Gag Rules

HMOs are suspected of effectively having “gag rules” that prevent their physicians from telling their patients about expensive tests and treatments that insurance companies and HMOs won’t pay for. In June, 1996, the American Medical AssociationExternal Page Policy 
(click to see policy and instructions) publicly rebelled against them. The doctors group voted to push for legislation requiring doctors to let patients know if they have signed such HMO-imposed disclosure agreements. Representatives for HMOs and other health insurance companies deny that they bar doctors from discussing clinical information. But they say doctors cannot criticize the companies or disclose “proprietary” financial information.


A Primary Care Provider who coordinates all care for a patient. The gatekeeper decides when a referral to a specialist is necessary or when certain tests should be done.
Gatekeepers are incentivized (financially) to minimize referrals and tests.

General Practitioner

A healthcare provider, that takes care of general healthcare needs, and refers patients to a specialist, as needed.
This physician usually is the Primary Care Provider.

General Stores

Storeroom or warehouse within a hospital. It contains stocked items for issue to departments within an IHS. Items are stored generally in large units of issue (i.e., as shipped from vendors). Can be medical or non-medical (e.g., floppies).

Generic Equivalence

Products are considered to be generically equivalent if they contain the same agent and are identical in dosage form, and drug strength.

Generic Formulation


Generic Sequence Number

The Generic Sequence Number (GSN) uniquely identifies a product (i.e., its formulation) specific to its agent, dosage form, and strength, and route of administration. It is not unique across manufacturers and/or package sizes. The digits which make up the GSN have no significance. Rather, The GSN is used to group generically equivalent pharmaceutical products.
Products sharing the same GSN are not necessarily bioequivalent. The GSN and the Orange Book Code must be used in combination to determine an allowable generic substitution.


Geographic Practice Cost Index (GPCI). Usually applies to the physician work, practice cost, and professional liability (malpractice) insurance (Mal) associated with healthcare service. Used in calculating Medicared payments to providers.


GPOs (Group Purchasing Organizations) negotiate contracts between a drug manufacturer and a group of hospitals (or IHSs). Contract management and logistics are then handled by distributors (e.g., McKessonHBOCExternal Page Policy 
(click to see policy and instructions)). On average, a hospital belongs to approximately 2.3 GPOs (circa late 1995).
Here’s a partial list of GPOs (circa late 1997),
Aligned Business Consortium  
Allhealth Blue Bell, PA
Alverno Administrative Services Mishawaka, IN
AmeriNet Inc St Louis, MO
Catholic Materials Management Alliance Cincinnati, OH
Cohr Inc Los Angeles, CA
Health Services Corporation of America Cape Girardeau, MO
Health Care Purchasing Partners Irving, TX
HSNE (Healthcare Services of New England) Braintree, MA
Medecon Services Louisville, KY
Owen Healthcare Inc Houston, TX
Premier Westchester, IL
SSM Diversified Health Services  
St Barnabas Hospital  
Tenet Healthcare Corp Dallas, TX
University Hospital Consortium Oak Brook, IL
VHA, Inc Irving, TX


Group Practices Without Walls. A type of OWA.

Group Model HMO

There are two kinds of Group Model HMO. The first type is called the closed panel, in which medical services are delivered in the HMO-owned health center or satellite clinic by physicians who belong to a specially formed but legally separate medical group that only serves the HMO (e.g., Permanente Medical Group serves only Kaiser Permanente in Northern California). The group is paid a negotiated monthly capitation fee by the HMO, and the physicians in turn are salaried and generally prohibited from carrying on any fee-for-service practice. See Staff Model HMO.
In the second type of group model, the HMO contracts with an existing, independent group of physicians to deliver medical care. Usually, an existing multi-specialty group practice adds a prepaid component to its fee-for-service mode and affiliates with or forms an HMO. Medical services are delivered at the group’s clinic facilities (both to fee-for-service patients and to prepaid HMO members). The group may contract with more than one HMO.