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HMOs defend doctor-patient rules of communication
December 9, 1996
Web posted at: 10:30 p.m. ESTFrom Correspondent Jeff Levine
WASHINGTON (CNN) -- Some managed health care organizations are going on the offensive after the government put them on notice not to muzzle their doctors with so-called "gag clauses."
The government has sent a letter to some 300 managed health care plans treating Medicare patients to warn that rules limiting "a physician's ability to ... counsel or advise a Medicare beneficiary ... are a violation of the law."
Rules governing doctor-patient communication are often referred to as "gag clauses," and critics charge they can harm patient care.
"What we have said in our letter to our own managed care companies, the ones that we fund for Medicare recipients, is 'no gag rules,'" said Health and Human Services Secretary Donna Shalala.
"That is a clarification, it isn't a new rule."
To more than four million elderly Americans, managed care plans and health maintenance organizations have become a way of life.
Although they may save money, critics complain the gag clauses are dangerous. The concern is that physicians can't tell patients about potentially life-saving treatments that may not be available in their plan.
Some experts encourage patients to take the initiative.
"They should question their physicians," said Dr. Thomas Reardon of the American Medical Association. He added that doctors have an ethical obligation to answer those questions honestly.
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The federal government will continue surveillance of Medicare plans for possible violations of patients' rights.
A spokesman for the managed care industry said any attempt to interfere with doctor-patient communication would be out-of-bounds.
"We do not believe there is any place in contracts for any language that inhibits physician communications with patients," said Karen Ignani of the American Association of Health Plans.
The question of gag rules is sure to come up in the next session of Congress. Kaiser Permanente, America's largest HMO, said it is dealing with the problem and hopes that legislative action won't be necessary.
"I'm not sure that legislation is required, but certainly the industry could fix its own problems and should," said Dr. Adrian Long of the Mid-Atlantic Permanente Medical Group.
The biggest managed care trade group says it supports the government directive on communication, and will unveil its own effort to resolve the dilemma next week.
Related stories:
- Poor and elderly do worse in HMOs - October 1, 1996
- Report: Plan to limit HMO doctor payments shelved - July 8, 1996
- Critics say HMOs hiding facts to save bucks - May 31, 1996
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