insurer and the contract the provider has with that specific insurer.

Under a true single-payer plan, administrative tasks would be substantially reduced. There would be one payer instead of multiple payers. Each patient who received a certain radiology service would be billed the same amount. The billing statement would be sent to the Medicare for all administrator and the radiologist would receive the same reimbursement for each patient.

Why Some Physicians, Including Radiologists, Are Rooting for Medicare For All

Bob Doherty, a senior vice president for government affairs and public policy at the American College of Physicians, stated that he thinks “physicians are frustrated with paperwork, preauthorizations, limited formularies, high-deductible plans, and narrow networks associated with private insurers each with their own and conflicting rules.” This makes them more amenable to a single-payer plan that will reduce their administrative costs, take away their worry about collecting deductibles as well as requiring simplified rules and only one set of rules to follow for Medicare for all.

Why Medicare for All Might Negatively Affect Radiology

Private insurance companies pay more for services than Medicare does. Current rates paid by Medicare are generally quite a bit less than the amount billed and amount to about 40 percent less than paid by private insurance for the same service in a hospital, and doctors about 30 percent less for their treatment.

If Medicare for all is implemented, and the current Medicare rates are the ones that are adopted, it will mean substantially less revenue for radiology groups that depend primarily on private insurance payments. On the other hand, those practitioners who are already largely dependent on Medicare, Medicaid, or other government programs might possibly make more money under a single payer plan.

It is Too Soon to Accurately Predict the Impact Single-Payer Will Have on Radiology

There are several different Medicare for all plans bouncing around the legislature, some would pay doctors based on the services they provide, other plans call for the federal government or regional directors to set the rates.

The Congressional Budget Office (CBO) was asked to weigh in on the .legislative bills. It specifically noted that one major consideration was how to pay physicians.

Additionally, the CBO expects that more people will be accessing health care and patients may end up waiting a long time for appointments. The CBO said that the government “could implement policies to increase the supply of providers” in order to decrease wait times.

It appears that single-payer, or Medicare for all will, sooner or later, be voted in. Radiology practices need to be ready for it and to plan for how to be sure revenue continues, and that a fair reimbursement system is established.

 

Sources

1. Polls showing consumers want single-payer plans: https://www.kff.org/slideshow/public-opinion-on-single-payer-national-health-plans-and-expanding-access-to-medicare-coverage/
2.  Urban Institute references: https://www.urban.org/sites/default/files/publication/99918/pros_and_cons_of_a_single-payer_plan.pdf
3. AMA coming close to withdrawing its opposition to Medicare for all: https://www.vox.com/policy-and-politics/2019/6/12/18662722/ama-medicare-for-all-single-payer-vote-2020
4. Thomas O’Rourke references: https://news.illinois.edu/view/6367/801191
5. Bob Doherty reference: https://www.vox.com/policy-and-politics/2019/6/12/18662722/ama-medicare-for-all-single-payer-vote-2020
6. Congressional Budget Office (CBO) references: https://www.advisory.com/daily-briefing/2019/05/02/single-payer

Other General Sources

1. https://www.marketwatch.com/story/what-medicare-for-all-would-do-to-the-health-care-sector-2019-04-11/
2. https://www.congress.gov/bill/116th-congress/house-bill/1384
3. https://www.advisory.com/research/imaging-performance-partnership/the-reading-room/2018/09/radiology-medicare-proposal
4. https://revcycleintelligence.com/news/greater-volumes-consolidation-likely-under-medicare-for-all