Posted on 07/24/2009 8:32:45 AM PDT by truthandlife
If the House of Representatives passes the health-care bill approved by the Ways and Means and Education committees, midwives--who sometimes deliver babies in place of doctors--will receive the same level of government reimbursement as obstetricians.
Section 1304 of the Affordable Health Choices Act of 2009 (H.R. 3200) would raise government Medicare and Medicaid reimbursement for certified nurse midwives to the same level as the reimbursement for doctors who perform the same services. Under current law, midwives only receive 65 percent of what a doctor receives for equal services.
Originally introduced in February as the “Midwifery Care Access and Reimbursement Act of 2009” (H.R. 1101), the proposal by Reps. Edolphus Towns (D-N.Y.) and Fred Upton (R-Mich.) was later added to the larger health reform package.
In a press release issued by the American College of Nurse-Midwives (ACNM) on Feb. 19, Towns said that the legislation “will not only advance women’s health services--particularly among those most disadvantaged--but it will give midwives the recognition they have long deserved.”
“A certified nurse midwife is basically an advanced practice registered nurse, similar to a nurse practitioner,” Lorrie Kline Kaplan, executive director of the ACNM told CNSNews.com, “but they go through their own program of study, typically it’s a graduate – a master’s degree program, and they are trained in providing all kinds of women’s health care throughout the life span, basically from adolescence through menopause, but obviously midwives have kind of a specialty in maternity care services.”
According to the midwives’ group, certified nurse midwives were involved with 317,168 births in the year 2006 – an increase of 33 percent over 10 years.
Asked about the criticism that the legislation might encourage people to use nurse midwives more and doctors less, Kaplan asked, “Why is that criticism?” She added: “Basically we’re talking about equal pay for the same exact service.”
“OB-GYNs have, you know, very favorable views of working collaboratively with midwives,” Kaplan noted. However, she said that the current reimbursement rate is a “disincentive to have a midwife on staff to provide those services.”
“This becomes kind of a barrier to access,” she said, “because the reimbursement is so depressed that, you know, because as I said, that physicians are less willing to have a midwife on staff, and it’s just not economic to have midwives provide the services, even though the c-section rates for midwives for, you know, a woman who has received care from a midwife and other kinds of medical interventions are usually a lot lower.”
Kaplan said it is “actually typically more cost-effective overall to work with a midwife during pregnancy and childbearing.”
Rep. Michael Burgess (R-Texas), chairman of the Congressional Health Care Caucus, expressed support for the idea – with conditions.
“When a nurse midwife practices under direct physician supervision in a hospital, I’m very comfortable with that being reimbursed at a rate that would be similar to a physician reimbursement, but a nurse midwife who’s practicing in a birthing center becomes a little bit more problematic for me,” Burgess, a member of Congress who is also an obstetrician, told CNSNews.com.
“The availability of physician backup, the availability or the ability to perform a caesarian section urgently, I think, is going to be the critical feature for me,” Burgess said.
Burgess was unequivocal, however, in his opposition to midwives performing home births.
“I don’t think that’s a good idea in general, and I wouldn’t be in favor of that being reimbursed at the physician rate, because you’re just simply not able to provide the same level of safety as someone who’s practicing in the hospital,” Burgess said. “But it has nothing to do with credential. I‘d probably feel the same way about a physician who’s delivering a baby at home.”
Kaplan estimated that 96 percent of births attended by certified nurse midwives are in hospitals, with others occurring in birthing clinics – and a much smaller number in homes.
The American College of Obstetricians and Gynecologists (ACOG) also supports the idea.
“Although we have not commented specifically on the Section 1304 provision in HR 3200, ACOG supports reimbursement equity for certified nurse midwives, as it has for many years,” the organization said in a statement issued to CNSNews.com.
As an obstetrician, Burgess also spoke very highly of nurse midwives from his professional experience and said he suggested that his former obstetrics practice partners hire one.
“I encouraged us to look at hiring a nurse midwife,” he said. “We didn’t do it when I was still in practice, but after I left they did indeed. The hospital did give them a little bit of difficulty with credentialing, but they eventually allowed it, and now the practice is quite satisfied and quite happy that they incorporated a nurse midwife into their obstetric practice.”
Perfect. So, without tort reform, and with the same pay as a midwife, clearly more and more physicians will be going into obstetrics. Right?
My wife has managed both newborn nurseries, has worked L&D and OB-GYN, and is a Clinical Nurse Specialist in a Newborn Intensive Care Unit for a total of 30 years. She's seen far more cases than you disagrees with you.
