February 2011 – Latest Medical News

Developmental Genes Have More Than One Way To Stop, Just Like Cars

Main Category: Genetics
Also Included In: Cancer / Oncology; Diabetes; Arthritis / Rheumatology
Article Date: 28 Feb 2011 – 0:00 PST

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There’s more than one way to silence gene activity, according to a Michigan State University researcher.

Downregulating activity is how healthy genes should shift out of their development cycle. The results, published in Current Biology, discuss how specific repressor proteins – which researchers have named Hairy and Knirps – slow genes during development and how the process is comparable to slowing down a car, says molecular biologist David Arnosti.

The binding of repressor proteins to DNA provides a molecular switch for such regulation. Although the two types of protein have been identified as silencers of gene expression, each one uses a distinct molecular mechanism to halt the process, said Arnosti, director of MSU’s Gene Expression in Disease Development initiative.

These mechanisms may hold the keys to explaining how diseases, such as cancer, diabetes and arthritis can be traced to genes that are unable to shift gears properly and can’t stop, Arnosti said.

“In automotive terms, a driver can either brake or downshift the transmission to achieve the same result,” said Arnosti, who published the paper with Li M. Li, a former MSU doctoral student now working at the University of California, Berkeley. “Similarly, short-range and long-range repressor proteins both interfere with the basic gene expression machinery, but in different ways.”

In sequencing the human genome, scientists have assembled a parts list and can point to genes that play a part in disease. Through Li’s and Arnosti’s research, however, scientists can now begin to see how these genes are regulated through special mechanisms, helping show how an entire organism’s genes are controlled.

“Mechanistic studies such as this are giving us the assembly instructions for the genome,” Arnosti said. “Basically, it’s giving us a way to read genomic control instructions.”

Arnosti’s research involved fruit flies, which have more genetic similarities to humans than was once thought. Based on these similarities, the team’s research could soon lead to advances in human medicine.

“We like to say that fruit flies are like little people with wings; they have the same basic genetic nuts and bolts, including genetic switches and proteins,” Arnosti said. “While our work is the first of its kind, it is only a small step for other scientists to begin conducting these same studies on human genes. With regards to disease, this study gives us the basic tools to look at genes in a disease state and understand what is going wrong at the genetic level.”

Arnosti’s research furthers the work of the GEDD, a group of MSU researchers using cutting-edge molecular approaches to understand mechanisms of gene regulation and promote excellence in training the next generation of biological researchers. One area that the group is promoting is integrated systems biology studies.

“By taking a systems biology approach, we’re beginning to understand that it’s not one bad gene that’s responsible for causing cancer,” Arnosti said. “We are starting to unravel how gene switches talk with one another as well as how a number of slightly defective genes interact to create a diseased state.”

Arnosti’s work is funded in part by the National Institutes of Health and the MSU Foundation.

Source:
Layne Cameron
Michigan State University

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HHS Issues Additional Information To States About Medicaid Eligibility Under The Affordable Care Act

Main Category: Medicare / Medicaid / SCHIP
Article Date: 28 Feb 2011 – 2:00 PST

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U.S. Department of Health and Human Services Secretary Kathleen Sebelius today issued a new letter and a frequently asked questions (FAQ) document that explain Medicaid and Children’s Health Insurance Program (CHIP) provisions in the Affordable Care Act in ways that afford greater flexibility to States. The new guidance clarifies aspects of the maintenance of effort (MOE) rules for Medicaid and CHIP. Further guidance will follow.

The Medicaid MOE provision in the Affordable Care Act generally ensures that States’ eligibility rules for adults under the Medicaid program remain in place pending implementation of eligibility rules changes that become effective in January 2014. The MOE provision for children extends to 2019.

The letter and supporting FAQ document address three aspects of the MOE provisions:

– The MOE exemption for higher-income adult populations in States that are experiencing budget deficits. Under the Affordable Care Act, if a State has or projects a budget deficit, the MOE provision does not apply to adults who are not eligible for coverage on the basis of pregnancy or disability and whose incomes are above 133 percent of the Federal poverty level. The FAQ document explains State options and how States can seek this exemption.

– The implication of the MOE provision on Section 1115 demonstration projects. Some States cover groups of people under Medicaid through a Section 1115 demonstration. As explained in the FAQ document, the MOE provision generally applies to these waivers and demonstrations. However, waivers and demonstration are, by their terms, time limited. The guidance clarifies that the MOE provision does not require States to seek a new or renewed waiver after the expiration of their waiver or demonstration.

