New York's HMOs are coming under sharp attack for allegedly prohibiting physicians from talking freely with patients and forcing doctors into contracts that jeopardize patient care.
The latest shots were fired by Richard Gottfried and Alexander B. "Pete" Grannis, two Democrats who chair the state Assembly's health and insurance committees. The assemblymen introduced a bill on Jan. 29 that would make it illegal for HMOs to prevent doctors from discussing matters related to an HMO's treatment policies, costs and financial arrangements.
Such "gag rules" jeopardize patient care and keep patients from learning about how some HMOs reward physicians for withholding care, the lawmakers said. "This is outrageous corporate interference with the practice of medicine," Gottfried charged.
No similar measure has been proposed in New York's Republican-led Senate.
The Assembly measure is backed by the 30,000-member Medical Society of the State of New York.
"The physician is, in many instances, overtly prohibited from saying anything to the patient about whether they think the due process by the managed-care organization is fair," said Tom Donoghue, a medical society spokesman. For example, he said, "If a plan says that a pregnancy is only allowed one sonogram, the physician is not allowed to say, `I really think you should have more than one, but your plan doesn't allow it.'*"
The New York State HMO Conference denies that HMOs in the state restrict doctors' ability to discuss treatment options openly. However, there may be HMOs that ask their doctors "not to make disparaging remarks about the health plan," said Leslie Moran, a spokeswoman for the HMO conference, which represents 25 HMOs.
The conference has no knowledge of instances in which HMOs have prevented doctors from discussing financial arrangements, Moran said. But such prohibitions are "possible" because an HMO's financial arrangements may be considered proprietary, she said.
In another example of managed-care backlash, a doctor and nurse activist group calling itself "Code Blue" is urging New York State Health Commissioner Barbara A. DeBuono, M.D., to hold public hearings on capitation. In a letter dated Jan. 25, Code Blue co-founder Carl Weber, M.D., said the switch to capitation by Aetna Health Plans of New York is causing "substantial harm to patients" by disrupting doctor-patient relationships and creating financial conflicts of interest.
Weber said his group objects to the insurance industry's use of care-rationing incentives because decisions about care should be made by the physician and patient.
Code Blue joins the League of Physicians & Surgeons, another New York-based advocacy group, in attacking Aetna's move to capitation. Aetna has defended its contracts, saying they are typical of contracts used nationwide.
A health department spokeswoman said DeBuono hasn't decided how she will respond to Code Blue's request.