[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.
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