Critics say HMOs hiding facts to save bucks
May 31, 1996
Web posted at: 6:05 a.m. EDTFrom Correspondent Jeff Levine
WASHINGTON (CNN) -- When it comes to HMOs, what you don't know can hurt you, according to critics of the rapidly growing managed care industry. They've proposed a new bill, the "Right to Know Act," that was debated on Capitol Hill Thursday.
The premise of the bill is that health maintenance organizations may be saving money on health care in part by shortchanging their patients on the facts.
Some 135 million Americans are covered through some sort of managed care plan. But many patients and doctors are complaining that the organizations are restricting crucial information about the existence of life-saving treatments.
"The freedom of doctors to provide that information to their patients without interference or restriction must be protected."
-- Rep. Edward Markey, D-Massachusetts
"The freedom of doctors to provide that information to their patients without interference or restriction must be protected," said Rep. Edward Markey, D-Massachusetts.
Currently, if a doctor refers a patient outside the plan, the physician can be fired for breach of contract.
Dr. William Osheroff, a doctor with PacifiCare of California, says the legislation isn't necessary. "We agree categorically that physicians must be free to discuss all appropriate treatment options with their patients," he said.
Other doctors disagree. Dr. Michael Haugh says he battled an HMO for 10 months for permission to use a high-tech brain scan. The neurologist was scolded by the company when he informed his patient of the problem, receiving a letter that said, "I should consider your letter to the member to be significantly inflammatory. You should be aware that a persistent pattern of pitting the HMO against this member may place your relationship with the HMO in jeopardy."
The proposed Patient Right to Know Act would eliminate so-called gag clauses in HMO contracts. It would cover all communications between doctors and patients, including discussions of everything from tests to treatments.
"Patients must be able to trust and rely on information provided by their physicians. These gag provisions effectively place a wedge between the physician and his patient," said Dr. Robert McAfee of the American Medical Association. (111K AIFF or WAV sound)
Advocates for the managed-care industry say some companies are already dropping their gag clauses voluntarily. They are fighting the proposed legislation, saying it would make it tough for the plans to do business and ensure quality.
"There are legitimate differences of opinion about the reach of the bill, the impact of the bill, and our ability to dismiss physicians from panels when there has been negligence," said Karen Ignani of the American Association of Health Plans.
Nevertheless, the Right to Know Act already has 100 co-sponsors in the House. The issue struck a chord with many consumers who feel their health plans are more interested in cost-control than care.
Related Story:
Related sites:
- Edward J. Markey - U.S. House of Representatives Member Directory
- PacifiCare Health Systems
- American Association of Health Plans
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