State Leadership Conference

Practicing psychologists must ensure their seat at the table in ongoing discussions of evidence-based practice in health care, said presenters at the 2007 State Leadership Conference. What's more, they need to showcase their field's grounding in empirical methods, and its integration of science into its practice.

"Evidence-based practice is really how many of us were taught in our graduate school training—to understand research and practice and how the two interrelate," said Lynn F. Bufka, PhD, APA's assistant executive director of practice research and policy, who presented at the session along with Ann Doucette, PhD, a senior research scientist with the Center for Health Services Research and Policy at The George Washington University Medical Center in Washington, D.C., and APA Treasurer Carol D. Goodheart, EdD, an independent practitioner in Princeton, N.J.

Defining EBP

The Institute of Medicine (IOM), a widely respected source on the topic often referenced in health-care policy, defines evidence-based practice (EPB) as the integration of the best research evidence with clinical expertise and patient values. APA's policy on evidence-based practice mirrors this all-encompassing definition, panelists explained, with slightly more emphasis on the field of psychology. Speakers advised psychologists to use APA's policy to rally against cost-saving efforts by federal and state governments and insurance companies to narrow EBP definitions, and subsequently, what mental health care treatments are reimbursed.

After providing an overview of EBP-related statements and policies, Bufka explained that many of these proposed policies are based on specific lists of EBP measures or treatments, rather than on the umbrella-like framework of evidence-based practice that APA advocates in its policy. She noted that in March the Substance Abuse and Mental Health Services Administration, an agency of the Department of Health and Human Services, released its new National Registry of Evidence-based Programs and Practices, which initially listed approximately 25 interventions approved by experts. Bufka said she's concerned that third-party payers will refuse reimbursement for treatments not listed on this registry. She alerted psychologists to state legislation in development that holds the potential to do just that.

"We're particularly concerned about the notion of lists," she said. "Lists often omit things and cannot be up to date on every kind of treatment and research study that's out there."

Bufka discussed APA's response to these threats, including the development of coalitions with other professional and consumer groups and interactions with legislators to explain the value of clinical expertise and individual patient characteristics in psychological practice.

One panelist implored psychologists to use education to bring third-party payers up to speed on what psychologists are doing. Peter Oppenheimer, PhD, said he talks with insurance companies frequently in an effort to educate them on psychology's important role in the health-care system.

"It's a matter of keeping your friends close and your enemies closer," said Oppenheimer, an APA Council of Representatives delegate and legislative chair and public education coordinator for the Rhode Island Psychological Association.

Measuring outcomes

Panelists also provided an overview of outcomes-measurement initiatives implemented by some third-party payers in response to the federal emphasis on increased transparency and consumer choice in health care, embodied by the phrase "value-driven care." Doucette discussed the potential benefits of pay-for-performance initiatives, which reward patients for choosing providers with favorable outcomes, and offer providers financial incentives or recognition for providing good patient care, as measured by patient self-report surveys and adherence to treatment. She also warned psychologists of the dangers of these types of programs, noting that they could be difficult to sustain over time. As providers focus on meeting thresholds, she said, the continued costs of supporting pay-for-performance may become unmanageable.

"If we start paying attention only to meeting thresholds, will we still pay attention to gathering additional evidence to build our arsenal and extend our knowledge of evidence-based practices and practice-based evidence?" she asked. "Probably not."

Panelist Sanford Portnoy, PhD, a member of APA's Committee for the Advancement of Professional Practice and an APA council representative for the Massachusetts Psychological Association, closed the session by reminding psychologists of the field's history as advocates of good science. He encouraged the use of APA's broadly framed definition of EBP.

"Evidence-based practice is our bailiwick, and it's one of the things that can eventually differentiate us from other health-care practitioners," Portnoy said.