It is now more than a decade since I ceased being the American College of Radiology’s man with the federal government in Washington. It was a post I occupied for 27 years, working closely with the College’s registered lobbyists and ACR volunteers who helped us make radiology’s case on issues where federal agencies and sometimes Congress got involved with radiology.
We started our own Washington presence when the ACR in 1964 hired a former Texas congressman, JT “Slick” Rutherford, to get radiology defined and paid for by Medicare as a medical specialty and not as a hospital service. It was quite a struggle. We ultimately prevailed despite opposition of proponents of the Medicare law, the American Hospital Association, and even President Lyndon Johnson. We had on our side Congressman Wilbur Mills, the chairman of the House Ways and Means Committee and the author of the Medicare legislation. He held the critical vote and gave it to us.
We learned that Congress is only the first act and that the bureaucratic implementation makes the real difference. The administrators assigned to the new program were against us, and it took several years to persuade some of them that radiology by radiologists was good medicine, good for patients and good for the Medicare program.
We also learned about radiology’s stake in the Atomic Energy Commission licensing medical uses of artificial isotopes, the Public Health Service’s involvement with radiation uses, the National Institutes of Health dereliction about supporting radiology research, the National Institute for Occupational Safety and Health’s black lung and asbestos compensation programs requiring chest x-rays, and dozens of other federal initiatives that affected radiology.
The most critical issues floating around the federal establishment were the frequently stressed definitions of radiology. Was ultrasound part of radiology? It took congressional language to answer “yes” to that despite challenges from other specialties. What about angiography and angioplasty? That answer is still the subject of squabbles. What about mammography. A very definite “yes.” Is nuclear imaging part of radiology or a separate specialty? Most of the way, it is radiology, but separatists never give up. What about CT and MRI? Yes, but not exclusively. What about federal standards for licensing radiologic technologists? Still a state problem and still opposed by every medical user of x-rays except radiologists. What about health facility planning? We had to define work loads for CT scanners for health planners to set volume standards. We had to tell the feds in a gentle way how to set fee levels for MRI. We worked out a way for radiation oncologists to get their professional service fees when it was recognized that they did not see cancer patients on every teletherapy day.
These turf issues, medical squabbles, and research and funding issues were brought to the Congress for resolution. Then they were forwarded to bureaucrats to say what the Congress meant. What the Congress and the feds did not decide, we often had to persuade the health care insurers to decide. Many of the carriers would prefer to pay only radiologists for imaging. But they lack the fortitude to do that in the face of vigorous opposition from every other physician who acquires an imaging device and takes up self-referral. There also is the real issue that radiologists perform only about half of the imaging procedures done outside of hospital x-ray departments. Could we logically go against the reality that any physician is licensed to do our thing for fun or profit?