I am having an on-going debate with several therapists over the impact of EBP from a reimbursement standpoint as well as reality of pay for performance in physical therapy and I would invite the readership of this blog to chimb in!

I have had extensive talks about EBP with some of the top private insurers in the U.S.  They all agree substantially on the precepts of EBP and the importance of adding the scientific inquiry process to the traditional model of patient care.  They all agree that practitioners who are more experienced are better at clinical judgement but less “up to date” and have less performance outcome AND generally speaking use what they learned in school/internships along with the tradition of the guild as their basis for intervention choice.  They further agree that EBP will have a substantial impact in  physical therapy and those providers who routinely practice EBP thru pre-processed information vis a vis EBP driven guidelines (as opposed to consensus driven) for a broad range of diagnoses and “real time” searches will be recognized by payors in some format or another (e.g. “gold stars” next to their name in the provider directories or some type of recognition as “preferred” providers). Interestingly enough, none of the payors speculated that in PT EBP will have any reimburesement implications.  The cited reasons include lack of ability in their “systems”, the small percentage of the health care dollar that PT represents, and bigger “fish to fry” in the health care arena (particularly the big 3-diabetes, asthma, and obesity).

Although “pay for performance” (P4P)appears to be gaining some traction in the family practice and internal medicine circles from 6 large insurance carriers (powerpoint presentation from IHA), its early integration looks to me to be a “pay for compliance” play rather than any attempt at EBP integration.  Some payors will pay a greater amount for those physician practices who routinely follow-up with their patients (again the big 3-diabetes for testing, asthma for meds, and obesity for cholesterol) with a greater compliance being rewarded (so much for promoting self-responsibility).

The incentive to use EBP lies with the practitioner in that it improves delivery and outcome.  A fairly recent white paper from Vanderbilt Center for EB medicine describes health plans encouraging physicians to practice EBP, I am not seeing it in our market and am skeptical about a payor mandate (or financial incentive) for EBP and P4P in PT.  What do you think?

Larry