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

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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.

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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 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.

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