Loosening HMO ‘Gags’ Doesn’t Complete the Job : Washington should extend its ban beyond Medicare

In a stern directive mailed to health maintenance organizations last week, the Clinton administration said HMOs cannot “gag” their physicians to stop them from discussing treatment options with Medicare patients. Any HMO prohibiting its doctors from speaking freely with patients about costly drugs or treatments deemed medically necessary could be denied Medicare dollars.

In recent years, the HMO industry has fiercely battled similar gag prohibitions introduced in state legislatures, including California’s. In this instance, however, the industry seemed to have nothing but praise for the new federal order. “People in Medicare HMOs have the same rights to know exactly what their treatment options are as anyone else in the Medicare program,” said Don White, spokesman for the American Assn. of Health Plans. Why are HMOs affording Washington more deference than they did the states? Because, having absorbed the pool of healthy, young Americans, HMOs are now struggling to recruit older Americans to maintain the phenomenal growth rates the stock market has come to expect of them.

At least one formidable obstacle, however, stands in their way. That is the perception among many Americans that HMOs provide substandard care to the aged. In October, a four-year study published in the Journal of the American Medical Assn. found that HMOs provide erratic levels of care to Medicare recipients. Elderly patients enrolled in HMOs were twice as likely to see their health decline as elderly patients enrolled in traditional “fee-for-service” insurance programs, the study said. The HMOs’ embrace of the new federal mandate against gag rules appears to be their way of reassuring Washington that they are serious about addressing the problems detailed in the JAMA report. But they should go beyond the federal guidelines. Many HMOs, for instance, reward physicians for seeing as many patients as possible during a given day. A proper emphasis would give doctors more time to serve the elderly and others who might be lost in the maze of managed care.

Most important, the federal government should make good on promises to expand the ban on gag rules to cover all HMO doctors, not just those serving Medicare patients. Washington should also ban financial incentives given to physicians for denying care to patients in an effort to hold down costs.

Working against government efforts to reduce costs is a variety of factors. Last month, for example, U.S. pharmaceutical companies began advertising campaigns promoting an expensive new drug promising to reduce the risk of heart attacks. Should HMOs be required to prescribe such drugs at the patient’s request? HMO executives like David Strand of Minneapolis’ Medical Health Plans say no. “To try to convince people that the best way to reduce cholesterol is to take a pill rather than eat healthy or get exercise,” Strand said, “is a bad result for all of us.”