Medicare for All: Considerations for Neuroradiologists

Article Figures & Data

Table 1:

Fundamental objectives of the Medicare for All Acts of 2019^2,3

Objectives
Establishment of a national health insurance program administered by the government that would cover all US residents
Creation of a nation health budget
Elimination of cost-sharing (deductibles, coinsurance, copayments) and balance billing for covered services
Interdiction against duplicate benefits from private health insurers or employers

Table 2:

Example of neuroradiology case mix and 2019 Medicare fees compared with private insurance^{5,6^a}

Examination (CPT)	No. of Examinations (2019)	Case Mix (%)	NR	Medicare Global	PI Global	Medicare PC	PI PC	Medicare TC	PI TC
CT head (70450)	44,300	69.5	$0	$115.20	$369.82	$43.72	$74.54	$71.48	$295.28
CT head with contrast (70460)	50	0.1	$0	$162.76	$420.63	$58.56	$95.97	$104.20	$324.66
CT head without and with contrast (70470)	564	0.9	$0	$190.09	$437.57	$65.34	$106.08	$124.74	$331.49
MR imaging brain (70551)	9400	14.7	$0	$224.92	$550.98	$76.16	$131.26	$148.77	$419.72
MR imaging brain with contrast (70552)	244	0.4	$0	$311.96	$486.19	$91.71	$158.49	$220.24	$327.70
MR imaging brain without and with contrast (70553)	9225	14.5	$0	$368.27	$911.65	$117.39	$217.90	$250.88	$693.75
Total	63,783	100.0

Note:—NR indicates nonreimbursed; PI, private insurance; TC, technical component; CPT, Current Procedural Terminology.
↵a Medicare fees are based on the Medicare Physician Fee Schedule database with the following criteria: year 2019 and MAC locality 0720201.⁵ There was no difference between Medicare facility and nonfacility fees. Private insurance fees were obtained from IBM MarketScan Commercial Claims and Encounters Database for the year 2017. Payments were adjusted for inflation using the Consumer Price Index for Medical Care obtained from the Federal Reserve Bank of St. Louis and expressed in 2019 US Ddollars.⁶

Table 3:

Case mix and professional component fees by payer type

CPT	Examination	Case Mix	Uninsured	Medicare⁵	Medicaid^{^a}	Private Insurance⁶
70551	MR imaging brain WO contrast	15%	$0	$74.64	$72.08	$131.26
74178	CT Abd/pelvis WO/W contrast	15%	$0	$102.53	$88.15	$173.22
76770	US Abd complete	10%	$0	$37.14	$32.59	$63.33
77067	Screening mammogram	20%	$0	$38.79	$37.86	$63.67
71046	XR chest single	40%	$0	$10.25	$8.52	$18.70
	Total	100%

Note:—W indicates with; WO, without; Abd, abdomen; US, ultrasound; XR, x-ray.
↵a Medicaid fees represent hospital-based Medicaid PC fee averages in Louisiana for the respective examinations and were provided by the Radiology Finance Department of our lead study site.

Table 5:

Change in professional component reimbursement under Medicare for All at a radiology practice in Louisiana

Examination	Payer Type Scenario
Examination	100% Medicare	Current General Population Payer Mix	% Difference	Current Inpatient Payer Mix	% Difference
MR imaging brain WO contrast	$74.64	$96.46	–23%	$89.14	–16%
CT Abd/pelvis WO/W contrast	$102.53	$125.85	–19%	$117.11	–12%
US Abd complete	$37.14	$46.07	–19%	$42.80	–13%
Screening mammogram	$38.79	$47.95	–19%	$44.81	–13%
XR chest single	$10.25	$13.20	–22%	$12.13	–15%
% Change if all uninsured, Medicaid, and privately insured patients are transitioned to Medicare			–20%		–14%