Health Plans Set Policy to End ‘Gag Rules’

Managed-care health plans, trying to head off restrictive legislation supported by their critics, introduced an industrywide policy Tuesday to guarantee open communication between doctors and patients.

The curbs on so-called gag rules, which have subjected the industry to criticism from lawmakers and physician groups, were announced by the American Assn. of Health Plans, the industry’s largest trade group, which represents such companies as Humana Inc. and PacifiCare Health Systems Inc.

“We want to send a very clear signal that our member plans do not support any encumbrances between physician and patient in health plans,” said Karen Ignagni, president of the group, which represents plans serving more than 140 million Americans.

The group also announced that member plans will provide patients with information about their reimbursement and treatment practices.

“This industrywide effort is important because it responds to patient and physician needs by putting more information in their hands about the policies and practices of health plans,” Ignagni said.

The association also pledged to support a rule by the Clinton administration warning managed-care companies that they would be violating the law if they interfered with doctor treatment recommendations to patients covered by Medicare.

The group said it will apply the rule to all of its patients. “Member plans pledge to support this principle through their policies and practices for all patients,” it said.

The initiative, called “Patients First,” says that “physicians should be encouraged to share information with patients on their health status, medical conditions and treatment options.” It says that health plans should, at a patient’s request, provide general information about how doctors are paid and about how plans determine whether a treatment or procedure is medically necessary.

HMOs lauded the plan.

“It’s a good thing for the industry,” said Susan Busch, a spokeswoman for United Healthcare Corp. She said the company already has a provision in its contracts with doctors that encourages open discussion between doctors and patients.

Louisville, Ky.-based Humana, which said it never has had gag clauses, said it also supports the move.