美国国家公共电台 NPR Some Doctors, Patients Balk At Medicare's 'Flat Fee' Payment Proposal

 

RACHEL MARTIN, HOST:

Today the Trump¹ administration is out with details of another piece of a campaign which is called Patients over Paperwork. Doctors would no longer have to submit detailed² notes to justify³ longer, complicated patient visits, but they would not get paid for longer visits. Martha Bebinger from member station WBUR in Boston reports.

MARTHA BEBINGER, BYLINE⁴: Here's how Seema Verma, the woman who runs Medicare, describes the problem she wants to fix for patients.

(SOUNDBITE OF ARCHIVED RECORDING)

SEEMA VERMA: We've all been to the doctor. And let's be honest, there's a lot more screen time going on than eye time.

BEBINGER: Verma, speaking in San Francisco this week, said proposed Medicare paperwork and payment changes would give doctors more time for their primary mission, taking care of patients.

(SOUNDBITE OF ARCHIVED RECORDING)

VERMA: And to be fair, no brilliant physician wants to be relegated⁵ to data entry while their time with patients continues to evaporate.

BEBINGER: That sounded pretty good to Dr. Angus Worthing, but then he tested the new rules.

ANGUS WORTHING: Doing my own analysis, I think I might spend one or two minutes less in front of the computer in a typical patient visit, which might be 15 minutes to 45 minutes.

BEBINGER: And while Worthing is currently paid two to three times more for a 45- versus⁶ a 15-minute visit, Medicare's plan is one, flat, just-below-the-current-average fee. For doctors like Worthing whose Medicare patients often have complicated cases, that would mean a personal pay cut, by his calculation, of 10 percent.

WORTHING: The proposal is well-intentioned. But unfortunately, it might cause a disaster.

BEBINGER: Al Norman, a 71-year-old Medicare patient, says he can see that disaster coming from his kitchen table in western Massachusetts.

AL NORMAN: If you're very frail⁷ or if you are very healthy, you're worth the same to a doctor. And obviously, that means that the people who are more disabled or frail are less desirable patients.

BEBINGER: Many doctors agree that the proposed Medicare payment changes may create an incentive⁸ to see fewer sick patients. But Dr. Paul Birnbaum says that would not be true across the board.

PAUL BIRNBAUM: With dermatology, most of the income comes from procedures, from removing skin cancers. And Medicare patients are the ones with the skin cancers.

BEBINGER: But Birnbaum is worried that paying doctors one lower fee would translate over time to lots of short visits.

BIRNBAUM: You would just see more people. You'd move people through faster, and so you might have somebody come back for repeat office visits.

BEBINGER: And more visits may mean more inconvenience and higher costs for patients. The Trump administration is not suggesting the payment changes would save money. In a letter to doctors, Verma says some would see their Medicare payments increase. The biggest winners are supposed to be OB-GYNs, who typically have fewer complicated Medicare patients. Still, Dr. Barbara Levy⁹ with the American College of Obstetricians and Gynecologists is worried.

BARBARA LEVY: There will be winners and losers, and my real fear is that it's not the physicians. My real fear is that it's the Medicare beneficiaries.

BEBINGER: The proposed Medicare physician payment changes are to be published today, open for comment through early September and would start in January. One Medicare patient rights group is calling for a delay and trial run if Medicare proceeds.

For NPR News, I'm Martha Bebinger in Boston.

(SOUNDBITE OF BETA RADIO'S "HERE TOO FAR")

MARTIN: That story is part of a reporting partnership¹⁰ with WBUR, NPR and Kaiser Health News.

1 trump   

n.王牌，法宝；v.打出王牌，吹喇叭

参考例句：

• He was never able to trump up the courage to have a showdown.他始终鼓不起勇气摊牌。
• The coach saved his star player for a trump card.教练保留他的明星选手，作为他的王牌。

2 detailed   

adj.详细的，详尽的，极注意细节的，完全的

参考例句：

• He had made a detailed study of the terrain.他对地形作了缜密的研究。
• A detailed list of our publications is available on request.我们的出版物有一份详细的目录备索。

3 justify   

vt.证明…正当(或有理)，为…辩护

参考例句：

• He tried to justify his absence with lame excuses.他想用站不住脚的借口为自己的缺席辩解。
• Can you justify your rude behavior to me?你能向我证明你的粗野行为是有道理的吗？

4 byline   

n.署名；v.署名

参考例句：

• His byline was absent as well.他的署名也不见了。
• We wish to thank the author of this article which carries no byline.我们要感谢这篇文章的那位没有署名的作者。

5 relegated   

v.使降级( relegate的过去式和过去分词 )；使降职；转移；把…归类

参考例句：

• She was then relegated to the role of assistant. 随后她被降级做助手了。
• I think that should be relegated to the garbage can of history. 我认为应该把它扔进历史的垃圾箱。 来自《现代汉英综合大词典》

6 versus   

prep.以…为对手，对；与…相比之下

参考例句：

• The big match tonight is England versus Spain.今晚的大赛是英格兰对西班牙。
• The most exciting game was Harvard versus Yale.最富紧张刺激的球赛是哈佛队对耶鲁队。

7 frail   

adj.身体虚弱的；易损坏的

参考例句：

• Mrs. Warner is already 96 and too frail to live by herself.华纳太太已经九十六岁了，身体虚弱，不便独居。
• She lay in bed looking particularly frail.她躺在床上，看上去特别虚弱。

8 incentive   

n.刺激；动力；鼓励；诱因；动机

参考例句：

• Money is still a major incentive in most occupations.在许多职业中，钱仍是主要的鼓励因素。
• He hasn't much incentive to work hard.他没有努力工作的动机。

9 levy   

n.征收税或其他款项，征收额

参考例句：

• They levy a tax on him.他们向他征税。
• A direct food levy was imposed by the local government.地方政府征收了食品税。

10 partnership   

n.合作关系，伙伴关系

参考例句：

• The company has gone into partnership with Swiss Bank Corporation.这家公司已经和瑞士银行公司建立合作关系。
• Martin has taken him into general partnership in his company.马丁已让他成为公司的普通合伙人。