303 pages | 9 B/W Illus.
Direct Pay: A Simpler Way to Practice Medicine examines the direct pay business model as a policy alternative and potential policy solution to the economic, technological, and sociocultural problems that have emerged for practicing physicians as a result of the Affordable Care Act. Based on a research study conducted by the author, the book addresses key research issues that are supported by theory and recent literature.
The research and hypotheses presented in the text are tested and proven through a set of questionnaires, interviews with direct pay physicians, and case studies that illustrate how the subject originated and why it is gaining momentum in today’s challenging health reform environment.
The book provides guidance on direct pay from a public policy perspective. It examines the impact of recent health reform policies and provisions on direct pay physicians, including the individual mandate and universal coverage provisions, patient-centered medical home (PCMH) certification and model of care, provisions to expand Medicaid and changes to reimbursement for Medicare, policy changes from HIPAA, and the HIT policy of Meaningful Use (MU).
The book analyzes the organizational style and culture of the participating direct pay practices using theoretical and practical tests of the Competing Values Framework. It not only gauges the practices and policy implementation of direct pay practices, but also searches for variations between pure versus hybrid organizational identity of direct pay practices, and variations between direct pay practices operating on all-inclusive, fee-for-care (FFC) models versus fee-for-service (FFS) payment models.
Providing a fundamental understanding of direct pay, the book highlights emerging trends and supplies authoritative analysis on how the direct pay business model can help to advance the practice of medicine through improved efficiency and effectiveness.
Background and Statement of the Policy Problem
Direct Pay: A Policy Solution
Purpose and New Contribution of the Study: Researching Direct Pay
Theories and Literature on Direct Pay
Population Ecology Theory and Literature
The Diffusion of Innovations Theory and Literature
EMR Adoption at Small, Private Health Practices
Isomorphism Theory and Literature
Franchising as Competitive Advantage
Measuring Organizational Culture through the Competing Values Framework
Concluding Notes on Theory Application
Limitations in Current Literature and Conclusions
Rationale for Research Method
Research Ethics and Participant Privacy
Data Analysis and Statistical Models
Hypothesis 1: Testing the Impact of Health Reform on Direct Pay
Descriptive and Inferential Statistics
Hypothesis 1: Characteristics of Health Reform and Impact on Direct Pay
Hypothesis 2: Electronic Medical/Health Record (EMR/EHR) Usage, Implementation, and HIT Policy Perceptions of Direct Pay Practices
Other HIT: Telemedicine, Patient-Controlled Health Records, and Mobile Health Apps
Hypothesis 3: Organizational Culture Differences across Direct Pay Practices
Interviews with Direct Pay Physicians
Brief Summary of Qualitative Analysis
Detailed Qualitative Analysis Results
Qualitative Themes from the Interviews
Stories of Positive and Negative Experiences regarding Direct Pay
Interview Findings: Overall Strengths and Weaknesses of Participating in Direct Pay
Final Conclusions and Policy Recommendations
Policy Impacts and Recommendations
Direct Pay and Impacts on Primary Care
Policy Challenges from Direct Pay
Limitations of the Study