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AMA: Title X Rule Infringes on Patient-Provider Relationships

The rule would restrict providers from referring patients to abortion as family planning, which AMA says violates patient-provider relationships.

patient-provider relationships

Source: Thinkstock

By Sara Heath

- The American Medical Association (AMA) is coming out against the Title X Family Planning program rule, stating that the rule would infringe on patient-provider communication and patient-provider relationships.

The rule, released last week by the Department of Health & Human Services (HHS), outlines new provisions for the Title X Family Planning program, which was established to connect low-income patients with critical reproductive health services.

Updates include numerous provisions to enforce certain statutes for funding and limitations on abortion services. Notably, the rule prohibits referral to abortion as a form of family planning, thus removing any requirements physicians previously had to disclose those services.

Instead, HHS says providers may engage in “non-direct” family planning or abortion counseling.

“To preserve open communication between the patient and the healthcare provider, the regulation permits, but no longer requires, nondirective pregnancy counseling, including nondirective counseling on abortion,” the agency wrote in the rule’s fact sheet. “Consistent with the statutory requirement that no funds may be expended where abortion is a method of family planning, this regulation no longer requires, and affirmatively prohibits, referral for abortion as a method of family planning.”

READ MORE: How Online Medical Info Impacts Patient-Provider Relationships

Instead, HHS says providers may encourage patients to access other family planning services, such as pre-natal care.

This rule change is akin to a physician gag clause, AMA president Barbara L. McAneny, MD, said in a statement. In putting limits on which services to which providers may refer their patients, HHS is getting in the way of a healthy patient-provider relationship.

“This rule interferes with and imposes restrictions on the patient-physician relationship,” wrote McAneny. “For all intents and purposes, it imposes a gag rule on what information physicians can provide to their patients. The patient-physician relationship relies on trust, open conversation and informed decision making and the government should not be telling physicians what they can and cannot say to their patients.”

The rule violates the AMA’s Code of Ethics, which sanctifies the patient-provider relationship, McAneny continued. Providers need to provide full guidance to their patients and disclose all treatment options. This latest rule revokes that imperative and infringes upon patient communications, she said.

Further, the HHS rule will hamper care access for underserved patient populations, McAneny said. The mandate to withdraw funding from certain Title X clinics will make it difficult for these clinics to deliver care to low-income patients or patients who otherwise face obstacles accessing care.

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

“The AMA also strongly objects to the administration’s plan to withhold federal family planning funding from entities that provide critical medical services to vulnerable populations,” McAneny asserted.

Title X clinics provide women with a plethora of health services, including cancer screenings, birth control, STI testing and treatment, and other reproductive health exams.

“This is the wrong prescription and threatens to compound a health equity deficit in this nation,” McAneny added. “Women should have access to these medical services regardless of where they live, how much money they make, their background, or whether they have health insurance.”

Instituting rules like the one HHS recently published will be a step backwards and will harm a well-liked public program, McAneny said.

“Title X is popular, successful, and has had bipartisan support for decades. Our country is at a 30-year low for unintended pregnancy and an historic low for pregnancy among teenagers — largely because of expanded access to birth control. We should not be walking back from that progress.”

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The Title X rule, which was released February 22, includes provisions to restrict funding for clinics where abortion is a form of family planning, protocol for encouraging better parent-child communication around reproductive health, maintaining clinician-patient confidentiality, and service eligibility.

Additionally, the final rule outlined protections for women and children who may be experiencing physical or sexual abuse.

AMA took a similar stance after HHS issued its proposed rule for the Title X Family Planning program back in August 2018. Following publication, AMA blasted the HHS proposal, maintaining that it is a violation of the patient-provider relationship.

“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.”

Proponents of the final rule say that it will help Title X clinics to provide more holistic healthcare because they will have more funding with which to provide other family planning services.

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