– How premiums are treated under the MOE requirements. Because premiums and premium increases have an impact on eligibility, previous guidance under the Recovery Act explained that new or increased premiums were considered to be a violation of the Recovery Act MOE requirement. Because the period during which the Affordable Care Act MOE provisions apply is considerably longer than the MOE period under the Recovery Act, this new guidance offers States additional flexibility relating to premiums and the MOE requirements under the Affordable Care Act. This will help a number of States that have been requesting the ability to adjust premiums for populations such as children in CHIP with family incomes above 150 percent of the Federal poverty line.

“Ensuring that our most vulnerable populations continue to receive Medicaid coverage during these difficult times requires as much flexibility as possible,” said Secretary Sebelius. “We will continue to review the maintenance of effort provisions under the Affordable Care Act and will issue further guidance to States, as needed.”

Source:

HHS

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Medicare Locals: Not The Magic Pill For Rural After-hours Care, Australia

Main Category: Medicare / Medicaid / SCHIP
Article Date: 28 Feb 2011 – 3:00 PST

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The Rural Doctors Association of Australia (RDAA) has warned that after-hours services are under severe
threat in many rural areas and that funding for Medicare Locals to address this issue may not solve the
problem.

RDAA President, Dr Paul Mara, said that while he welcomed recognition in the current health reform agenda of the
important role of doctors in meeting substantial patient health load in the community, significant numbers of rural
doctors were considering their future participation in after-hours services in light of the current proposals.

“This is a particularly important issue in the bush, where doctors are often the first point of call for patients seeking
healthcare through general practices, with these same doctors also servicing the local hospital both during-hours
and after-hours” Dr Mara said.

“Unfortunately, many of these hard-working country doctors have already spent years providing these services with
little support, and a tipping point has been reached-after-hours care in rural communities across NSW and in
many other areas of the country is under threat.

“There are already a number of country towns where doctors have been forced to withdraw after-hours services
due to doctor burn-out and excessive workloads.

“This is a very difficult and stressful decision for any doctor to make, particularly where they are intimately involved
with their local community.

“We want to work with Medicare Locals to ensure their role in co-ordinating after-hours care complements and
supports existing local after-hours models that are already working well, rather than replaces these services,
competes with them or renders them unviable.

“However, the real issue is around the ongoing health workforce shortage. The only solution is to build increased
health workforce capacity in rural communities, so doctors can cover after-hours without having to work extended
hours, can have adequate time off to compensate and can meet the needs of their communities locally.

“This means turning one-doctor towns into two-doctor towns, and two-doctor towns into three and four-doctor
towns.

“It also means a national training scheme that delivers the advanced skills required to provide medical care in
isolation, backed up by financial compensation and incentives that reflect the complexity and conditions of rural
practice, so junior doctors see rural practice as a viable and rewarding career path.”

Source:

Rural Doctors Association of Australia (RDAA)

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Elderly And Disabled STD Testing Considered By Medicare And Medicaid Services

Editor’s Choice
Main Category: Medicare / Medicaid / SCHIP
Also Included In: Sexual Health / STDs; Seniors / Aging
Article Date: 26 Feb 2011 – 13:00 PST

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Apart from already covering beneficiaries for HIV tests, CMS (Centers for Medicare and Medicaid Service) says it is considering whether to cover screenings for other STDs, such as chlamydia, syphilis, hepatitis B, and gonorrhea. CMS is also considering paying for preventive counseling.

In the USA approximately 39 million elderly people and 7.6 million younger individuals with disabilities are covered by Medicare.
In a communiqué, CMS says its focus would be on detecting STDs in pregnant disabled women and other high-risk groups.

CMS officials should announce a draft decision by 24th August, 2011.

A National Coverage Analysis would like to see cover for the following:

Counseling for all sexually active teenagers and adults at high risk
Testing for chlamydia for high risk women over the age of 24, as well as all women under 24 who are sexually active
Testing for gonorrhea for all females
Testing for syphilis for all high risk individuals
Testing pregnant women for hepatitis B

According to data gathered through various public bodies, the incidence of STDs among older Americans has been going up. According to the CDC (Centers for Disease Control and Prevention), almost one-quarter of Americans who are HIV positive are aged over 50 years. Chlamydia rates among men aged between 45 and 64 went up about 200% during the ten-year period up to the end of 2006 (doubled among females).

