Trying to cool the push for federal legislation, the American Association of Health Plans last week unveiled a campaign to give HMO patients more information about how their plans work.
The nation's largest managed-care trade group is considering sanctions against its member plans that don't comply with the new program.
The "Patients First" initiative will encourage HMOs to tell their members, upon request, how physicians are paid, how treatment is reviewed, the basis of specific treatment decisions, whether a specific drug is included in a formulary, and how the plan decides that a procedure is experimental.
HMO executives and the AAHP hope such information will replace what they say is mistaken perceptions of HMO care spawned by negative media coverage.
The AAHP's actions are widely viewed as an effort to head off federal legislation banning contract clauses that "gag" physicians. Some doctors contend such clauses prevent them from fully informing patients about treatment options and other healthcare matters.
But the American Medical Association, while commending the AAHP's program, urged the group to support such legislation, which "failed to secure passage in the closing hours (of the last Congress) partly due to AAHP opposition," said a statement by Nancy W. Dickey, M.D., the AMA's board chairman.
However, not all physician groups share the AMA's point of view.
Douglas E. Henley, M.D., board chair of the American Academy of Family Physicians, said the gag clauses "should be resolved in the private sector, rather than by the government."
The AAHP also said it would extend to all its 1,000 member plans HCFA's recent directive that HMOs ensure open communication between Medicare providers and patients.
"We're pleased by the wide degree of acceptance (of the Patient First initiative) by plans," said Philip Nudelman, AAHP chairman-elect. He's also president and chief executive of Group Health Cooperative of Puget Sound in Seattle.
Meanwhile, an AAHP task force is working on making sure the program has teeth, he said.
The task force is discussing sanctions to be used against plans that don't comply with the program, including possible loss of membership, he said.
"What we will be looking for is voluntary agreement and compliance. The next step is how about those that decide not to comply," Nudelman said. "We're looking at an entire industry tainted with a broad brush. It's very important to us as an industry that those that don't comply not be recognized as those that do comply."