1st Edition

Direct Pay A Simpler Way to Practice Medicine

By Divya Srinivasan Sridhar Copyright 2015
    304 Pages 9 B/W Illustrations
    by Productivity Press

    303 Pages
    by Productivity Press

    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.

    Introduction
    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

    Research Objectives
    Research Questions
    Hypothesis
    Hypothesis
    Hypothesis

    Methodology
    Rationale for Research Method
    Mixed Methods
    Sampling
    Sampling Method
    Power Analysis
    Research Ethics and Participant Privacy
    Instrumentation
    Key Measures
    Data Analysis and Statistical Models

    Quantitative Results

    Hypothesis 1: Testing the Impact of Health Reform on Direct Pay
    Descriptive and Inferential Statistics
    Multivariate Regression
    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
    EMR/EHR Usage
    Other HIT: Telemedicine, Patient-Controlled Health Records, and Mobile Health Apps

    Hypothesis 3: Organizational Culture Differences across Direct Pay Practices

    Qualitative Results

    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
    Conclusion
    Policy Impacts and Recommendations
    Direct Pay and Impacts on Primary Care
    Policy Challenges from Direct Pay
    Limitations of the Study

    References

    Biography

    Divya Srinivasan Sridhar