According to experts, there are several reasons why older individuals are at risk of developing STDs:

A significant number are sexually active. Erectile dysfunction drugs, such as Viagra, Levitra and Cyalis have allowed a considerable number of older males to continue being sexually active. Studies have shown that STD rates among males using Viagra are double those of males who do not.
Older people are less inclined to use condoms compared to younger sexually active people
STD-prevention educational programs rarely include the elderly

Experts say that screening and preventive care should work out much cheaper in the long run. If patients are detected and treated early on, the risk of expensive complications is reduced considerably. Early detection would also help curb the spread of STDs.

Written by Christian Nordqvist

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Medicare Continues To Impose Conditions When Covering New Technologies

Main Category: Medicare / Medicaid / SCHIP
Also Included In: Medical Devices / Diagnostics
Article Date: 27 Feb 2011 – 0:00 PST

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The Centers for Medicare and Medicaid Services (CMS), the government agency that administers the Medicare program, made 11 National Coverage Determinations (NCDs) for medical technologies and procedures in 2010. NCDs permit or prohibit Medicare coverage for new technologies on a nationwide basis. Since Medicare is the largest single purchaser of healthcare in the country, these decisions have far-ranging effects, influencing health coverage by private plans and the development of medical technologies.

Medicare demands supporting clinical evidence of effectiveness before considering coverage approval. In 2010, only two of the eleven NCDs were unrestricted positive coverage decisions.[1] The remainder were either restricted in some manner, requiring the satisfaction of additional criteria (five), deferred to the discretion of regional Medicare contractors (two), covered in order to comply with an updated statute (one) or not covered (one, Collagen Meniscus Implant).

A study by researchers at Tufts Medical Center and the Center for Medical Technology Policy (CMTP), published in the New England Journal of Medicine last year, shows that CMS has been frequently citing the lack of evidence of improved health outcomes in its decisions about whether to provide coverage for new technologies. The data indicate that CMS is relying heavily on clinical trials that prove the effectiveness of the procedures, in order to ensure that public funds are exclusively delegated to technologies with proven positive health benefits. According to the analysis, the agency is beginning its assessments with the presumption that NCDs won’t be covered, unless strong documented evidence is provided that the procedure is both reasonable and necessary for the diagnosis or treatment of illness or injury.

“The data show that Medicare is continuing its move towards evidence-based medicine,” said Peter J. Neumann, ScD, Director of Tufts Medical Center’s Center for the Evaluation of Risk in Health (CEVR). “It is covering medical technologies only where the evidence is strongest. This trend will continue, especially with Medicare’s need to reduce its spending growth.”

CMS has a long history of covering medical interventions with restrictions. Data from the Tufts Medicare NCD Database, which details all aspects of NCDs, reveal that 84 (55 percent) of the 152 NCDs since 1999, resulted in coverage for only those Medicare beneficiaries that met specified conditions. These restrictions typically pertained to a Medicare beneficiary’s health status, the prior failure of other treatment options, the performance of a procedure restricted to certain treatment facilities, or to a “coverage with evidence development” (CED) policy, the granting of provisional coverage while generating additional evidence to establish whether unconditional or expanded coverage is warranted. The trend is critical, as medical interventions subject to NCDs affect a significant number of Medicare beneficiaries and are expected to have a major impact on the future of the Medicare program.

The Tufts Medicare NCD Database includes detailed information on all complete NCDs from 1999-2010, providing a thorough and independent review, summary, characterization and categorization of CMS decisions by Tufts Medical Center researchers. The database offers unique analyses of the NCDs, in terms of trends in CMS policies, review times and use of evidence for a variety of drugs, devices, diagnostics, and procedures.

Summary of 2010 Medicare National Coverage Determinations

Title of NCD – CMS’ final decision – Conditions on coverage

Positron Emission Tomography (NaF-18) to Identify Bone Metastasis of Cancer – Coverage with conditions – Only approved within CED data collection process

Dermal injections for the treatment of facial lipodystrophy syndrome (FLS) – Coverage with conditions – Restricted to certain population subgroups

Collagen Meniscus Implant – Non-coverage – NA

Magnetic Resonance Angiography (MRA) – Coverage decision referred to local contractors – NA

Allogeneic Hematopoietic Stem Cell Transplantation (HSCT) for Myelodysplastic Syndrome – Coverage with conditions – Only approved within CED data collection process

Positron Emission Tomography for Initial Treatment Strategy in Solid Tumors and Myeloma – Coverage decision referred to local contractors – NA

