With the spiraling cost of health care in the United States, it is critical to demonstrate the effectiveness and efficiency of therapy treatment. As payers, health care systems and the public question the efficacy and cost effectiveness of rehabilitation, objective documentation is becoming more important. Therapists must have a more scientific basis for their practice. Evidence based treatment is indeed best practice. Referrals are increasingly based on objective, value-based criteria including metric-driven rehabilitation performance, rates of successful home discharges, re-hospitalization rates and patient experience ratings.