She says, "I wanted the midwife and the rocking chair. What I needed was a fetal monitor."
Peas and apples. Midwives work in hospitals too, with all the monitoring equipment.
And another friend has a child with brain damage due to the midwife's failure to recognize cord strangulation.
I have a step-sister who had the same complication under "supervision" from a physician.
Thanks, I'll take the guy with the residency and the board certification. And with all the time he spent getting board certified, he deserves better pay.
Thanks, but I'd rather let the market decide. Right now, midwife compensation is under the control of physicians.
Holostic and herbal medicine will be big. The U.S. will be a mirror image of the Soviet Union. There will be all kinds of "alternatives" out there, because it'll be the only medical help available. There will be voodoo, aura alignments, chanting, candle burning.....
Welcome to Obomas Government Run Health Care (when you see the dead lying along the road, just step over them. Someone will be along shortly to clean them up).
Isn't that the plan? The liberals never forgave Reagan for tearing down that "heavenly" wall.
Well, I am definitely going to need my aura aligned before this is all over. Right now I am emitting very bad vibes in the direction of the U.S. Capitol and that can’t be good for aura health.
If the paitent doesn’t wake up then they save a bunch of money on health care.
Interesting, where is this accredited college for midwives? Oh, there are none. If midwives are experts AND can avoid problems maybe THEY should go to Medical school.
If parents love there kids so much why would they let some hippie in their crotch when a certified health professional can actually save the babies life as well as the mothers?
Stupid hippies
Remember what happened in Africa when they pulled an Oboma? They drove all the white farmers off their land and gave it to the blacks. The blacks had no idea how to farm and now the people are starving to death.
Never elect a community organizer to do a presidents job.
That is what happened in Russia, Eastern Europe and China when communism was imposed. They destroyed centuries worth of wealth, and the people even more enslaved than they were under feudalism and monarchy. And look what happened to Great Britain when the Socialist Labor party took over there. Centuries of wealth destroyed, along with their decent medical care. Mrs. Thatcher tried to stem the tide, but her efforts have been reversed. So BO and the Democrats know what the results of their policies will, because this has been tried before, and failed, but they are imposing this dysfunctional system on us nevertheless.
The only problem with any of the births occurred when my 2nd son was born. We had an ob/gyn in attendance along with a midwife. My son's umbilical cord was wrapped around his neck and the ob/gyn managed to break it (which is difficult to do) as he was attempting to unwind it. My son had to be born rather quickly as a result. Had the midwife unwound the cord there wouldn't have been any drama....
Pretty soon we’ll have that wonderful Red Chinese institution, the Barefoot Doctor.
You have correctly identified the issue. You pay for what you get. Since no one knows in advance whether there will be complications or not, why would someone opt for the person least able to handle the complication if it arises?
Where my wife works now, a nurse midwife has an MS with a board cert.
This is what socialized health care is all about. Midwives is probably a good option is 90% of births but it’s the 10% that has problems in delivery where you need the OB. With socialized medicine the 90% think it is great the gov’t pays for the midwife overwhelming the other 10% who will not have access to a OB when Obamacare passes.
Oh, and this is slander to the profession of nurse midwives. They work in hospitals, just like physicians do. They have access to crash carts and operating rooms staffed with obstetricians to handle emergencies.
I'm not in the business directly, but I did medmal defense when I was in private practice, so at the time I knew who the bad apples were. I personally chose my OB because he was the director of OB surgery at my hospital (a very common surgical procedure is named after him), and he had a stellar reputation for coolness under fire and vast experience.
Admittedly he was an older guy in the South (he's gone to his reward now), where midwives have been equated with "granny-women" for years. But he was very open to discussion and new ideas (his attitude towards natural childbirth ought to be a model for every OB - as it turns out I went natural and it was a breeze, but he cautioned me up front it it was 'not for everybody' and I liked that) and I'm sure if he were still alive he'd be examining the options just like he always did.
If the midwives are good, the attitude of OBs will change. But if the government gets involved, they will screw it up. Guaranteed.
She is not a doctor and should not be paid like one.
PS My wife is a nurse, MS, BSN, CNOR, etc.
We had a similarly eminent physician delivering for my wife in the unit she managed. Because he was leaving town for a polo tournament, so he induced her with pitocin to the point where he almost killed our daughter after 14 hours of labor. It's a good thing he knew what he was doing with forceps or she would have been a crash C-section.
more communist tripe from BO
Let the market decide. IMO (and my wife's), OB physicians create many of the problems they mitigate.
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