Intensive Cardiac Rehabilitation (ICR) Program – Dr. Ornish’s Program for Reversing Heart Disease – Coverage – NA

Intensive Cardiac Rehabilitation (ICR) Program – Pritikin Program – Coverage – NA

Counseling to Prevent Tobacco Use – Coverage with conditions – Restricted to certain population subgroups; Treatment restriction applied

Ventricular Assist Devices as Destination Therapy – Coverage with conditions – Restricted to certain population subgroups; Restricted to patients receiving care in specific care settings

Cardiac Rehabilitation Programs – Update to ensure consistency with statute – NA

Source:

Tufts Medical Center

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Pharmacists Have Much To Offer Medicare Locals, Australia

Main Category: Medicare / Medicaid / SCHIP
Also Included In: Pharmacy / Pharmacist
Article Date: 24 Feb 2011 – 4:00 PST

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The release of guidelines for the establishment of Medicare Locals clearly shows pharmacists have an integral role to play in the organisations, the Pharmaceutical Society of Australia says.

National President of the PSA, Warwick Plunkett, said the guidelines specified the criteria that will establish Medicare Locals.

The guidelines have been developed following a consultation process in which PSA participated.

“Among the objectives are that the bodies will improve disease prevention and management and improve access to health services,” Mr Plunkett said.

“This is a role pharmacists have long undertaken as part of their everyday professional work,” Mr Plunkett said.

“Often their expertise in the provision of primary health care has been overlooked but with the establishment of Medicare Locals that contribution can now be integrated more consistently in team-based care.

“In addition, the fact that pharmacists are the most accessible heath care professionals means they can bring to Medicare Locals a more immediate view of health issues in their local areas.

“Consumers walk in and speak to pharmacists about health issues, often before they speak to other health professionals, which enables pharmacists to provide immediate care or refer as necessary to other members of the health-care team.

“This will be an invaluable resource for Medicare Locals, and one which should not be missed.”

Mr Plunkett said the establishment of Medicare Locals was part of the health-reform agenda, a process which PSA supported as it would help to ensure Australians continued to enjoy a world-class health system.

“With the expertise of pharmacists combining with that of other health professionals, Medicare Locals will herald a new era in health care in this country,” Mr Plunkett said.

“PSA looks forward to continuing to work constructively with other stakeholders to progress the establishment of Medicare Locals.”

Source:

Pharmaceutical Society of Australia

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Seniors Group Asks Medicare Part-D Plans To Provide Affordable Gout Medication For Patients

Main Category: Medicare / Medicaid / SCHIP
Also Included In: Gout
Article Date: 25 Feb 2011 – 2:00 PST

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As part of the 60 Plus Association’s “Keeping Seniors Safe” project, the organization’s chairman, Jim Martin, recently sent letters to the CEOs of five Part-D Medicare plans, urging them to provide accessible colchicine-based medications to gout patients after untested and potentially harmful options were removed from the marketplace as part of an important Food and Drug Administration (FDA) safety-initiative.

“In light of the FDA’s removal of unapproved colchicine from the market, [these outlying companies] must follow the lead of other Part-D insurers around the country and reclassify COLCRYS as a tier-1 or 2 drug to ensure seniors have access to their vital gout medications” Martin wrote to the CEOs of the companies. “It is unjust to force patients to suffer through often excruciatingly-painful acute gout flare-ups despite the fact that they were promised affordable coverage for their medications.”

The FDA’s “Unapproved Drugs Initiative” calls for the removal of unapproved drugs from the market when approved versions exist. The agency recently acted on this initiative by removing untested colchicine products from the market.

“The FDA did what was best for patients by removing untested colchicine products from the market,” wrote Martin. “We hope your company will also act in the best interest of patients and immediately work to ensure that seniors enrolled in your Part-D plan have access to the colchicine products they were promised-and sorely need.”

In addition to the CEOs of offending insurance companies, copies of Martin’s letter were sent to Secretary of Health and Human Services Kathleen Sebelius, HHS Deputy Secretary William Corr, CMS Administrator Donald Berwick, Senator Bill Nelson (D-FL), Representative Pete Stark (D-CA), Representative Nancy Pelosi (D-CA), Representative Henry Waxman (D-CA), Senator Chuck Schumer (D-NY), Senator Sherrod Brown (D-OH), Senator Robert Menendez (D-NJ), Senator John Cornyn (R-TX), and Representative Allyson Schwartz (D-NY).

