Evidence Based Practice Behaviors: Implications for Third Party Reimbursement
Current third-party reimbursement schedules are structured by profession rather than by level of education or measurable client outcomes. Social workers are routinely reimbursed 50% of the standard rate for a physician and 65% of the standard rate of a licensed psychologist for the same intervention and amount time spent with a client. Although some would contend this differential is related to level of education, education is only one determining factor in reimbursement. Providers holding a doctorate in social work (or other practice related professions) are currently only reimbursed at the Masters level of compensation.
At this time there are no studies supporting the assertion that certain groups of behavioral health providers consistently demonstrate superior client outcomes warranting higher levels of reimbursement. However, a proxy for this may be the degree to which different professions are engaging in EBP, which is believed to lead to better client outcomes. Consequently, the purpose of this study was to assess whether higher levels of education would be associated with higher levels of engagement in EBP process behaviors, and subsequently whether there are differences between the professions in EBP engagement when similar levels of education are compared.
Methods: This study utilized systematic random sampling methods to conduct a cross-sectional survey of licensed professionals from a diversity of practice based professions (LMFT, Psychologist, Social Work, and LPC) within a large Southern state. Participants completed the Engagement/Behaviors scale of the Evidence Based Practice Process Assessment Scale – Short Form (EBPPAS).This scale includes a subscale consisting of 8 questions that measure practitioners’ level of engagement in EBP. Participants were also asked to answer demographic questions including education level, profession, licensure, age, gender, years in practice and ethnicity.
Results: Results indicate psychologists had higher engagement in EBP related behaviors than social workers, F(4,984) = 5.60, p = .000. However, comparisons including only PhD level providers indicate that social workers engaged in these behaviors at higher levels than those who identified as psychologists, F (4,198) = 3.06, p = .018. Additionally, all providers, regardless of education or discipline reported engaging in these behaviors at moderate levels limiting the substantive significance of these findings.
Conclusions and Implications: These results support re-evaluation of the current reimbursement structure for clinical services provided by non-physician providers such as social workers, professional counselors and marriage and family therapists. It appears that education alone, or a certain type of professional licensure does not assure higher levels of engagement in EBP. Additional implications specific to third-party reimbursement policy and social work education are addressed, as well as future directions for research.