[Congressional Record Volume 165, Number 63 (Thursday, April 11, 2019)]
[Senate]
[Pages S2428-S2429]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                         ACCESS TO PRIMARY CARE

  Mr. ALEXANDER. Mr. President, I ask unanimous consent that a copy of 
my opening statement at the Senate Health Education, Labor, and 
Pensions Committee be printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                         Access to Primary Care

       Mr. ALEXANDER. Dr. Lee Gross, of Florida testified last 
     year at this Committee's fifth hearing on the cost of health 
     care. He told us that, after seven years as a primary care 
     doctor, he had an epiphany: too many government mandates and 
     insurance companies were getting between doctors and patients 
     and making primary care more expensive than it needed to be.
       So in 2010, Dr. Gross created one of the first Direct 
     Primary Care practices. Instead of working with insurance 
     companies and government programs, Dr. Gross' patients pay 
     him a flat monthly fee directly: $60 a month per adult, $25 a 
     month for one child, and $10 a month for each additional 
     child.
       Dr. Gross is one of more than 300,000 primary care doctors 
     in the United States who most of us go to see for day-to-day 
     medical care--receiving vaccines like the flu shot, annual 
     physicals, and help managing chronic conditions, like 
     diabetes. It is also our entry point to coordinate additional 
     medical care, if, for example, we need to get our hip 
     replaced or an MRI to diagnose a problem.
       We heard from Dr. Brent James of the National Academies of 
     Medicine at our second hearing that between 30 and 50 percent 
     of what we spend on health care is unnecessary. I have asked 
     for specific suggestions on what the federal government can 
     do to lower the cost of health care for American families, 
     and this year, I am committed to passing legislation based on 
     that input to create better outcomes and better experiences 
     at a lower cost.
       Dr. Gross' practice is one of about a thousand similar 
     clinics in the United States, and is a good example of how a 
     primary care doctor can help reduce costs. The first way Dr. 
     Gross does this is by helping with his patients' wellness. 
     For $60 a month, Dr. Gross can do EKGs and cortisone 
     injections, manage chronic conditions like diabetes, asthma,

[[Page S2429]]

     and hypertension, and remove minor skin cancers right in his 
     office.
       Second, by keeping you out of the emergency room. For $60 a 
     month, patients have unlimited office visits, and they can 
     also email, text, call and use an app to contact his office--
     anytime, day or night. So for example, if you have stomach 
     pains at 11 pm, you could text Dr. Gross, who knows that it 
     might just be a side effect of a new medicine he prescribed 
     you.
       And third, primary care is patients' access point to more 
     advanced care. When Dr. Gross refers people for additional 
     care, he is able to provide cost and quality information 
     about the different options, so his patients can choose the 
     best option.
       For example, one of his patients with rheumatoid arthritis 
     was quoted $1,800 for blood work, but Dr. Gross was able to 
     find a laboratory to offer the blood tests for under $100. 
     This echoes what Adam Boehler, who leads the Center for 
     Medicare and Medicaid Innovation, recently told me. He 
     estimated that primary care is only 3-7 percent of health 
     care spending but affects as much as half of all health care 
     spending. And as Dr. Roizen of the Cleveland Clinic has said 
     before this Committee, regular visits to your primary care 
     doctor, along with keeping your immunizations up to date and 
     maintaining at least four measures of good health, such as a 
     healthy body mass index and blood pressure, will help you 
     avoid chronic disease about 80 percent of the time.
       This is important because, according to Dr. Roizen, over 84 
     percent of all health care spending is on chronic conditions 
     like asthma, diabetes, and heart disease. I believe we can 
     empower primary care doctors, nurse practitioners, and 
     physicians assistants to go even a step further.
       At our fourth hearing, we heard about how the cost of 
     health care is in a black box--patients have no idea how much 
     a particular treatment or test will end up costing. Even if 
     information on the cost and quality of health care is easily 
     accessible, patients still have trouble comparing different 
     health care options.
       For example, earlier this year, hospitals began to post 
     their prices online, as required by the Centers for Medicare 
     and Medicaid Services, but to the average consumer, this 
     information has proved to be incomprehensible.
       And while the data may be incomprehensible today, it is a 
     ripe opportunity for innovation from private companies, like 
     Health Care Bluebook, a Tennessee company that testified a 
     hearing last fall, and non-profit organizations to arrange 
     the data so primary care doctors, nurse practitioners, and 
     physicians assistants can help their patients have better 
     outcomes and better experiences at lower costs.
       There are other ways to lower health care costs through 
     expanded access to primary care. Dr. Gross' direct primary 
     care clinic is one example. Another is community health 
     centers, which we talked about at our last hearing and that 
     are where 27 million Americans go for their primary care. And 
     employers are increasingly taking an active role in their 
     employees' health and in the cost of health care.
       One of our new committee members, Senator Braun, was an 
     employer of a thousand people and was aggressive about 
     helping his employees reduce health care costs. Like primary 
     care doctors, more good data could help employers like 
     Senator Braun more effectively lower health care costs. 
     Employers are also employing a doctor on-site so employees 
     don't have to take time off of work to see a primary care 
     doctor.
       On-site primary care makes it easier to keep employees 
     healthy by helping to manage a chronic condition or get a 
     referral to a specialist. Today, I am interested in hearing 
     more about specific recommendations to improve access to 
     affordable primary care.

                          ____________________