Source:

60 Plus Association

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HHS Announces $100 Million In Affordable Care Act Grants To Prevent Disease

Main Category: Medicare / Medicaid / SCHIP
Article Date: 25 Feb 2011 – 4:00 PST

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As part of the nation’s efforts to prevent an increase in the number of people with chronic health conditions, the Department of Health and Human Services (HHS) announced a new, $100 million program allowing states to offer incentives to Medicaid enrollees who adopt healthy behaviors such as quitting smoking or losing weight.

“Keeping people healthy is an important goal of the Affordable Care Act,” said HHS Secretary Kathleen Sebelius. “One way to reach that goal is to encourage all Americans to make better choices about diet, exercise and smoking to avoid potentially disastrous outcomes down the road like heart disease, cancer or diabetes.”

Under the Act, states may apply to the Centers for Medicare Medicaid Services (CMS) for grants to fund programs that demonstrate changes in health risk and outcomes, including the adoption of healthy behaviors.

One way to encourage difficult changes in life habits such as overeating or smoking, research has shown, is to offer economic incentives to those who reach stated goals. With that in mind, CMS will encourage states to adopt such strategies as rewarding Medicaid enrollees who meet goals established for them such as weight loss, smoking cessation or diabetes prevention or control. Rewards could range from direct cash incentives, gift cards to grocery stores or other retailers, reduced Medicaid program fees (if any apply) or offering services not normally available through Medicaid.

“With the right incentives, we believe that people can change their behaviors and stop smoking or lose weight,” said CMS Administrator Donald Berwick, M.D. “Not only can preventive programs help to improve individuals’ health, by keeping people healthy we can also lower the nation’s overall health care costs.”

The program focuses on those behaviors that can cause some of the most critical chronic conditions that together affect millions of Americans for example:

– Tobacco use is responsible for more than 430,000 deaths each year, and is the largest cause of preventable morbidity and mortality in the U.S. Although rates have declined over the past decades, roughly one in five high school students and adults smoke cigarettes. Also, for every person who dies from a smoking-related disease, about 20 more people have at least one serious illness related to smoking.

– Overweight and obesity have been shown to increase the likelihood of certain diseases and other health problems, and are important concerns for adults, children, and adolescents in the U.S. An estimated 26.7 percent of adults in the U.S. reported being obese in 2009, up 1.1 percentage points since 2007, and approximately 300,000 deaths per year may be attributable to obesity. In 2008, the annual healthcare cost of obesity in the U.S. was estimated to be as high as $147 billion a year.

– More than one-third of adults have two or more of the major risk factors for heart disease, a leading cause of morbidity, mortality, and health care utilization and spending.

– Diabetes is the seventh leading cause of death in the U.S. and accounted for $116 billion in total U.S. healthcare system costs in 2007, and almost 24 million Americans have diabetes, including 5.7 million who don’t know they have the disease. Also about 186,300 people younger than 20 years have Type 1 or Type 2 diabetes.

Research in the field, largely based on commercial insurance program experience, has shown that financial incentives can be effective in the short run for simple preventive care and distinct behavioral goals, but this demonstration will attempt to identify the most effective strategies for major, long-term changes in unhealthy habits.

“We are hopeful that these approaches will help to sustain patients’ behavior change over their lifetime, especially in the areas of physical activity, nutrition, and smoking cessation,” said Berwick. “We need to take aggressive steps to help give everyone the tools they need to improve their health.”

States can get more information about the incentive grants here.

Source:

Centers for Medicare Medicaid Services

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Obesity And Knee Osteoarthritis Shorten Healthy Years Of Life

Main Category: Arthritis / Rheumatology
Also Included In: Obesity / Weight Loss / Fitness; Heart Disease; Diabetes
Article Date: 17 Feb 2011 – 0:00 PST

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An estimated 10 million Americans suffer from knee osteoarthritis (OA), making it one of the most common causes of disability in the US. Due to obesity and symptomatic knee OA, Americans over the age of 50 will together lose the equivalent of 86 million healthy years of life, concluded researchers at Brigham and Women’s Hospital (BWH), who investigated the potential gains in quality and quantity of life that could be achieved averting losses due to obesity and knee OA. These findings are published in theAnnals of Internal Medicine.

