THE VIRGINIAN-PILOT
Copyright (c) 1996, Landmark Communications, Inc.
DATE: Friday, June 28, 1996 TAG: 9606280498
SECTION: FRONT PAGE: A2 EDITION: FINAL
SOURCE: ASSOCIATED PRESS
DATELINE: CHICAGO LENGTH: 58 lines
The American Medical Association rebelled Thursday against HMO gag rules that prevent doctors from telling patients about expensive tests and treatments that insurance companies won't pay for.
The doctors group voted to push for legislation requiring doctors to disclose when they have signed the HMO-imposed disclosure agreements.
``Gag clauses strike at the heart of the physician-patient relationship,'' Dr. John C. Nelson, an AMA trustee, said before the vote. They erode trust and also open the physician to malpractice lawsuits, he said.
The AMA was already on record as wanting a ban on the clauses, but in lieu of that, patients should be told in plain language that they exist, the group's policymakers said.
``It was to continue to encourage us to do everything we can to eliminate gag clauses from contractual relationships with the managed care industry,'' said Dr. Robert E. McAfee, immediate past AMA president and a member of the board of trustees.
In Washington, a bill outlawing gag clauses advanced from a House subcommittee Thursday.
Health maintenance organizations and insurance company representatives deny barring doctors from discussing clinical information. They just say doctors can't criticize the companies, or disclose proprietary financial information.
``The Health Insurance Association of America always maintains that patients should be able to have access to all the relevant information that they need to make their health-care decisions,'' said Michael Fortier, associate director of the group, based in Washington.
He said the AMA's real intent is to prohibit contract provisions that say doctors can't ``disparage'' the health plan or criticize it.
``In any business arrangement, you have that; you cannot disparage your employer,'' Fortier said. ``You can't say, `Well, this is a good product but the fellow down the street has a much better product.' ''
But Dr. Brian J. Eades, an obstetrician-gynecologist, said an HMO with which he has a contract gagged him from talking about the possible medical consequences of one of its policies.
He said he had put a sign up in his waiting room notifying his patients that the HMO had changed its rules, prohibiting women from seeing obstetrician-gynecologists as general care doctors and telling them to consult him if they wanted more information.
Patients complained to the HMO, he was called before the HMO board and a senior member of the physicians group he belongs to asked him to resign, even though Eades said he had expressed no opinions about the HMO.
The AMA's annual five-day meeting ended Thursday. ILLUSTRATION: IN VIRGINIA
A new Virginia law that goes into effect Monday requires doctors
enrolled in health maintenance organizations to tell patients of any
financial arrangements that would discourage the doctors from making
referrals to specialists. The law does not apply to companies that
are self-insured.
KEYWORDS: HMO by CNB