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The Trump administration announced a plan Friday that would affect about 40 percent of the payments physicians receive from Medicare. Not everybody鈥檚 pleased.

The Centers for Medicare & Medicaid Services calls聽聽a historic effort to聽聽and improve patient care. But some doctors and advocates for patients fear it could be a disaster.

The CMS plan, published in Friday鈥檚 Federal Register, is now open for public comment until early September. It would combine four levels of paperwork required for reimbursement, and four levels of payments, into one form and one flat fee for each doctor鈥檚 appointment (although there would still be separate filing systems for new and established patients).

In a letter previewing the plan to doctors earlier this month, CMS Administrator Seema Verma said that physicians waste too much time on mindless administrative tasks that take time away from patients.

鈥淲e believe you should be able to focus on delivering care to patients,鈥� Verma wrote, 鈥渘ot sitting in front of a computer screen.鈥�

Initially, that sounded pretty good to聽, a rheumatologist in Washington, D.C. Then he tested the claim with his own analysis.

During a typical 15- to 45-minute appointment with a patient, Worthing figured, 鈥淚 might spend one to two minutes less in front of the computer, documenting and typing.鈥�

Dr. Kate Goodrich, CMS鈥� chief medical officer, noted that 鈥渟aving one to two minutes per patient adds up pretty quickly over time.鈥�

But Worthing said the small savings in time is not worth the reduced payment he鈥檇 get. The CMS plan would offer a flat fee for each office visit with a patient, whether the doctor is a primary care physician or a specialist.

Rheumatologists, in general, could expect a 3 percent reduction in Medicare鈥檚 reimbursement because they typically see and bill for more complicated patients, said Worthing, who chairs the government affairs committee for the American College of Rheumatology.

And he noted that his personal net income from Medicare patients would drop even more 鈥� by about 10 percent. That鈥檚 because 70 percent of his costs 鈥� for rent, payroll and other expenses 鈥� are fixed or rising.

Worthing is leading efforts by rheumatologists to persuade CMS to adjust its funding formula before the plan goes into effect in January.

鈥淭he proposal is well-intentioned but it might cause a disaster,鈥� he said, if it leads to fewer medical students going into rheumatology and other specialties that require doctors to manage complex patients. And physicians might stop taking Medicare patients altogether, or avoid those with more difficult problems.

Al Norman, a 71-year-old Medicare patient, said he can see that disaster coming.

鈥淚f you鈥檙e frail or if you are very healthy, you鈥檙e worth the same to a doctor [under the proposed plan], and obviously that means that the people who are more disabled or frail are less desirable patients,鈥� said Norman, who worked on elder care issues in Massachusetts before retiring last year.

Many doctors predict that the proposed payment changes would establish a financial incentive to see fewer Medicare patients. Goodrich, the Medicare official, disagrees.

鈥淭hat鈥檚 an unintended consequence we wanted to mitigate on the front end and avoid,鈥� Goodrich said. Under the proposed system, doctors who need more time with patients could file for an 鈥渁dd-on鈥� payment of $67聽per appointment. That would require a small amount of additional documentation, she admitted, but would still reduce a doctor鈥檚 keyboard time, according to CMS estimates.

This 鈥渁dd-on鈥� payment is 鈥渋ntended to ensure that physicians are being appropriately compensated for seeing the most complex patients,鈥� Goodrich said.

Still, critics of the plan say there are other unintended consequences CMS may not have anticipated.

Dr. Paul Birnbaum, who has been practicing dermatology in the Boston area for 32 years, said he鈥檚 worried that paying doctors a reduced fee per appointment would translate to lots of short visits.

鈥淵ou would just see more people,鈥� Birnbaum said. 鈥淵ou鈥檇 move people through faster. And so you have somebody come back for repeat office visits.听础苍诲听that, over time, would be inflationary.鈥�

More frequent trips to the doctor would mean more copays for patients and higher costs for Medicare, he said.

The Trump administration is not suggesting the payment changes would save Medicare money. In her letter to doctors, Verma said some physicians would see their Medicare payments increase.

And it鈥檚 not just doctors who treat elderly patients who are likely to be affected. If the Medicare payment changes take effect, private insurers might follow suit, in part because it鈥檚 easier for all insurers to use common billing procedures.

Theoretically, obstetrician-gynecologists would be among the biggest winners; they treat fewer complex Medicare patients. Still, many OB-GYNs are worried about the coming changes, too.

鈥淭here will be winners and losers, and my real fear is it鈥檚 not the physicians [who will lose the most]. My real fear is that it鈥檚 the Medicare beneficiaries,鈥� said聽, vice president for health policy at the American College of Obstetricians and Gynecologists.

Some Medicare advocates are urging CMS to postpone these changes and consider a trial run.

鈥淚f we鈥檙e going to talk about this kind of wholesale, large-scale reconfiguration of the way reimbursement is given to doctors,鈥� said聽, president of the Medicare Rights Center, 鈥渋t鈥檚 probably best to do that in a demonstration project where we can closely study the ramifications.鈥�

CMS hopes to enact any changes to Medicare fee schedules on Jan. 1, 2019.

The main challenge remains convincing patients and physicians that the changes are worth doing in the first place.

This story is part of a partnership that includes , and Kaiser Health News.