“Reducing obesity to levels observed in 2000 would prevent 172,792 cases of coronary heart disease, 710,942 cases of diabetes, and 269,934 total knee replacements,” said Elena Losina, PhD lead author of the study and co-director of Orthopedics and Arthritis Center for Outcomes Research in the Dept of Orthopedic Surgery at BWH. “All told, it would save roughly 19.5 million years of life among US adults aged 50-84.”

Experts have long known that knee osteoarthritis is on the rise among Americans, due in part to the growing obesity epidemic and longer life expectancy. Obesity and knee OA are among the most frequent chronic conditions in older Americans. However, how that translates into years of healthy life lost has not been accurately estimated. Dr. Losina and colleagues used a mathematical simulation model to assemble national data on the occurrence of knee OA, obesity and other important conditions such as coronary heart disease, diabetes, cancer and chronic lung disease. Their analysis examines the contribution of both obesity and knee OA to losses in quantity and quality of life. It also evaluates how those losses are distributed among racial and ethnic subpopulations in the United States.

“There are 86 million healthy years of life at stake, a disproportionate number of them being lost by Black and Hispanic women,” said Jeffrey N. Katz, MD, Director of the Orthopedics and Arthritis Center for Outcomes Research at the BWH and a senior author of the study. “These staggering numbers may help patients and physicians to better grasp the scale of the problem and the potential benefits of behavior change.”

This study was funded by grants from National Institute of Arthritis, Musculoskeletal and Skin Disease and the Arthritis Foundation. Contributing authors include Rochelle P. Walensky, MD, MPH, Massachusetts General Hospital, William M. Reichmann, MA, Holly L. Holt, Hanna Gerlovin, Daniel H. Solomon, MD, MPH and Jeffrey N. Katz, from Brigham and Women’s Hospital, David Hunter MD from University of Sydney, Australia, Joanne M. Jordan, MD from University of North Carolina, Chapel Hill, Drs. Lisa Suter and A. David Paltiel, from Yale University School of Medicine.

Source:
Holly Brown-Ayers
Brigham and Women’s Hospital

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Medicare Locals: Guideline Number One

Main Category: Medicare / Medicaid / SCHIP
Also Included In: Primary Care / General Practice
Article Date: 23 Feb 2011 – 3:00 PST

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AMA President, Dr Andrew Pesce, said that Medicare Locals could enhance primary care and benefit patients if they are established according to the core guideline that GPs must remain the coordinators of patient care.

“Medicare Locals will only work to improve primary care if their main purpose is to support the central role of GPs in caring for patients,” Dr Pesce said.

“This means that GPs must be the coordinators of patient care, they must be strongly represented on the Medicare Local Boards, and there must be an absolute minimum of bureaucracy and red tape.

“Significant clinician engagement must be the key feature of Medicare Locals in the same way that it has been recognised as being crucial in public hospital reform.

“The Medicare Locals must support general practices and not divert services from GPs or engage in fundholding arrangements that would steer funding away from GPs and their patients.

“Primary care reform is needed but it has to be the right kind of reform.

“There must be no duplication of services that currently work well, gaps in local service provision must be identified, and those gaps must be remedied.

“The current system makes it difficult for GPs to easily access all the care they require for their patients, there are not proper links between general practice and hospitals, and there is not enough overall funding for general practice.

“These things need to be fixed, but we are yet to see how the Medicare Locals will fix them.”

Dr Pesce said that the Medicare Locals Guidelines document contains some positive themes but it leaves the door open for some arrangements that would be strongly opposed by the medical profession should they proceed.

“The AMA has some concerns that today’s document appears to have extended the reach of Medicare Locals without any consultation with the profession about increased roles and activities,” Dr Pesce said.

“The Government is pushing ahead with Medicare Locals with good intentions but it has yet to comprehensively rule out the introduction of role substitution, managed care, and fundholding, which have plagued primary care reform in other countries.

“The possibility of these arrangements being introduced has increased with the release of the Guidelines.

“Above all, the operation of Medicare Locals must not repeat the failures of the centralised ‘top down’ governance of the public hospital system, from which we are now extricating ourselves.”

Dr Pesce said the Government has previously committed to the central role of GPs in its publication – A National Health and Hospitals Network for Australia’s Future: Delivering Better Health and better Hospitals (the ‘red book’) on page 42, where it states:

Strong clinical engagement will be a key feature of Medicare locals. The role of Medicare Locals will be to support clinicians, not to get involved in clinical decision-making about individual patients.

“This commitment must be maintained throughout the establishment and operation of Medicare Locals,” Dr Pesce said.

Source:

Australian Medical Association

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