For example, fifteen years ago a teenager with a severe affective disorder would have been treated in a residential facility. Now, in many instances that same adolescent is being treated as an outpatient with one session every other week for a limited number of sessions. In other words, previously, that patient would have been treated in a safe surrounding. In today's managed care environment, it is difficult for the practitioner to launch effective treatment for the patient. Yet, the liability for the practitioner is the same as it was 15 years ago.
Practitioners have an obligation to deliver quality patient care.
If, in the practitioner's opinion, a patient needs additional treatment, it is up to the practitioner to advocate on behalf of the patient for managed care authorization of additional care. Practitioners who advocate too much risk being excluded from a managed care panel or losing referrals. In areas where there is only one significant MCO, this potential loss can be substantial. MCOs keep a profile of their providers. While provider profiling is not illegal, it certainly can have a chilling effect on how a therapist interacts with the managed care organization.