Following the lead of lawmakers in several states, two members of Congress last week introduced legislation that would bar "gag rules" in physicians' contracts with managed-care organizations.
The "Patient Right-To-Know Act" would prohibit HMOs and other managed-care plans from terminating contracts or taking other retaliatory actions because a physician told a patient about a treatment that the plan doesn't cover or about plan policies that deny or permit such treatments.
Managed-care groups argue that such clauses cover only confidential business arrangements and are not intended to interfere with the doctor-patient relationship.
"I don't know of any plan that has contract language that says a physician can't discuss clinical alternatives," said Lee Newcomer, M.D., chief medical officer for United HealthCare Corp.
But Rep. Greg Ganske (R-Iowa), a plastic surgeon sponsoring the legislation, said managed-care plans are using such clauses to deny patients needed care.
"Patients rely on their doctors to tell them the truth," Ganske said.
"No doctor can perform good medical practice in a muzzle," added Rep. Edward Markey (D-Mass.), a co-sponsor of the legislation.
More than a half-dozen states are considering legislation similar to the Ganske-Markey measure.
The American Medical Association supported the legislation, saying it responded to the organization's call for managed-care plans to drop such contract clauses.
"To those managed-care plans still threatening the health of Americans with unethical gag policies, we say: `Why are you afraid of your patients receiving complete information on their treatment options?' " said Donald T. Lewers, M.D., a member of the AMA's board of trustees.