Critics of managed-care companies last week called for national legislation prohibiting so-called "gag clauses" in HMO-physician contracts, saying they "punish good-faith communications" between doctors and patients.
Managed-care industry representatives contended, however, that gag clauses are not an industry practice and that any contract clause that restricts communication between doctors and patients is "mitigated or vitiated" by other provisions encouraging full and open communications.
The forum for the debate between managed care's detractors and defenders was a Capitol Hill hearing on managed-care contracting and quality issues by the House Commerce health subcommittee.
But the discussion quickly turned to the national "Patient Right-To-Know Act," which would bar gag clauses. The act is sponsored by two committee members, Rep. Greg Ganske (R-Iowa), a plastic surgeon, and Rep. Edward Markey (D-Mass.).
Physicians testifying before the subcommittee argue that they are being "gagged" in their discussions with patients because of contract language that restricts what doctors can tell patients about treatment options not covered by the health plans and the doctors' financial relationships with the plans.
They also criticized anti-disparagement clauses, which allow plans to fire physicians for criticizing the plans.
"These gag clauses drive a wedge between physicians and their patients," said Robert McAfee, M.D., past president of the American Medical Association.
But Karen Ignagni, president and chief executive officer of the American Association of Health Plans, said managed-care plans do not interfere with doctor-patient discussions.
"We have not seen evidence of gag clauses," Ignagni told the subcommittee. "What we have seen is liberal interpretations" of contract clauses that doctors have used for political purposes, she said.
She added that the legislation would interfere with health plans' authority to protect themselves from disclosure of proprietary information and from providers encouraging patients to switch plans.