we ask for your continued support of the primary karin sentiv payment, the 10% bonus payment to providers for certain primary care services. the commonwealth fund recently published a study that the pcip if made permanent yield a six fold lower return in costs. the net result would be a drop in medicare costs of nearly 2%. senators, we all want the same thing. better health care at less cost. there's a proven way to go along way toward achieving that outcome. invest in primary care. we have ample evidence that doing so will not increase the overall cost of care per individual per year. thank you for your commitment to the health of this nation and family physicians are eager to assist you in making the differences we need. >> thank you, sir. next. >> chairman and senators thank you very much for this opportunity and good morning to you today. i come to you to speak on behalf of improving the care for the surgical patient and inspiring quality amongst surgeons. so on bea half of the american college of surgeons there's a couple key points i would like to make and be brief. we have several