Health policy changes and major transitions, such as the one now under way, can provoke anxiety among health care stakeholders, including individual health professions such as occupational therapy. Health professions naturally seek to guard, if not advance, their role and prerogatives in the health care system to protect their practice domains, prestige, legitimacy, and sources of payment. In the current but fading fee-for-service payment system, a profession typically does so through credentialing, state practice laws, and the like but also by guarding specific bits and pieces of documentation needed for reimbursement and quality assessment.

For occupational therapy, this process may include making sure that occupational therapy is included in health benefits packages, that the Current Procedural Terminology American Medical Association, 2015 ) includes acceptable occupational therapy–related codes, that functional assessment instruments include domains (e.g., upper-limb mobility, functional cognition) that reflect occupational therapy’s involvement or contributions, and that electronic medical records (EMRs) include codes and descriptors for occupational therapy inputs. These are some of the ways in which health professions mark territory and validate their role in the health system. This territorial marking behavior is entirely predictable, but it is also necessary in a fee-for-service system.

Over time, territorial marking as practitioners have known it will become obsolete, but marking a place in the system will remain necessary. In future years, a health profession’s legitimacy will depend less on what it does and the procedural codes it checks off and more on how it adds value to overall patient outcomes. Coding, documentation, and scope of practice may still be relevant but in different ways. Both in practice and in advocacy, the relevant question is not whether occupational therapy is adequately represented but how occupational therapy—its timing, type of intervention, and intensity—adds value for the patient and the health care system broadly in both the near and the long term. If value is measured by health outcomes divided by costs, then it is essential that the profession advocates for outcomes that are in accord with patient goals and societal values that also reflect occupational therapy impacts. To do so requires scientific evidence resulting from a robust research agenda and credible evidence stemming from patient cohort studies using nimble electronic data systems.