Direct Pay PDF

Introduction

The purpose of this chapter is to discuss a new field of medicine and business model for private practices, known as direct pay, which may provide policy solutions to the challenges encompassing many private health care practices, especially those in primary care. Many of the economic, technological, and social challenges faced by traditional, private practice physicians (especially those in primary care) may be due to the influences of the Patient Protection and Affordable Care Act (PPACA, or ACA) that was written into law in 2010. Physicians of direct pay practices, which are also referenced and categorized as concierge medicine and direct primary care (DPC), may have unique attitudes and may be taking unique actions toward recent health reform and health information technology (HIT) policies, which allows these practices to adapt and survive, compared with traditional private practice. In order to analyze this phenomenon, it is important to study direct pay physicians' perceptions and actions in the care delivery and financial reimbursement process. The term direct pay medicine is used interchangeably with direct pay and retainer medicine throughout the study detailed in this book to suggest the most common umbrella term to represent the field and genre of direct pay services that must, at least in part, operate on a retainer medicine basis.

Through a short introduction and background on the ACA, I deduce the implications of the ACA specific to private practice, especially for primary care physicians (PCPs). I propose the incentives that private practice PCPs have to participate in direct pay, rather than traditional forms of private, preventative medicine. I provide a short description of direct pay care and its characteristics, by suggested differences across pure, hybrid, fee- for- care (FFC), and fee- for- service (FFS) forms of care. Then, I provide my statement of purpose and reason for new contribution to the field, which is to illuminate a potential policy solution to the social, economic, and technological challenges faced by traditional primary care. The statement of the purpose is followed by the research objective and research questions, which include the three major hypotheses for the study. The research question has been framed after analysis of the theories that pertain to direct pay and the current data and limitations of previous research on direct pay in journal articles, news articles, and books.