Not long ago, physicians routinely decried evidence-based medicine (EBM) as an encroachment on their professional autonomy, a barrier to good patient care, insensitive to health care’s growing complexity, and at odds with the transcendent value of the physician-patient relationship. Those objections have been swept away by the 21st century’s tidal wave of health care change-the quality improvement movement, pay-for-performance initiatives, and adoption of information technology. The 109th Congress’ last-minute passage of legislation that boosts reimbursement to physicians who report data on the quality of care they deliver is a huge step to tying EBM to reimbursement. Legislators may take further steps. They are using guidelines to pinpoint and, eventually, eliminate regional variations in medical treatments; to reduce spending on expensive ineffective therapies; and to encourage physicians to use evidence-based low-cost treatments rather than high-tech ones without mountains of EBM behind them. In short, EBM isn’t going away.
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February 2007Evidence-based medicine-the conscientious, explicit, and judicious use of current best data in making decisions about patient care-is here to stay. Payers are determined to align financial rewards to better clinical outcomes, which are defined through evidence-based guidelines. It sounds simple; it isn’t.
Most medical specialties, including otolaryngology, lag behind internal medicine in developing evidence-based medical guidelines. It isn’t because EBM is less important to specialties than to primary care medicine, only that each specialty consumes less of the health care spending pie than do primary medicine’s diagnoses. Understandably, public and private payers have pursued the most commonly diagnosed conditions that consume, in the aggregate, a proportionally larger amount of available resources-the low-hanging fruit.