detaining with my left, we'll hear from dr. hoven, president-elect of the american medical association. next is dr. glen stream, president of the american academy of family physicians. third will be frank opa, vice chancellor of clinical affairs and professor of surgery with louisiana state university health and science center. fourth, doctor douglas weaver. dr. weaver's vice president and assistant medical director of heart and vascular services at the henry ford health system. and, finally, doctor barbara mcaneny, chief executive officer, new mexico oncology hematology consultants. your written statement will be included in the record. please limit your oral statements to three minutes is where senate's here today. i would like this to be more the roundtable, that is, after each major statements, we'll have a few questions, and i'd like us to kind of interchange back and forth. if you want to say something, pipe up and say it. that goes for both our panelists as well as for senators. so you start, dr. hoven. were very happy to see

on the other hand, as dr. hoven points out, is that when you have doctors and hospitals working closer together, now you signed the alignment problem, they will align and try to create better value. >> we got an s.g.r. problem, basically. it is not very far off, we have a -- -- to extend it. do we just extend it another year? if we don't, what changes to you suggest? these are all great ideas. it is very stimulating, this discussion, but we have a practical question. what do we do about all of this? short-term versus long-term. to me, a colleague asked an interesting question about more individualized treatment. medicine, all this fancy stuff you read about in the papers, genome sequencing. there was a very interesting article a few days ago about a lady who got very specialized treatment. she died two weeks later. then there is stem cell reform.coms that have occurred over time. things are just changing quickly. what should we do in short-term and what shoiled we do long-term? we deal with the practical problem of

. >> thank you dr. hoven. dr. stream. >> chairman baucus and senators for inviting the american family physicians state our views rvs bleeped out canion is an efficient and delivers lower-quality care barzee because it undervalues primary care. bft is convinced that no single alternative payment method will rebuild primary care. we needed combination of methods. of a mp promotes the patient-centered pcmh supported by a blended blended payment system that includes fee-for-service care management fees and the quality and payment. we know it works to improve health health care and restrain costs in the long run. the evidence for this is accumulating rapidly in our statement provides several examples. findings from the programs across the nation are compelling success in improving quality and restraining health care costs. earlier this year afp sent recommendations to the acting administrator of cms. these were the result of a sponsor task for some primary care valuation. the key recommendation is in order to build a

and i really want to support what dr. hoven said about creating partnerships and new ways of delivering care into the rural environments. partnerships from these delivery systems that are forming that create some new connectivity whether that's telemedicine out to the specialty areas so that there's early intervention and prevention of avoidable, preventable, adverse patient events. it's deeply troubling in surgical care what we're seeing in the absence of surgeons in rural america, and it's something we're tracking, but i don't know that we have a solution for it. >> well, if we were to have a solution, what might it tend to be? >> well, i think finding out what the barriers are to creating the kind of partnerships we need, getting the right surgeon to the right environment for the right time matching the surgical need. there could be a sense of what, how do we actually create regionalization of key parts of surgery, and how do we get rural surgeons into those rural environments? some of that's going to be recruiting from the