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.”
The services might be "equal", if nothing goes wrong, but doctors are better trained for dealing with the unexpected. Many (most?) people are willing to pay for the extra confidence they can have with a doctor. If doctors no longer cost more, I wonder how much business will be left for midwives.
I've got nothing against polo (I help exercise a local guy's ponies for him when they come off winter quarters), but anybody who rushes an induction to make a date is a bad apple. Period. He wouldn't have passed my investigation (and I would have been sweating bullets if he had been one of my client's insureds).
Obstetrics was my man's life (he died in harness). He didn't leave the hospital while we were waiting to see what my placenta would do, he was sitting right there drinking coffee with my long-suffering husband. And his partner was there bright and early the next morning, "What the )(*&%$! is this I hear about you hoarding your )(**(&*^$ placenta, honey? We can't GIVE the (*&*%^@! things away!"
My roommate (a scholarly and refined lady who was getting her doctorate in Old Testament Theology at Emory) was horrified, but I thought he was a hoot!
The market is deciding, right now. People choose whether to use a midwife or an OB, based on multiple factors, one of which is cost. What percentage of births are handled by midwives now? What will the percentage be, if the cost is arbitrarily increased?
My wife was the manager of the unit that received the kid. She knew every one of those physicians, and he was the best among them. What does that tell you?
Really, part of the problem IS their compensation because they end up with a case load such that they can't pay attention. He was managing two other cases, and did a C-section while my wife was late in labor. He couldn't be there. That's indicative of a structural problem. If we had more MS nurse midwives watching the cases by the bedside and kept the physicians in reserve for consultation and C-sections, my guess is the system as a whole would work better and cost less.
As it was, the doc did not realize that my daughter was badly positioned (IIRC occiput-transverse and asynclitic) for a very long time because he wasn't there to do the sonograms. Things almost went very badly.
Not in hospitals, I promise you. Physicians' organizations have suppressed all sorts of competitors via their political clout, whether chiropractors, PAs, or nurse-practitioners. They've even used that clout to divert funds for education of their competitors at state universities.
It's political restraint of trade. There was even a SCOTUS ruling against the American College of Surgeons on the topic.
We are only starting to recognize the number of lifelong complications resulting from the prevalence of c-section deliveries, everything from pulmonary problems to a lack of skin flora imparted by the vaginal tract. Although we are developing therapies to compensate for these deficits, it seems we systematically fail to do the research by which to justify allocating the resources to preclude the need.
Natural child-birth is a far more complex and comprehensive process than it's been given credit. While the ready option of a c-section has created a large enough population of complications to bring that data come to light, it's caused a lot of long term problems that weren't part of the overall risk assessment when the decision to proceed to c-section is made. More important, these complications rarely play into the decision process to allocate resources by which to more often preclude the need for surgical delivery. I put that unconsciousness squarely at the feet of the medical community, for in their myopic desire to fend off the lawyers, they've negated the ancillary complications without really looking at them as critically as they should have done were the question determined scientifically and actuarially.
Sounds like the ob/gyn my friend had. He scheduled her to have her baby induced only because he was going out of town on holiday.
In addition, I believe board certification was required.
>>Pretty soon we’ll have that wonderful Red Chinese institution, the Barefoot Doctor.<<
We’ll all be needing to download this:
http://www.hesperian.org/publications_download_wtnd.php
If I have to get medical care from an incompetent stranger, I’d just as soon do it myself.
One of the reasons I quit doing OB about 2 years ago. I had two patients show up at the hospital ER with complications. I never signed anything to cover for a midwife. But being on call put me on the hot seat. Not one phone call from the midwife. Nothing. Just a patient with problems I had never seen before and had NO paper work on. I quit. Not worth the hassle and espically the 550.00 payment by Medicaid.
Not all do. I have no problem if they work in Hospitals. It is those at home births that they dump their problems on via the ER that irks me.
RE: “wow. way to destroy the medical profession!”
*********
You got that right! Back in the seventies/eighties I recall learning, while on trips to the old Soviet Union, that a doctor in, say, Moscow, ‘earned’ the same ‘salary’ as a taxi driver! If that doesn’t give one chills, what does?
Obama, with his plans and policies, does want to destroy the entire medical profession as we know it. It’s not perfect now but as many have said, we can tweak the current system a bit without destroying our futures.
No doubt some midwives are ecstatic. I knew a batch of them at County General in L.A. way back in the seventies, when midwifery was really taking hold. Went to a dinner with a bunch of them; I was the only person there who was NOT a nurse or midwife. Almost all of them detested the doctors they worked with and spat out all sorts of vile invective about them.
Seems it was a real clash of the egos — well, who went to med school and put in all the hours, hmm? I have no problem with nurses, but doctors they are NOT.
Agreed. Take a look at Post #46 and tell me what you think.
So you’re saying you don’t get to choose where you go to give birth? You seem to have the wrong country, though many are trying to change this one.
They --the insidious lying bastards running the democrat criminal enterprise-- will protest that assertion with pleas to upcoming elections, but they know such is yet another dissembling of the reality they have so successful achieved, where government dependents will vote as they are ordered to do in order to retain their handouts and democrat/socialist engineered voter fraud cancels tens of millions of legitimate votes.
ping! (Interesting post at #14)
Interesting post at #14...
So you need to change what I said in order to have an argument? There are plenty of instances of systematic restraint-of-trade exercised by physician groups by both political and economic means, some of which have resulted in judgments against those organized associations.
This OB was famous not only for his surgical skill but his intuitive convictions that "something isn't right" - which really wasn't intuition but highly developed diagnostic ability. And that only comes with catching a few thousand babies.
Also, he was of the old school that didn't jump to the knife at the first sign of trouble. A friend of mine had a long and difficult labor, but he shepherded her and her baby through just fine without a C-section. Only sign of the difficulty were the little indentations on baby's head from the forceps, and those went away quickly. She's an honor student at Columbia right now.
The young ones go to the C-section largely to avoid legal liability. Nobody was ever sued for going to a C-section too early (although if what you say is true, that may be the next area the vultures go after).
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