Monday, October 25, 2010

Midwives with Medicare

sisters Anna and Jenni, and their beautiful babies

Today I have checked through the application form that midwives are required to complete in order to obtain a Medicare provider number.

I would love to be able to say to my clients that from 1 November they will be able to claim Medicare rebates on my fees. However, as I do not yet have a doctor who will meet the legal requirements of the Midwives Collaborative Arrangements Determination I cannot proceed with any such application.

If you want to check the full detail of the Medicare fee schedule, go to the Federal Register of Legislative Instruments F2010L02640. [I can't find the link, but I have the document saved as a .pdf]

Here are a few examples of the Medicare fee schedule for a participating midwife's services:
Item 82100
Initial antenatal professional attendance by a participating midwife,
lasting at least 40 minutes, including all of the following:
(a) taking a detailed patient history;
(b) performing a comprehensive examination;
(c) performing a risk assessment;
(d) based on the risk assessment — arranging referral or transfer of the patient’s care to an obstetrician;
(e) requesting pathology and diagnostic imaging services, when necessary;
(f) discussing with the patient the collaborative arrangements for her maternity care and recording the arrangements in the midwife’s written records in accordance with section 2E of the Health Insurance Regulations 1975
Payable only once for any pregnancy

Item 82120
Management of confinement for up to 12 hours, including delivery (if undertaken), if:
(a) the patient is an admitted patient of a hospital; and
(b) the attendance is by a participating midwife who:
(i) provided the patient’s antenatal care; or
(ii) is a member of a practice that provided the patient’s antenatal care
(Includes all attendances related to the confinement by the participating midwife)
Payable once only for any pregnancy (H)

Item 82130
Short postnatal professional attendance by a participating midwife, lasting up to 40 minutes, within 6 weeks after delivery

Clearly it would be in the intersts of both the woman and the midwife for this funding to be accessible. Midwives practising in homebirth would at least be able to give their clients the benefit of rebates for prenatal and post natal visits. Once midwives have visiting access at public hospitals (this is still theoretical), women who choose to have their own midwife attend them at a hospital would be able to claim a substantial rebate for the fee.

As I have considered how I could possibly comply with these requirements, without giving up my integrity as a midwife, the only pathway I can see is if I can obtain a collaborative arrangement with a public hospital. In effect, that's the way I have collaborated with the medical profession for many years. My clients have homebirth backup bookings at (usually) the Women's, Monash Clayton, or Box Hill. If medical referral is needed at any time through the episode of care, the medical team on duty at the time accepts the referral.

I will keep readers informed as we progress down this pathway.
A quick calculation of the fees payable by Medicare for:
  • an uncomplicated hospital birth (1 midwife) $1504.65
  • antenatal and postnatal care for planned home birth $779.90
[These amounts are calculated assuming that the mother has 3 long and 2 short prenatal checks; and two long and 3 short postnatal checks.  Other once only consultations as described in the legislation.] 

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