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

RACHEL MARTIN, HOST:

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

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

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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.

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VERMA: And to be fair, no brilliant physician wants to be relegated 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- versus 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 frail 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 incentive 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 Levy 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.

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