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.”
When I say "natural childbirth" I don't mean "vaginal delivery". I mean going drug-free with Lamaze, Dick-Read, whatever.
My mom was a Dick-Read disciple (I still have her copy of Dick-Read's original book, the first edition), and I was probably one of the only natural childbirth babies in Atlanta GA at the time (mom had to shop all over to find an OB who would agree to even TRY this crazy idea).
My OB was open to the notion, but seemed to think that when push came to shove, so to speak, I would be asking for the epidural. As a matter of fact I did ask for an epidural at one point, but as soon as they checked me I was 10 and plus 2, so we said, "What the heck!" and daughter was born 10 minutes later. And as soon as I found out I was that far along it didn't hurt any more (proving once again that a lot of it is in your head.)
What portion of ObamaCare would be market driven?
What portion of your rhetorical question is truly directed to anything I've advocated?
Not really. You logically arrived at that because I didn't cite anything beyond physical consequences of c-sections to subsequent child development. However, I do think there are benefits to the pain of natural childbirth, most of which are related to the resulting bond between mother and child.
I think the pain of childbirth is overrated - my knee arthroscopy AND my hand surgery both hurt worse - but it’s probably just us tough old Scots. My mom was the same way - two kids by the Dick-Read method back when it was unheard of (I think the Doc was still alive at the time).
What market forces are you referring to in your previous post?
That said, I would never have a home birth with a lay midwife - never never never. I did, however, have hospital deliveries with a certified nurse midwife (who worked for an OB) who, as far as I'm concerned, walks on water. Had the monitoring, had an epidural for one, everything was great. With one I started hemorrhaging after the birth and she took care of it immediately.
Agreed, it is generally preferable to deliver at a hospital, but it could be a lot better. See Post 46.
Our first was a c-section due to his being 10 pounds, but all the rest were natural with our CNM.
How are those homeschooled daughters of yours doing?
At 16, one of them has four AP scores of 4, in calculus B-C (with a 5 on the A-B sub-score), biology, chemistry, and environmental science. We think she didn’t get a five this year because she was a little slow with the calculations and shy on lab experience. The younger didn’t test as well, although frankly, both my wife and I think her more innately intelligent. We don’t know what the problem was. So they’re both off to junior college next year, among other reasons because the older one can drive and they can attend lab classes (the lack of which I think was part of the problem). They should do fine.
Right. The pay will be so low no one will be arguing about this anyway.
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