Time for Medicare Provider Numbers; it has only taken 24yrs

On the weekend I was in Melbourne and I was fortunate to hear this piece of information which made me sit up and think.... has much changed over 24yrs?..and if we miss this chance will it take another 24yrs?

The information comes from " COMMONWEALTH OF AUSTRALIA MEDICARE BENEFITS REVIEW COMMITTEE (2ND REPORT) JUNE 1986 p 230;

Submissions concerning midwifery were received from the National Midwives Association the Royal Australian Nursing Federation, the New South Wales Nurses Association, the Launceston North Coast Home Birth Support Group and numerous Private individuals. ......Most of the submissions proposed that midwife be recognised on an equal footing with medical practitioners in respect of the payment of Medicare benefits for certain services associated with uncomplicated birthing........of the many medical and paramedical issues raised with this committee, the question of the payment of registered midwives generated the greatest depth of paramedical submissions addressed 25% were midwifery related......

Has much changed in 24 years..... we are on the brink of change.

Some midwives are confusing the Medicare Provider Number with the requirement of insurance. However the issue of insurance is a requirement of National Registration s129(1)registered health practitioner must not practise the health profession in which the practitioner is registered unless appropriate professional indemnity insurance arrangements are in force in relation to the practitioner's practice of the profession.

In order to have a Medicare Provider Number you need to be an eligible midwife... Have a look on the Australian Nursing and Midwifery Board site to remind you what these requirements are;

The Health Insurance (Midwife and Nurse Practitioner) Determination 2010; for the Medicare Provider Numbers... check out the determination; the Midwifery services and fees range from $31.10 -$724.00 also is included 6 weeks of postnatal care...which is excellent for women and will also help provide greater postnatal care....

This is the beginning of new things, an opportunity of greater access for all women... however we must remember that unfortunately this does not include homebirth...therefore we need to more than ever keep the pressure on the government.. to pass this service fee onto women who choose a homebirth.....

Legal issues? Homebirth again!

The Medical Observer writes Homebirths GP's new legal dilemma.... "If your patient decides on a midwife-led home birth and asks for prescriptions, could you be legally liable if something goes wrong?"
sometimes I am still amazed at what the AMA will come up with next..... really it should be no surprise that this tactic would be used.....
"Midwives are able to legally administer Syntocinon but cannot prescribe it, until 1 November when changes to federal laws mean nurse practitioners will have limited access to the MBS and PBS."
Giving syntocinon has always been part of a Midwives role, this drug is not new to the profession....it is part of our job, however the drug is only used if there is postpartum hemorrhage.
Part of a midwives course is a detail pharmacological unit, which entails knowing about the drugs used within midwifery there use and contraindications of drugs..... the way this article reads is as if this is a new drug that midwives have no idea about.....midwives are trained professionals.

According to Homebirth Australia spokesperson Justine Caines, the group has had reports of women in the ACT, NSW, Queensland, Victoria and SA who have been refused scripts for Syntocinon, vitamin K and ultrasound referral by their GP.

She says there is a steady growth in home birth as more women become what she calls “refugees” from the hospital system, reluctant to return for another birthing experience of “substandard or unsafe care”.

Ms Caines condemns the decision to refuse women these scripts and believes GPs are being unnecessarily cautious.

“I think [GPs] have less to fear than when they normally prescribe, as in this case the woman is in the care of a registered midwife,” she says.
Indemnity insurers are not so confident. There are legal risks for GPs if they do choose to prescribe painkillers, vitamin K or Syntocinon to patients wanting a home birth, they say.
Cheryl McDonald, medico-legal manager at MIGA (which will handle the new Midwives Insurance Scheme) says GPs are quite within their rights to refuse to write scripts in the case of home births, where they have no control over the medical outcome.

This really makes a mockery of the Collaborative arrangements Determination 2010....and really begs the question, how well thought out was the collaborative arrangements....? and did the AMA plan this all along knowing that these arrangements would not be workable. I am all for good collaborative arrangements that are workable, fair and equitable, not power orientated.

As midwives we have to be as proactive as the AMA..... we need to be allowed to practice our profession just as they are......this is about monopoly, money and power.
We need to be considering "women's choice" fairness and equity and right to refuse....

ref pic: littlekanga-roo.blogspot.com

Anger due to cuts in private obstetricans fees

This is an interesting debate the cutting of costs for rebates in private health insurance. Previously women could claim 80 per cent of out-of-pocket obstetrics fees after reaching the safety-net threshold.
It is also interesting to see that low risk women are asked to attend local hospitals as opposed to mainstream high risk hospitals where the intervention rate is much higher. This is where we would benefit from having more birth centers, or midwives working out of hospitals within the community.
The question is will this push women to seek midwifery led care in low risk cases, as opposed to paying more to see a private obstetrician and risk the cascade of intervention..... and higher costs.
The recent newspaper article Anger over cut to obstetrics rebate discusses these issues, stating that in the current boom will we run out of beds in our hospitals.

What the article fails to mention is that midwifery led care in low risk women is a more affordable option and saves the tax payer millions of dollars.....