Abstract
The practice of selective contracting in managed care organizations has caused frequent transfers of psychiatric patients from emergency rooms and hospitals that have been excluded from provider networks. Psychiatrists and other physicians who do not participate in these networks may be reluctant to transfer patients into unfamiliar clinical arrangements simply at the request of insurance companies. Possible reasons for such resistance include an unwillingness of physicians to disrupt treatment once it has begun, concerns about the risk of injury while transporting psychiatric patients, and the need to stabilize patients prior to transfer. Although fears of patients injuring themselves or others in transit appear to be unwarranted, certain clinical and risk management issues merit further consideration by HMOs and managed care organizations.