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AMA: Title X Rule Harms Patient-Provider Relationship, Care Access

Proposed changes to the Title X family planning program could get in between the patient-provider relationship, AMA said in a recent statement.

ama patient-provider relationship

Source: Thinkstock

By Sara Heath

- Proposed changes to the Title X Family Planning program could harm the patient-provider relationship by introducing government interference into the exam room, according to the American Medical Association.

Specifically, the proposed changes could dictate the content of conversations between patients and providers, a situation the AMA says breaches the standards for positive patient-provider communication.

“Protecting the sanctity of the patient-physician relationship, including defending the freedom of communication between patients and their physicians, is a core priority for the AMA,” the organization wrote in a statement. “The ability of physicians to have open, frank and confidential communications with their patients has always been a fundamental tenet of high quality medical care.”

The proposed rule, which HHS issued in May 2018, calls for withdrawing federal funds to qualified family planning services that also offer abortion services. The rule also proposes to pull federal funding from Title X clinics that provide abortion service referrals or counseling about abortion services; get rid of requirements that Title X care sites offer multiple family planning methods and counseling on those methods; and funnel new funding opportunities toward faith-based or other groups that promote fertility awareness and abstinence-based family planning education.

According to HHS, these updates aim to “make notable improvements designed to increase the number of patients served and improve their quality of care.”

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“The Title X program serves approximately 4 million people annually, and the proposed update seeks to ensure a holistic and health-centered approach; safeguarding the short and long-term family planning needs of more women, men, and adolescents in need of services,” HHS added when announcing the proposal.

“It is of utmost importance that individuals in low-income communities receive comprehensive family planning services, and care that promotes the welfare of adults and youth. It is equally important that, as stewards of taxpayer funds, the Department assures that the program operates according to statutory requirements.”

However, these changes could harm the patient-provider relationship, reduce patient access to family planning care services, and hinder patient access to other healthcare services, wrote AMA CEO and executive vice president James L. Madara, MD.

Proposals to limit referrals to abortion or other family planning services would hinder providers’ abilities to feely communicate with their patients, AMA said. Quality healthcare depends upon an open, trusting, and free relationship between patients and providers. By putting into place laws to regulate those relationships, AMA said the HHS proposals could cause considerable harm.

“The proposed changes on counseling and referral described above would not only undermine the patient-physician relationship, but also could force physicians to violate their ethical obligations,” AMA said, citing ethical considerations listed in the group’s Code of Medical Ethics.

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“Physicians’ inability to comply with their ethical obligations could not only harm the patient-physician relationship, but also could result in harm to their pregnant patients at Title X projects, especially if such patients are delayed in finding abortion providers.”

AMA also pointed out limits on evidence-based family planning services that could harm patient access to quality care.

“HHS emphasizes non-medical services, such as abstinence, natural family planning, and adoption as a way to manage infertility,” AMA said. “HHS’ emphasis on non-medical services is contradicted by data showing that fertility awareness methods are among the least effective methods of family planning, and the Food and Drug Administration has warned that these are not reliable forms of contraception.”

And outside of family planning services, AMA commented on the impacts to low-income families who depend on Title X services.

The proposed Title X changes would amend the definition of “low-income,” for example, to now include all women whose employer-sponsored healthcare does not include family planning or contraceptive care because of moral or religious obligation. In theory, this could qualify all women to receive care at a Title X facility, creating a potential scarcity of resources and harming patient access to care.

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“The Title X program is already underfunded and overburdened and the Proposed Rule could result in even fewer resources to serve low-income patients,” AMA noted.

Among other concerns are issues with patient privacy for adolescent patients and exclusion of qualified providers from receiving federal funding.

“Title X is the only federal program dedicated specifically to providing low-income patients with essential family planning and preventive health services and information. As such, it plays a vital role in the nation’s public health safety net by ensuring that timely, safe, and evidence-based care is available to women, men, and adolescents, regardless of their financial circumstances,” the AMA statement concluded.

“The AMA believes that this Proposed Rule, if finalized, would limit access to critically needed care and services for millions of individuals who depend upon the Title X program for their care and would result in harm to patients and the public’s health. We urge HHS to withdraw this proposal.”

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