Whitehouse Holds Hearing Highlighting How Strengthening Primary Care Would Improve Patient Health, Reduce Costs

Senator releases discussion draft to strengthen primary care under Medicare

Washington, D.C.—This morning, U.S. Senator Sheldon Whitehouse (D-RI), Chairman of the U.S. Senate Budget Committee, held a hearing titled “How Primary Care Improves Health Care Efficiency,” to highlight how strengthening primary care can deliver better health care, lower costs, and improve outcomes for patients.  The U.S. spends more on health care as a share of its GDP than peer countries, but U.S. life expectancy is below that of its peers—and it is falling.  

At the hearing, Chairman Whitehouse introduced a discussion draft of a bill that considers polices to encourage the Centers for Medicare & Medicaid Services (CMS) to accelerate its efforts to support high-quality primary care and improve pay for primary care providers in Medicare. A fact sheet on the discussion draft is available here.

WATCH: Chairman Whitehouse delivers opening remarks

“U.S. health spending makes up 17% of GDP; as you can see, a far higher percentage than in peer nations.  Yet U.S. life expectancy is below peer nations, and even falling; it’s now fallen to its lowest in two decades … Why is American health spending so inefficient?  One answer is how badly we fund primary care,” said Chairman Whitehouse.

“[D]espite overwhelming evidence that primary care is associated with longer life expectancy and lower downstream health costs – the U.S. continues to spend less on primary care, as a share of total health spending, than any other peer OECD country.  In fact, average primary care spending across our peer nations is nearly double ours. U.S. percentage spending on primary care actually declined from a sad 6.5% in 2002, to a woeful 4.7% in 2019.  Today, three in ten Americans report not having a usual source of primary care.  In some areas, often rural areas, the situation is much worse,” the Chairman continued.

“Today, I released a discussion draft of a bill tasking CMS to accelerate value-based primary care by creating hybrid payment models for Medicare primary care providers.  Hybrid payments start the move away from the failed fee-for-service treadmill, by at least partially paying primary care providers based on their patient mix.  These hybrid payment models reward providers who provide the best care to their patients — care that reduces patients’ emergency visits, hospitalizations, excess specialist services, and other big cost drivers — and these hybrid payment models reward patients with better health,” Chairman Whitehouse continued.  

“The reforms contained in my discussion draft would help doctors deliver high-quality primary care to many more Americans; and improve their health outcomes; and lower total health care spending, because more and better primary care reduces the need for expensive specialty and hospital care.  These are savings we achieve with no — none, zero — benefit cuts,” said Chairman Whitehouse. 

READ MORE: The Chairman’s full opening remarks

***What They’re Saying: Senator Whitehouse’s Primary Care Discussion Draft***

At a time when three in ten people report not having a usual source of primary care, and reports find the U.S. will face a shortage of 17,000 - 45,000 primary care doctors over the next decade, the policies considered in Senator Whitehouse’s discussion draft could head off a very expensive primary care shortage while also improving Medicare beneficiaries’ health outcomes and helping primary care providers lower health costs. 

The discussion draft contains policies that would:

  • Encourage CMS to adopt a “hybrid payment” approach for all primary care providers in Medicare.
  • Provide Medicare beneficiaries with cost-sharing relief for certain primary care activities and services.
  • Create a new technical advisory committee to help CMS more accurately determine Fee Schedule rates.

Here's what key stakeholders are saying:

  • American Academy of Family Physicians: “Family physicians understand that value-based payment benefits physicians, better supports practices, centers patients and ultimately lowers health care costs. The American Academy of Family Physicians appreciates Senator Sheldon Whitehouse’s commitment to championing primary care and for initiating an important conversation with his discussion draft on ways to further accelerate the transition to value-based payment. We look forward to working with the Senator and his colleagues to develop and advance legislation that prioritizes the important role of primary care in our health care system and more appropriately pays for and supports access to primary care across the country.”— American Academy of Family Physicians
  • Primary Care Collaborative: “Thank you, Senator Whitehouse, for your addressing some of the most glaring flaws in America’s broken health care system—ones that place unfair burdens on our health, our well-being and our economy.  Despite record costs, our health is getting worse, and people find it harder and harder to access the care they need. We look forward to working with you and your colleagues to ensure everyone has access to high-quality primary care.” — Ann Greiner, President and CEO of the Primary Care Collaborative
  • Rhode Island Acting Health Insurance Commissioner: “The elements in this draft build on what the Office of the Health Insurance Commissioner is doing and what we have learned in working with health insurers for fifteen years. Changing how primary care is valued and paid improves access to regular care and rebalances our health care system. We appreciate Senator Whitehouse’s leadership on this critical issue facing Medicare beneficiaries and our country.” — Rhode Island Acting Health Insurance Commissioner Cory King